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Gallstones & Its Complications: Presented By: Anish Dhakal (Aryan)
Gallstones & Its Complications: Presented By: Anish Dhakal (Aryan)
Gallstones & Its Complications: Presented By: Anish Dhakal (Aryan)
COMPLICATIONS
• Rare in the gall bladder whereas form in the bile duct and are
related to bile stasis and infected bile
Transabdominal ultrasonography
Radionuclide scan
• Complication
• If no resolution
• Gallbladder empyema
• Wall become necrotic and perforate with localized
peritonitis
• Abscess perforate into peritoneal cavity with septic
peritonitis (uncommon)
INVESTIGATIONS
• Peripheral blood leucocytosis
• Minor increase in transaminase and amylase
• Chest x-ray
• USG aids in diagnosis
• CT uncertain diagnosis
DIFFERENTIAL DIAGNOSIS OF
CHOLECYSTITIS
ACUTE NON-CALCULOUS
CHOLECYSTITIS
• Acute and chronic inflammation of the gall bladder can
occur in the absence of stones and give rise to a clinical
picture similar to calculous cholecystitis.
• Occurs in seriously ill patients
• Postoperative state after major, non-biliary surgery
• Severe trauma
• Burns
• Sepsis
In these patients, the diagnosis is often missed, and the mortality
rate is high
TREATMENT
• Asymptomatic gallstones→ not require treatment, unless the patient
• Has a porcelain gallbladder (which has an increased incidence
of carcinoma)
• Has a stone > 2–3 cm
• Is a pediatric patient.
• Is immunocompromised
• Symptomatic patients→ cholecystectomy
CONSERVATIVE MEASURES
• More than 90 per cent of cases, the symptoms of acute cholecystitis
subside with conservative measures
• Non-operative treatment is based on four principles
• Nil per oral (NPO) and intravenous fluid administration until the pain
resolves.
• Administration of analgesics
• Administration of antibiotics
• A broad-spectrum antibiotic effective against Gram-negative aerobes is
most appropriate (e.g. cefazolin, cefuroxime or gentamicin).
Subsequent management.
• When the temperature, pulse and other physical signs show that the
inflammation is subsiding, oral fluids are reinstated followed by regular
diet.
• Ultrasonography is performed to confirm the diagnosis.
• If an early operation is not indicated, one should wait approximately 6
weeks for the inflammation to subside before operating.
CHRONIC CHOLECYSTITIS
• Chronic inflammation of gallbladder
• Symptoms:
• Recurrent attack of upper abdominal pain; often at night
following meal
• Clinical feature: similar to acute calculous cholecystitis
but milder
• Patient recover spontaneously or following analgesia and
antibiotics
• Management:
• elective cholecystectomy
EMPYEMA OF GALL BLADDER
Results from progression of acute cholecystitis with persistent cystic
duct obstruction to superinfection of stagnant bile with pus forming
organisms
Clinical features:
• High grade fever
• Pain and tenderness over
Rt. Hypochondrium
Treatment:
• IV antibiotics: Cefotaxime,
Ceftriaxone
• Drainage
• Later cholecystectomy
Complications:
• Septicaemia
• Rupture and Peritonitis (Biliary or Bacterial)
MUCOCOELE