Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Trauma: adult trauma
- Trauma: paediatric trauma
- Trauma: trauma scoring systems
- Trauma: traumatic brain injury
- Trauma: thoracic trauma
- Trauma: abdominal trauma
- Burns
- Acute abdomen
- Acute pancreatitis
- Acute appendicitis
- Acute cholecystitis
- Large-bowel obstruction
- Small-bowel obstruction
- Perforated gastro-duodenal ulcer
- Volvulus
- Gastrointestinal bleeding
- Mesenteric ischaemia
- Acute limb ischaemia
- Leaking abdominal aortic aneurysm
- Epistaxis
- Inhaled foreign body (FB)
- Urinary retention
- Gross haematuria
- Renal colic
- Testicular pain
- Priapism
- Paraphimosis
- Necrotizing fasciitis
- Principles of fracture classfication and management
- Compartment syndrome
- Acute abdominal pain in pregnancy
- Paediatric surgical emergencies
- Acute hand injuries
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Acute cholecystitis
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Trauma: adult trauma
- Trauma: paediatric trauma
- Trauma: trauma scoring systems
- Trauma: traumatic brain injury
- Trauma: thoracic trauma
- Trauma: abdominal trauma
- Burns
- Acute abdomen
- Acute pancreatitis
- Acute appendicitis
- Acute cholecystitis
- Large-bowel obstruction
- Small-bowel obstruction
- Perforated gastro-duodenal ulcer
- Volvulus
- Gastrointestinal bleeding
- Mesenteric ischaemia
- Acute limb ischaemia
- Leaking abdominal aortic aneurysm
- Epistaxis
- Inhaled foreign body (FB)
- Urinary retention
- Gross haematuria
- Renal colic
- Testicular pain
- Priapism
- Paraphimosis
- Necrotizing fasciitis
- Principles of fracture classfication and management
- Compartment syndrome
- Acute abdominal pain in pregnancy
- Paediatric surgical emergencies
- Acute hand injuries
- Section 3 Surgical disease
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Summary
Definition
Acute inflammation of the gallbladder. One-third of patients with biliary colic develop acute cholecystitis within two years.
Aetiology
90% of cases associated with obstruction of the cystic duct by a gallstone. Acalculous (absence of gallstones) cholecystitis occurs in 2–5% of cases and is associated with prolonged fasting, trauma (burns, fractures), severe illness, intensive care admission, parenteral nutrition (TPN) and AIDS.
Pathophysiology
Cystic duct obstruction with continued gallbladder secretions leads to an increase in pressure. Concomitant infection by intestinal organisms leads to gallbladder inflammation, diaphragmatic irritation. The stone often slips back into the gallbladder fundus allowing drainage and resolution of inflammation. Continued obstruction of the duct results in collection of mucus (mucocoele) and then pus in the gallbladder forming an empyema (pus-filled gallbladder). Subsequently ischaemia of the gallbladder wall may lead to infarction, necrosis, perforation and ultimately biliary peritonitis.
Acalculous cholecystitis often results from reduced gallbladder contraction due to decreased cholecystokinin release, with viscous bile thought to result in gallbladder obstruction and subsequent bacterial seeding. Cystic duct compression may also be caused by extrinsic compression (tumour, node, inflammatory mass).
Symptoms
Continuous RUQ and epigastric pain (in contrast to the fluctuating pain of biliary colic). Pain may radiate to back or to right scapula (due to peritoneal irritation via T7–9 dermatomes). Note that pain may be very similar to that of acute gastritis or peptic ulcer disease (PUD). Associated nausea, anorexia, fever and vomiting. May have known history of gallstones/ biliary colic.
Examination
Pyrexia, tachycardia, dehydration and possible tachypnoea with shallow respiration. Jaundice may result due to a common bile duct stone.
- Type
- Chapter
- Information
- Hospital SurgeryFoundations in Surgical Practice, pp. 216 - 220Publisher: Cambridge University PressPrint publication year: 2009