Acute cholecystitis

Acute cholecystitis

    * Introduction
    * Signs and symptoms
    * Diagnosis
    * Treatment
    * Evolution and complications
It is an acute inflammation of the vesicular wall, coexist in the vast majority of cases with bile flow in the way of realizing pbstacol suffering an acute inflammatory mechanical. Acute cholecystitis is most common complication of gallstones. May occur in patients with bile or debut last as first symptom of gallstones. Right upper quadrant pain is the most important symptom, it grows rapidly in intensity and does not respond to common antispasmodics. Grace and vomiting are present in over half of patients. Mobilization of a calculation shows frequent vomiting in association with a duct or pancreatitis. Fever is a common symptom in acute cholecystitis. The old fever is not consistent with the severity of injuries. Jaundice occurs in only a quarter of patients with acute cholecystitis is not intense and not always signify the existence of a calculation in the main bile duct. As laboratory tests most useful in case of gallstone is Bilio hepatic-pancreatic ultrasound, performed in an emergency. Medical therapy is rarely produces clinical improvement. Most times to install a stationary phase of acute cholecystitis cold, the pains have disappeared, the fever was not normalized, and remains slightly elevated leukocytosis. In these cases need surgery because serious complications can occur. Immediate surgery is required in cases of generalized peritonitis. The mortality rate in acute cholecystitis is about 3%, most deaths being recorded at the age of 60 years or diabetes. The elderly secondary cardiopulmonary complications contribute to increased mortality. Uncontrolled sepsis and intrahepatic abscesses are adding new aggravating factors to the underlying disease. Bile duct lithiasis is present in 15% of cases, the worst being accompanied by acute pancreatitis or colangitice phenomena.
Pathogenesis Acute cholecystitis is inflammation of the gallbladder caused acute in most cases of cystic duct obstruction, resulting in acute inflammation of the gallbladder wall. The cause of obstruction is usually a bile stone. Acute cholecystitis is one of the major complications of gallstones. Inflammatory process begins with cystic duct obstruction or biliary ampoule. The precise mechanism by which it is initiated is unclear. Microorganisms are recognized in 80% of cases of early stage disease. Escherichia coli is the main bacteria found, other microorganisms are aerobic gram-negative cocci, enterococci and some anaerobes. Bacterial invasion is not considered as initial event, because 20% of the patients in the examination shows bacteria. This side event is not considered the main bacterial invasion. Factors that can initiate the inflammatory process include: -Formation of mediators of inflammation: prostaglandins and lisolecitina Increasing intraluminal pressure- Compromised blood-intake Bile acids-chemical irritation. Spontaneous resolution can occur 5-7 days after onset of symptoms by releasing the biliary lumen. In most cases bile wall fibrosis is a characteristic of chronic cholecystitis. In over 90% of biopsy specimens of chronic cholecystitis is already present. If the cystic duct remains blocked, inflammatory cell infiltration with hemorrhagic necrosis of mucosa and cause the development of mural gangrenous cholecystitis. Acalculozica has a different clinical cholecystitis. It is more common in men, especially children and people over 65 years. Pathogenesis is not well known is probably multifactorial. This is likely to grow in conditions of biliary stasis, training of mediators of inflammation and localized tissue ischemia sitema. Patients who emfizematoasa cholecystitis, gallbladder wall ischemia followed by infection with bacteria that produce gas in the lumen, wall or both. In 30-50% of patients diabetes mellitus is present, the rate of women: men is 5:1. Gallstones are present in 30-50% of cases and mortality rate is 15%. There is a predisposition to gangrene and perforation, but symptoms are mild and may mislead the physician. Cholecystitis may occur after chimioembolizare emfizematoasa performed as palliative method for hepatocellular carcinoma after embolism ateromatos intro aortografie gallbladder after hypoperfusion during cardio-respiratory resuscitation.
Causes and Risk Factors Often increase the risk factors predisposing patients to develop biliary stasis: -Starvation diets Parenteral-nutrition -Narcotic analgesics -Lack of mobilization after surgery. Hypovolaemia and predispose to ischemia shock. Ischemia can occur in small and medium vessel vasculitis, a complication of liver chimioembolizarii. Extrinsic compression may play a role in determining bile stasis. In most patients with cholecystitis acalculozica infection may occur after typhoid fever, infection with Salmonella species, Cryptosporidium citomegalus or virus. The following conditions were often associated with cholecystitis acalculozica: -Abdominal surgery, severe burns, gastroenteritis -Severe trauma, parenteral nutrition, mechanical ventilation Post-transfusion-allergic reactions, dehydration, narcotic analgesia -Diabetes mellitus, antibiotics, hepatic arterial embolization Post-partum complications Vascular-renal vasculitis -Arteriostenoza, hypertension, AIDS. Gallbladder empyema may develop as a complication of acute cholecystitis, and can penetrate. Other less common causes of cystic duct obstruarii may include: -Septa, intramural vesicular diverticulosis Cystic-plied, valvular abnormalities, congenital vasculobiliare - Parasitic obstruction, tumor, inflammatory.