Definition and classification
Acute cholecystitis is acute inflammation of the gallbladder . It is the most common complication of gallstones (over 95% of cases) and often occurs in later life ( 50-70 years).
Acute obstruction of the cystic duct of the inclavat calculation initially determines the concentration of bile into the lumen through the process of resorption of water , the content is rich in pigments and bile salt crystals colesteină produce a chemical irritation of the lining resulting in an aseptic inflammation . Following mucus is secreted in large quantities , the pressure increases gallbladder and gallbladder increases.
Pathological forms of acute cholecystitis :
• Mules when gallbladder is distended , red to violet , with edematous wall ;
• phlegmon , with microabscesses in the gallbladder wall thickness , the area became the site of fibrous deposits gallbladder ;
• gangrene , which gives the appearance of a faded leaf parts of gallbladder wall , perforation with peritonitis evolving into bile.
Clinical and laboratory diagnosis
Diagnosis must differentiate acute cholecystitis or biliary colic simply type suppurative complication .
Clinically it is manifested by:
– Nature colicky pain in the right upper quadrant (HD ) with dorsal irradiation , progressively increases in intensity ;
– Nausea and vomiting ;
– Fever , chills and especially ;
– Defense or muscle contracture ;
– Tachycardia , oliguria are serious signs of CA ;
– Gentle palpation in HD may lead to pain in inspiration ( Murphy ‘s sign )
Laboratory diagnosis is established by :
a) bioassays : increased leukocytosis ;
b ) ultrasound provides data on the presence of certain stones , size calculation, gallbladder and gallbladder wall thickness CBP and the sandwich becomes layout .
Evolution and treatment
Under the most conservative treatment that they can have a positive development by giving acute inflammatory phenomena . The third of patients but the disease progresses to complications are multiple and often very serious , including:
– The perforations , which can be :
• localized blocked , leading to abscesses subfrenice , subhepatic abscess or abcedate blocks ;
• the large peritoneal cavity , leading to a generalized biliary peritonitis mortality was above 30% ;
• biliary -digestive fistulas , colecisto ulcer or colon as a result of that open abscesses secondary digestive lumen .
– Gallbladder gangrene occurs in 15% of patients;
– Different intensities accompanying pancreatitis cca.7 % CA ;
– Stones CBP is present in about 20 % of cases.
Treatment of acute cholecystitis , since I can not predict developments should be performed in the hospital.
Conservative treatment is immediately set consists of:
– Nasogastric suction probe for gastric decompression ;
– Infusion of saline to rehydrate the patient ;
– Analgesics and antispasmodics for pain ;
– Antibiotics .
Indication of treatment in patients diagnosed with AS , surgery and becomes absolutely vital when there is perforation or biliary peritonitis . The operation will consist of:
• simple cholecystectomy ;
• ultrasound guided cholecystectomy .
Cholecystectomy can run about classical ( open ) or laparoscopic (which is actually very common due to reduced trauma operators ) .