Acute calculus cholecystitis occurs in middle-aged women who develop obstruction of the cystic duct by stones or by swelling. The gallbladder subsequently becomes distended and develops thickened edematous walls. Secondary infection and decreased blood flows occur. With this situation secondary infection with bacteria from the GI tract can lead to sepsis or cholangitis.
Clinical presentation:
Patients with acute calculus cholecystitis present with the usual complaints of biliary colic. They may have Murphy's sign. The gallbladder may also be palpable. One-third of patients develop fever, high heart rate, rapid heart rapid respiratory rate and jaundice.
Lab investigations show elevated white cell counts with a "left shift" indicating an acute infection. Amylase may be elevated. Usually the liver function tests are also elevated. The alkaline phosphatase or transaminases may be elevated.
Radiographic evidence from ultrasound includes thickened gallbladder wall, fluid around the gallbladder and stones. A HIDA scan may be positive. This indicates that the cystic duct is obstructed.
Complications:
Applications associated with acute cholecystitis include:
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Perforation. |
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Gallstone ileus. |
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Mirrizzi syndrome. |
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Common bile duct obstruction. |
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Gangrenous gallbladder. |
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Emphysematous gallbladder. |
Management:
Patients are made NPO. NPO means nothing by mouth. This avoids stimulation of the gallbladder. A nasogastric tube may also be placed. Intravenous fluids, intravenous antibiotics and intravenous analgesics are utilized. Usually laparoscopic cholecystectomy performed within several days.
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