A CUTE C HOLECYSTITIS Prepared by:Zhaksybay Nazgul Kazakh National Medical University named after S.D. Asfendiyarov

P LAN : 1.Acute Cholecystitis 2. Signs and symptoms 3. Diagnosis 4.What causes Acute Cholecystitis? 5.Prevention and treatment

A CUTE C HOLECYSTITIS Cholecystitis (Greek, -cholecyst, "gallbladder", combined with the suffix -itis, "inflammation") is inflammation of the gallbladder, which occurs most commonly due to obstruction of the cystic duct with gallstones (cholelithiasis). Blockage of the cystic duct with gallstones causes accumulation of bile in the gallbladder and increased pressure within the gallbladder. Concentrated bile, pressure, and sometimes bacterial infection irritate and damage the gallbladder wall, causing inflammation and swelling of the gallbladder. Inflammation and swelling of the gallbladder can reduce normal blood flow to areas of the gallbladder, which can lead to cell death due to insufficient oxygen. Not everyone who has gallstones will go on to develop cholecystitis.Greekinflammation gallbladdergallstonescholelithiasiscystic ductgallstonesgallbladder

W HAT IS IT ? By definition, cholecystitis is an inflammation of the gallbladder wall and nearby abdominal lining. Abdominal wall Gallbladder

D IAGNOSIS The symptoms of acute cholecystitis can resemble many other illnesses. Therefore, your doctor will want to know about your medical history as well as your symptoms. He or shee will probably check your abdomen for swelling or tender areas, or order additional tests. Abdominal ultrasounds use sound waves to create an image of your organs. Hepatobiliary scintigraphy is a procedure that creates an image of the upper portion of the small intestine, liver, gallbladder, and bile ducts. Cholangiography uses dye injected into the bile ducts to show the gallbladder and bile ducts on an X-ray. CT scans are computerized images used to create images of your internal organs. If your doctor has determined that you do have acute cholecystitis, he or she may also order blood tests to determine if there are any other problems. For example, liver function tests can be abnormal with this condition. Complete blood counts may show higher than normal amounts of white blood cells.

Rupture of the gallbladder becomes a danger, along with spread of infection of the hepatic duct and liver. If the disease is severe and interferes with the blood supply it can cause the gallbladder to become gangrenous. Gangrenou s gallbladder Gallstones

G ALLSTONES.. The presence of gallstones in the gallbladder is called cholelithiasis.

S IGNS AND SYMPTOMS The main symptom is pain in the upper right side or upper middle of your belly that usually lasts at least 30 minutes. You may feel: Sharp, cramping, or dull pain Steady pain Pain that spreads to your back or below your right shoulder blade Other symptoms that may occur include: Clay-colored stools Fever Nausea and vomiting Yellowing of skin and whites of the eyes (jaundice)

S IGNS AND S YMPTOMS. Complaints of indigestion after eating high fat foods. Localized pain in the right- upper quadrant epigastric region. Anorexia, nausea, vomiting and flatulence. Increased heart and respiratory rate – causing patient to become diaphoretic which in turn makes them think they are having a heart attack.

M EDICAL M ANAGEMENT. Lithotripsy for patients with only a FEW stones. If the attack of cholelithiasis is mild – bed rest is prescribed. patient is placed on NPO to allow GI tract and gallbladder to rest. an NG tube is placed on low suction. fluids are given IV in order to replace lost fluids from NG tube suction.

M EDICAL M ANAGEMENT. Cholecystectomy or Laparoscopic Cholecystectomy – removal of the gallbladder. This is the treatment of choice. The gallbladder along with the cystic duct, vein and artery are ligated.

M EDICAL M ANAGEMENT. If stones are present in the common bile duct, an endoscopic sphincterotomy must be performed to remove them BEFORE a cholecystectomy is done. A number of various instruments are inserted through the endoscope in order to "cut" or stretch the sphincter. Once this is done, additional instruments are passed that enable the removal of stones and the stretching of narrowed regions of the ducts. Drains (stents) can also be used to prevent a narrowed area from rapidly returning to its previously narrowed state.

W HAT CAUSES A CUTE C HOLECYSTITIS ? The gallbladder is an organ that sits below the liver. It stores bile, which your body uses to digest fats in the small intestine. Acute cholecystitis occurs when bile becomes trapped in the gallbladder. This often happens because agallstone blocks the cystic duct. This is the tube that bile travels into and out of the gallbladder. When a stone blocks this duct, bile builds up, causing irritation and pressure in the gallbladder. This can lead to swelling and infection.bilegallstone Other causes include: Serious illnesses such as HIV or diabetes Tumors of the gallbladder (rare) Some people are more at risk for gallstones. Risk factors include: Being female Pregnancy Hormone therapy Older age Being Native American or Hispanic Obesity Losing or gaining weight rapidly Diabetes

P REVENTION AND TREATMENT If you have severe belly pain, seek medical attention right away. In the emergency room, you'll be given fluids through a vein. You also may be given antibiotics to fight infection. Cholecystitis may clear up on its own. However, if you have gallstones, you will probably need surgery to remove your gallbladder.surgery to remove your gallbladder Nonsurgical treatment includes: Antibiotics to fight infection Low-fat diet (if you are able to eat) Pain medicines You may need emergency surgery if you have complications such as: Gangrene (tissue death) Perforation (a hole that forms in the wall of the gallbladder) Pancreatitis (inflamed pancreas) Persistent bile duct blockage Inflammation of the common bile duct If you are very ill, a tube may be placed in your gallbladder and through your skin to drain it. Then, once you are feeling better, you may have surgery.surgery