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cholecystitis.pptx

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cholecystitis.pptx

  1. 1. Cholecystitis
  2. 2. Inflammation of the gall bladder
  3. 3. Causitive Organisms: • E Coli (most common) • Klebsiella,Pseudomonas,Proteus • Strep.Faecalis • Salmonella • Clostridium Welchii
  4. 4. Classification • Acute Calculous Cholecystitis –stones present • Acute Acalculous CholecystitisCholecystitis- stones absent
  5. 5. Pathogenesis • Stone causes Obstruction at hartmann’s pouch or in cystic duct • Obstruction causes Stasis • It leads to Edema of the wall • Bacterial Infection occurs • Leads to Acute Cholecystitis
  6. 6. Impacted Stone - -  mucosalerosion Thereby Bile Salts will act on Submucosal tissue Bile is toxic to tissues Leads to Necrosis, Infection and Perforation
  7. 7. Presentation SYMPTOMS  FEVER  RIGHT UPPER QUAD PAIN NAUSEA
  8. 8. SIGNS  RIGHT UPPER QUAD TENDERNESS GUARDING RIGIDITY MURPHY’S SIGN (arrest of inspiration with gentle pressure under the R costal margin due to tenderness) BOAA’s SIGN- Hyperasthesia at 9thto 11thrib posteriorly on R side PALPABLE TENDER GALLBLADDER TACHYCARDIA
  9. 9. Acute Acalculous Cholecystitis • 5% • ICU patients, Post OP patients, Burns, Cholecystoses • Gallbladder distension, release of Factor VII • Acute Presentation • Rx – Cholecystectomy
  10. 10. Surgery in a/c Cholecystitis When presents within 2 to 3 days LAP CHOLECYSTECTOMY When presents more than 3 days INTERVAL CHOLECYSTECTOMY after 6 weeks In Pregnancy CHOLECYSTECTOMY @ T2 EMERGENCY Empyema, Persisting and Progressing Symptoms CHOLECYSTECTOMY
  11. 11. Complications  PERFORATION  PERITONITIS  PERICHOLECYSTIC ABSCESS  CHOLANGITIS and SEPTICEMIA  PANCREATITIS  EMPYEMA GB  GANGRENOUS GB
  12. 12. Chronic Cholecystitis Chronically Inflammed Thickened Gallbladder which is NONFunctioning NONdistending
  13. 13. Causes • GALL STONES • CHOLECYSTOSIS • CHRONIC ACALCULOUS CHOLECYSTITIS Organisms: Klebsiella Steptococci Salmonella
  14. 14. Pathology • GB is shrunken, contracted,small, nonfunctioning, fibrotic with thickened GB wall Mucosa proliferates into Lumen Muscular wall replaced by Fibrotic tissue
  15. 15. Treatment of Chronic Cholecystitis is CHOLECYSTECTOMY
  16. 16. Surgicaltherapy •Laparoscopic cholecystectomy is ideal. •Open cholecystectomy is done if patient unfit for laparoscopy through Right Sub-costal (KOCHERS’s) incision.
  17. 17. thank you very important

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