PATHOPHYSIOLOGY AND Department of Surgery

TREATMENT

Cholecystitis
 Your Picture Here

We Create
Quality Professional
PPT Presentation

ACUTE
CHOLECYSTITIS
 CALCULOUS

Etiology

• Most common; less serious type

• Develops when cystic duct is blocked by a
gallstone or by biliary sludge
• Results to build – up of bile in the
gallbladder
 Etiology
• Less common; More serious type
• Develops as a complication of serious illness,
infection or injury
• Often associated with accidental damage to
GB during major surgery, serious injuries
ACALCULOUS
or burns, sepsis, AIDS
 ABDOMINAL
Colicky; PAIN
RUQ/Epigastrium
NAUSEA &
VOMITING

FEVER
SYMPT
OMS
 RIGHT INTERSCAPULAR
PAIN
Radiation from RUQ pain

ANOREXIA

Focal tenderness and guarding

Murphy’s sign
SYMPT
OMS
 Pathophysiology
OBSTRUCTION at the
gallstones Hydrolysis of Luminal
Neck of the GB or
Cystic Duct Lecithin

Exposure to Disruption of Production of toxic

epithelium to direct glycoprotein mucus lyolecithin
detergent action of layer
bile salts Compromised
.

(+) GB distention & mucosal BF

(+) GB
Inc. Intraluminal
dysmotility INFLAMMATION
pressure
Diagnosti
c
procedur
es
ULTRASONOGRAPHY

- Is the most useful radiologic

test for diagnosing acute
cholecystitis.
- Presence or absence of stones
- Thickening of gallbladder
wall and pericholecystic fluid
Biliary radionuclide scan (hida
scan)
- May be help in the atypical
case.
- Lack of filling of the
gallbladder after 4 hours
indicates an obstructed duct
- Highly sensitive and specific
for acute cholecystitis
CT SCAN

- Frequently performed on
patients with acute
abdominal pain
- Demonstrates thickening of
the gallbladder wall as well as
air in the gallbladder.
 Gallbladder
perforation and local
abscess
 Cholangitis or sepsis COMPLICATIONS
 Gallbladder rupture
 Biliary enteric
(cholecytenteric)
fistula
 Treatment
NON – SURGICAL

IV; Analgesic and Antibiotics

• Antibiotics – cover gram – negative aerobes and anaerobes

3rd Gen cephalosporin + Metronidazole – typical regimen
 Treatment
NON – SURGICAL
Analgesic

• Ketorolac (Preferred)
• Given 30 to 60 mg single dose, IV
• Opioids such as morphine, hydromorphone or meperidine
• For patients contraindicate to NSAIDS
 Treatment
NON – SURGICAL
Gallbladder drainage
• High surgical risk such as being septic or critically ill 
• No appreciable clinical improvement after 1-3 days of
nonoperative management with antibiotics 
• Decompresses infected bile or pus from the gallbladder
• Allows both local inflammation and systemic illness to resolve
before gallbladder removal
 I W
Treatment
SURGICAL A A
Cholecystectomy

• Definitive treatment for acute cholecystitis.

Early cholecystectomy  performed within 2 to 3 days
Delayed cholecystectomy  performed 6 to 10 weeks after
treatment
 I W
Treatment
SURGICAL A A
Laparoscopic Cholecystectomy

• Procedure of choice for acute cholecystitis.

Early cholecystectomy  performed within 2 to 3 days
Delayed cholecystectomy  performed 6 to 10 weeks after
treatment
 I W
Treatment
LAPAROSCOPIC A A
CHOLECYSTECTOMY
• Management based on Grading
Grade I (Mild): Early laparoscopic cholecystectomy (within 72 hours)
Grade II (Moderate): Early cholecystectomy (laparoscopic or open)
Grade III (Severe): Urgent management of organ dysfunction and
gallbladder draining
 Your Picture Here

We Create
Quality Professional
PPT Presentation

CHRONIC
CHOLECYSTITIS
 Etiology

 Due to repeated attacks of acute

cholecystitis
 Most attacks are caused by gallstones
 Common in women; > 40 y.o.
 ABDOMINAL
Colicky; PAIN
RUQ/Epigastrium
NAUSEA &
VOMITING

RIGHT INTERSCAPULAR
PAIN
Radiation from RUQ pain

SYMPT
OMS
Pathophysiology
Your Text Here
Get a modern PowerPoint Presentation
that is beautifully designed. I hope and I
believe that this Template will your Time.

Your Text Here Your Text Here

Get a modern PowerPoint Presentation Get a modern PowerPoint Presentation
that is beautifully designed. I hope and I that is beautifully designed. I hope and I
believe that this Template will your Time. believe that this Template will your Time.

Your Text Here

Your Text Here Your Text Here
Get a modern PowerPoint Presentation Get a modern PowerPoint Presentation
that is beautifully designed. I hope and I that is beautifully designed. I hope and I
believe that this Template will your Time. believe that this Template will your Time.
Diagnosti
c
procedur
es
Ultrasound (Abdominal)

- Diagnostic test for gallstones

- Demonstrates thickening of
the gallbladder wall with
gallstones
 I W
Treatment
SURGICAL A A
Cholecystectomy

• For symptomatic and

complicated disease
 I W
Treatment
SURGICAL A A
Elective Laparoscopic Cholecystectomy

• advised in patients with symptomatic gallstones

Prevention
Lose weight slowly
Maintain a healthy weight
Choose a healthy diet