HWN Suggests

Emergency Gallbladder Surgery And The Life Lesson Of Patience

Up here in Canada, north of the 49th parallel, we celebrate Thanksgiving several weeks before our American friends. During the second weekend of October, Canadians enjoy a three-day holiday taking stock in the fall harvest, friendship, and family while giving thanks for what we have, and who we are.

On October 7, our family held a dinner for 20 people. Eight adults and 12 children gathered round colors of orange, red and yellow and feasted on turkey, stuffing and pumpkin pie.

Before the gorging ensued, I gave a toast. “May we give thanks to each other, to those we have lost, to everything we have received, and to our health; never take it for granted.”

Eight hours later…

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  SonoPro Tips and Tricks for Acute Cholecystitis

Don’t forget the neck. There is a reason the gallbladder was so nicely distended and easy to find. Be sure to scan carefully in two orthogonal planes to pick up subtle stones in the neck of the gallbladder! Impacted, “non-mobile” Neck Stone = Big Problem and likely to progress to acute cholecystitis.

 The Trolling Stones: Cholecystitis

Gallstone disease, most commonly manifesting as cholecystitis, is seen in up to 10% of patients who have symptomatic gallstones.

Articles of Interest

Acalculous cholecystitis

Acalculous cholecystitis is seen mostly in the intensive care unit as a complication of pre-existing critical illness. This may account for ~5% of cholecystitis. However, the precise incidence is murky given lack of definitive diagnostic criteria.

Acute cholecystitis

Acute cholecystitis—inflammation of the gall bladder—is most often caused by gall stones. Gall stones are one of the most common disorders of the gastrointestinal tract, affecting about 10% of people in Western society.

Cholecystectomy for acute cholecystitis. How time-critical are the so called “golden 72 hours”? Or better “golden 24 hours” and “silver 25–72 hour”? A case control study

Early cholecystectomy within 72 hours has been shown to be superior to late or delayed cholecystectomy with regard to outcome and cost of treatment. Recently, immediate cholecystectomy within 24 hours of onset of symptom was proposed as standard procedure for the management of fit patients presenting with acute cholecystitis.

Differentiation of acute cholecystitis from chronic cholecystitis

In conclusion, increased adjacent liver enhancement, increased gallbladder dimension, increased wall thickening or mural striation, and pericholecystic fat haziness or fluid are the most discriminative MDCT findings of acute cholecystitis.

Management of Acute Cholecystitis

Acute cholecystitis is a common serious complication of gallstones. The reported mortality of acute cholecystitis is approximately 3%, but the rate increases with age or comorbidity of the patient. If appropriate treatment is delayed, complications can develop as a consequence with a grave prognosis. The current standard of care in acute cholecystitis is an early laparoscopic cholecystectomy with the appropriate administration of fluid, electrolyte, and antibiotics.

Stone-In-Neck phenomenon: a new sign of cholecystitis

Physicians performing right upper quadrant ultrasound should have a high index of suspicion for cholecystitis when the SIN phenomenon is present, and should be aware that this group of patients are at much higher risk for cholecystitis than those with simple lithiasis.

Resources

BMJ Best Practice

Acute cholecystitis is acute inflammation of the gallbladder, and is one of the major complications of cholelithiasis (the presence of gallstones). In most cases (90%), acute cholecystitis is caused by obstruction of the cystic duct due to a stone in the gallbladder neck or cystic duct, which leads to inflammation within the gallbladder wall. In 5% of cases, bile inspissation (due to dehydration) or bile stasis (due to trauma or severe systemic illness) can block the cystic duct, causing acalculous cholecystitis.

Harvard Health

Most people recover from episodes of acute cholecystitis within a few days to a few weeks. Rarely, a person can become critically ill from a complication, such as gallbladder perforation, cholangitis or pancreatitis and in rare cases the condition can be fatal. Removing the gallbladder prevents cholecystitis from coming back. Rarely, gallstones may remain hidden in bile ducts to cause other problems after surgery.

Mayo Clinic

In most cases, gallstones blocking the tube leading out of your gallbladder cause cholecystitis. This results in a bile buildup that can cause inflammation. Other causes of cholecystitis include bile duct problems, tumors, serious illness and certain infections.

MedlinePlus

Sometimes, the bile duct becomes blocked temporarily. When this occurs repeatedly, it can lead to long-term (chronic) cholecystitis. This is swelling and irritation that continues over time. Eventually, the gallbladder becomes thick and hard. It does not store and release bile as well as it did.

NHS Inform

Calculous cholecystitis is the most common, and usually less serious, type of acute cholecystitis. It accounts for around 95% of all cases.The blockage in the cystic duct results in a build-up of bile in the gallbladder, increasing the pressure inside it and causing it to become inflamed. In around 1 in every 5 cases, the inflamed gallbladder also becomes infected by bacteria.

NORD

The specific symptoms associated with cholecystitis vary among patients. Upper abdominal pain, often localized to the right upper quadrant, is the most common symptom. In acute calculous cholecystitis, the pain is often sudden and intense but it can be described as cramping, dull, or steady. Pain can become excruciating.

RadiologyInfo.org

It usually occurs when drainage from the gallbladder becomes blocked (often from a gallstone). It may be acute (come on suddenly) and cause severe pain in the upper abdomen. Or it may be chronic (multiple recurrent episodes) with swelling and irritation that occurs over time.

StatPearls

The pathophysiologic mechanism of acute cholecystitis is blockage of the cystic duct. Cholecystitis is a condition best treated with surgery; however, it can be treated conservatively if necessary. This condition can be associated with or without the presence of gallstones and can also be classified as acute or chronic...