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    Cholecystitis

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    Enkhmaa Boldbaatar
    1. Cholecystitis is inflammation of the gallbladder commonly caused by gallstones blocking the cystic duct. 2. Symptoms include right upper quadrant abdominal pain, fever, and jaundice. Ultrasound and CT scans are used to diagnose. 3. Treatment involves antibiotics, pain medications, and often laparoscopic surgery to remove the gallbladder to prevent future attacks. Complications can include gallbladder rupture or infection if not treated.

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    Cholecystitis

    Uploaded by

    Enkhmaa Boldbaatar
    121 views37 pages
    1. Cholecystitis is inflammation of the gallbladder commonly caused by gallstones blocking the cystic duct. 2. Symptoms include right upper quadrant abdominal pain, fever, and jaundice. Ultrasound and CT scans are used to diagnose. 3. Treatment involves antibiotics, pain medications, and often laparoscopic surgery to remove the gallbladder to prevent future attacks. Complications can include gallbladder rupture or infection if not treated.

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    1. Cholecystitis is inflammation of the gallbladder commonly caused by gallstones blocking the cystic duct. 2. Symptoms include right upper quadrant abdominal pain, fever, and jaundice. Ultrasound and CT scans are used to diagnose. 3. Treatment involves antibiotics, pain medications, and often laparoscopic surgery to remove the gallbladder to prevent future attacks. Complications can include gallbladder rupture or infection if not treated.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    121 views37 pages

    Cholecystitis

    Uploaded by

    Enkhmaa Boldbaatar
    1. Cholecystitis is inflammation of the gallbladder commonly caused by gallstones blocking the cystic duct. 2. Symptoms include right upper quadrant abdominal pain, fever, and jaundice. Ultrasound and CT scans are used to diagnose. 3. Treatment involves antibiotics, pain medications, and often laparoscopic surgery to remove the gallbladder to prevent future attacks. Complications can include gallbladder rupture or infection if not treated.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 37

    Cholecystitis

    АШУҮИС АУС 419-р хэсэг


    Б.Энхмаа
    Г.Удвал
    А.Амгалан
    Anatomy
    Anatomy

    Basicmedicalkey.com
    Oddi`s sphincter , Ampulla of Vater
    Anomaly of Gallbladder
    Blood supply

    https://teachmeanatomy.info/
    Blood supply anomaly

    https://www.semanticscholar.org cystic artery


    Anomaly of Cystic artery
    Anomaly of Cystic duct

    www.coleraw.com
    webmedmon.mn
    Nerve supply of gallbladder
    Physiology
    • Bile function
    • 1- Excretion of toxins and metabolite from liver
    • 2- Absorption of nutrients from intestinal tract
    Bile (500-1000ml\day)
    • Bile salts (Cholic acid , Deoxycholic acid)
    • Protein (Glycoprotein)
    • Lipid (Phospholipid ,Cholesterol )
    • Pigment
    Gallbladder
    • Hydrogen ion (ph)
    • Mucin (Glycoprotein) *pronucleating
    Bile salt physiology
    Bile salt in digestion
    Lipid metabolism in liver

    • Pharmacologic inhibition of
    IDOL could reduce plasma
    LDL cholesterol by increasing
    plasma LDL receptor density.
    • IDOL (Inducible Degrader of
    the LDL receptor)
    Pigment (Billirubin)
    Liver anatomy
    Space of Disse

    Ito cell
    • Contains fat
    • Fat soluble vitamins
    Bile flow

    • Neural , humoral
    Parasympthatic activity
    Hormone (Cholecystokinin *CCK ,Secretin)
    Cholecystitis
    • Calculus
    • Acalculus
    1. Risk factor (Age , Trauma , TPN , Diabetes , immunosupression)
    • Tumor (Adenocarcinoma)
    • Biliary Cyst
    • Primary sclerosing cholangitis (PSC) – idiopathic usually associated with auto
    immune
    Cholelithiasis risk factors
    • Genetic
    1. Female gender
    2. Pregnancy
    3. Family history
    • Enviromental factor
    • Type 2 DM
    • Dyslipidemia (low on HDL, High Triglycerides )
    • Diet (High in fats , Low on fiber)
    • Cirrhosis
    • Long term fasting
    • Rapid weight loss
    Gallstone types
    Stone forming process
    • Cholestrerol
    1. Hypersecretion of cholesterol (Hepatic metabolism)
    2. Distorted balance between pronucleating (Crystallization promoting) –
    antinucleating (Anti-Crystallization)
    3. Loss of gallbladder muscular wall motility
    4. Excessive sphincter contraction
    • Pigment stone (More frequent in Asia)
    1. RBC breakdown
    2. Infection of biliary tract
    Gallstone formation
    Aftermath
    • Stone \ non stone obstruction of Cystic duct
    • Pressure on gallbladder
    • Organ enlargement
    • Wall thickens
    • Blood supply decreases Obstruction of Oddi`s sphincter
    • Exudate may form (Gallstone pancreatits)
    • Infection
    • Necrosis
    • Gangrene
    Diagnosis
    • Clinical signs
    • Laboratory
    ALP elevated
    Billirubin elevated
    Transaminase elevated
    WBC- Leukocytosis
    • Ultrasonography
    Sens-85% Spes-95%
    • HIDA scan
    • CT (Less sensitive and specific than US)
    Symptoms
    Asymphtomatic – 80%
    The Charcot triad
    •Fever
    •Jaundice (Uncommon in acute cholongitis) *5mg\d< cutaneous jaundice
    •Pain (Right upper quadrant)
    The Reynold`s pentad
    •Fever
    •Jaundice (Uncommon in acute cholongitis)
    •Pain (Right upper quadrant)
    •Hypotension
    •Change in mental status
    Others
    •Tachycardia , Shock, Mirizzi`s syndrome (Hartmanns pouch stone)
    Pain

    • Murphy`s sign positive (ddx of biliary colic)

    • Epigastric \ Right upper quadrant

    • After meal
    Physical exam
    • Ultrasonography of Acute cholecystitis

    Pericholecystic fluid, Thickened gallbladder


    wall
    Differential Diagnosis

    • Hepatitis
    • GB cancer
    • Pancreatitis
    • Hepatic abscess
    • Angina pectoris (MI)
    • Gastric duodenal ulcer
    • Right lower pneumonia
    Complication of acute cholecystitis

    • Ruptured cholecystitis
    • Acute empyema of the gallbladder
    • Gangrenous cholecystits
    • Flegmonous cholecystits
    • Obstruction of cystic duct
    • Obstruction of bile duct
    Treatment
    • NPO

    • IV (NaCl , Hartmann`s solution)

    • IV (Antibiotic *emperal)

    • IV (Narcotics)

    • Surgery (Open , Laparoscopy )

    • ERCP
    Surgery treatment options
    Laparoscopy
    Thanks for your attention
    References

    • Sabiston textbook of surgery 20th edition

    • Chapter 54 (Biliary system) page 1482-1509

    • Osmosis.com (Ascending cholangitis)

    • Emedecine.Medscape.com \Cholelithiasis

    • Uspharmacist.com

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