Acute Cholecystitis

La Ode Rabiul Awal

 Cholecystitis

Acute Cholecystitis Chronic Cholecystitis

Acalculou
Calculous
s
Acute Cholecystitis

• Inflammation of the gallbladder

• Most commonly because of an obstruction of the cystic duct
• Most commonly by gallstones arising from the gallbladder (cholelithiasis) 
90-95%
• Acalculous cholecystitis (tanpa batu)  5-10%
 Pathogenesis

• Obstruction of the cystic duct by gall stones

• Increase of intraluminal pressure within the gall bladder
• Acute inflammatory response
• Synthesis of prostaglandins I2 and E2
• Secondary bacterial infection (most
commonly Escherichia coli, Klebsiella, and Streptococcus
faecalis)  20% of cases
 Signs and symptoms

• Upper abdominal pain

• Signs of peritoneal irritation
• Pain frequently begins in the epigastric region and then localizes to RUQ
• Pain may initially be colicky but almost always becomes constant
• Nausea and vomiting are generally present, and fever may be noted
Patients with acalculous cholecystitis may present with fever and sepsis
alone.
 Elderly (especially diabetics)
May present with vague symptoms and
without many key historical and physical
findings (eg, pain and fever), with
localized tenderness the only presenting
sign; may progress to complicated
cholecystitis rapidly and without warning.
Etiology
Risk factors for calculous cholecystitis mirror those for cholelithiasis and include
the following (4F):
• Female (F1)
• Obesity/Fat (F2)
• Pregnancy/Fertile (F3)
• Increasing age/Forty (f4)
• Drugs (especially hormonal therapy in women)
• Rapid weight loss
Children
May present without many of the classic findings
Physical examination

• Fever, tachycardia, and tenderness in the RUQ or epigastric region, often with
guarding or rebound
• Palpable gallbladder or fullness of the RUQ (30-40% of patients)
• Jaundice (~15% of patients)
Laboratory tests (not always reliable)

• Leukocytosis
• Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels
may be elevated
• Bilirubin and alkaline phosphatase assays may reveal
• Amylase/lipase assays are used to assess for pancreatitis
• Alkaline phosphatase level may be elevated (25% of patients with cholecystitis)
Diagnostic imaging

• Radiography
• Ultrasonography
• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Hepatobiliary scintigraphy
• Endoscopic retrograde cholangiopancreatography (ERCP)
Complications

• Gangrenous cholecystitis (2-30%)

• Gallbladder perforation (10%)
• Cholecystoenteric fistulas
• Gallstone ileus  considered in elderly patients
Management:

• Treatment of cholecystitis depends on the severity of the condition and the

presence or absence of complications.
• Initial treatment includes bowel rest, IV hydration, correction of electrolyte
abnormalities, analgesia, and IV antibiotics
• In cases of uncomplicated cholecystitis, outpatient treatment may be
appropriate.
Management
Surgical and interventional procedures

• Laparoscopic cholecystectomy (standard of care for surgical treatment of

cholecystitis)
• Percutaneous drainage
• ERCP
• Endoscopic ultrasound-guided transmural cholecystostomy
• Endoscopic gallbladder drainage
Prognosis

• Uncomplicated cholecystitis has an excellent prognosis

• Complete remission within 1-4 days
• 25-30% of patients either require surgery or develop some complication
• If perforation/gangrene develop, the prognosis becomes less favorable
Thank you....