Cholecystitis clostridica

Cholecystitis clostridica

    * Introduction
    * Signs and symptoms
    * Diagnosis
    * Treatment
Clostridii cholecystitis is caused by a rare and severe variant of acute cholecystitis characterized by the formation of gas in the gallbladder wall, inside or pericholecystic tissues in the absence of communication with the biliary tree gastrointestinal tract.
Clostridica cholecystitis is caused by Clostridium perfringens bacteria that ferment organic compounds and produce large quantities of gas. Diagnosis is typically on the observed gas in the gallbladder lumen or wall aceteia the abdominal radiograph. Due to the training event gas is part of cholecystitis cholecystitis clostridica emfizematoase. Emfizematoase cholecystitis are associated with high degrees of gangrene and perforation of the gallbladder compared with simple acute cholecystitis. Predisposing factors are diabetes, old age and male sex.
The clinical picture met the right upper quadrant pain include fever, jaundice and vomiting. Septic shock or peritonitis may occur later in the disease.
The standard treatment is surgery with cholecystectomy with immediate antibiotic therapy against anaerobic bacilli. Clostridica cholecystitis is considered the most aggressive and deadly form of cholecystitis, with mortality rates of 15-25%.
Pathogenesis
Genus Clostridium can ferment a wide variety of organic compounds. Produce metabolites such as butyric acid, acetic acid, butanol and acetone, and large amounts of gas (CO2 and H2) during fermentation of sugars. Clostridia produce and numjeroase extracellular enzymes to degrade large molecules (proteins, lipids, collagen, cellulose, etc.)..
In nature clostridiile have an important role in the degradation of organic debris. In anaerobic environments the human body currently no invasion enzymes and their role in disease pathology.
Clostridium perfringens produces a wide range of infections in humans: surgical infections that lead to gaseous gangrene, severe uterine infection. Hemolizinele clostridiei and extracellular enzymes: protease, lipase, collagenase and hyaluronidase, contribute to the invasive process. By eating foods contaminated with Clostridium endospores triggers of food poisoning. The infection in the gallbladder lumen gas is formed without the presence of organ walls Bilio-enteric fistulas. Approximately 30-50% of patients do not have gallstones. Clostridica cause perforation and gangrene cholecystitis.
Pathogenic mechanism of gangrene involves the cystic artery thrombosis in patients with atherosclerotic disease. And the development of cholecystitis has been reported in patients clostridica who underwent endoscopic surgery of hepatic arterial embolization and endoscopic retrograde cholangiopancreatography.
Infection is more common in immunocompromised patients. For example those with diabetes are affected by 38-55%. Metabolic abnormalities and old age contribute to increased risk for developing infection.
Causes
Genus Clostridium bacteria contain large, gram-positive, bacillary. All species form endospores and have a strictly fermentative type metabolism. Most do not survive in aerobic conditions and vegetative forms are killed by exposure to O2. But their spores are able to survive long periods of exposure to air. Clostridiile are leaving in the soil bacteria, sediments and aquatic animal's intestinal tract. Most are saprophytic. Some are pathogenic to humans: Clostridium perfringens, Clostridium difficile, Clostridium tetani and Clostridium botulinum. They have a primary saprophytic life in nature and are opportunistic in certain circumstances.