Chronic cholecystitis: Difference between revisions

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Revision as of 17:11, 27 January 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Historical Perspective

Pathophysiology

Epidemiology & Demographics

Risk Factors

Screening

Causes

Differentiating Cholecystitis

Complications & Prognosis

Diagnosis

Treatment

Histopathological Findings: Chronic Cholecystitis

References

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bs:Holecistitis de:Cholezystitis hr:Kolecistitis it:Colecistite sv:Gallblåseinflammation

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 ==Treatment==
 [[Cholecystitis medical therapy|Medical therapy]] | [[Cholecystitis surgery|Surgical options]] | [[Cholecystitis primary prevention|Primary prevention]]  | [[Cholecystitis secondary prevention|Secondary prevention]] | [[Cholecystitis cost-effectiveness of therapy|Financial costs]] | [[Cholecystitis future or investigational therapies|Future therapies]]
-==Complications of cholecystitis==
-*[[Perforation]] or [[rupture]]
-*[[Ascending cholangitis]]
-===Complications of cholecystectomy===
-*bile leak ("biloma")
-*bile duct injury (about 5-7 out of 1000 operations. Open and laparoscopic surgeries have essentially equal injuries, but the recent trend is towards fewer injuries with laparoscopy, probably because the open cases often result because the gallbladder is too difficult or risky to remove with laparoscopy)
-*[[abscess]]
-*[[wound]] [[infection]]
-*[[bleeding]] (liver surface and cystic artery most common sites)
-*[[hernia]]
-*organ injury (intestine and liver at highest risk, especially if [[gallbladder]] through inflammation has become adherent/scarred to other organs (e.g. [[transverse colon]])
-*[[deep vein thrombosis]]/[[pulmonary embolism]] (unusual- risk can be decreased through use of sequential compression devices on legs during surgery)
-====Gall bladder perforation====<!-- This section is linked from [[Gallbladder rupture]] -->
-Gall bladder perforation (GBP) is a rare but life-threatening complication of acute cholecystitis.  The early diagnosis and treatment of GBP are crucial to patient morbidity and mortality. <ref name="pmid17203529">{{cite journal |author=Derici H, Kara C, Bozdag AD, Nazli O, Tansug T, Akca E |title=Diagnosis and treatment of gallbladder perforation |journal=World J. Gastroenterol. |volume=12 |issue=48 |pages=7832-6 |year=2006 |pmid=17203529 |doi=}}</ref>
-Approaches to this complication will vary based on the condition of an individual patient, the evaluation of the treating surgeon or physician, and the facilities' capability. It can happen at the neck from pressure necrosis of an impacted [[calculus]], or at the fundus. It can result in a local [[abscess]], or perforation into the general peritoneal cavity; if the bile, is infected diffuse [[peritonitis]] supervenes readily and rapidly. Death can result. <ref name="pmid17203529">{{cite journal |author=Derici H, Kara C, Bozdag AD, Nazli O, Tansug T, Akca E |title=Diagnosis and treatment of gallbladder perforation |journal=World J. Gastroenterol. |volume=12 |issue=48 |pages=7832-6 |year=2006 |pmid=17203529 |doi=}}</ref>
-A retrospective study looked at 332 patients who received medical and/or surgical treatment with the diagnosis of acute cholecystitis.  Patients were treated with analgesics and antibiotics within the first 36 hours after admission (with a mean of 9 hours), and proceeded to surgery for a [[cholecystectomy]].  Two patients died and 6 patients had further complications.  The morbidity and mortality rates were 37.5% and 12.5%, respectively in the present study.  The authors of this study suggests that early diagnosis and emergency surgical treatment of gallbladder perforation are of crucial importance.<ref name="pmid17203529">{{cite journal |author=Derici H, Kara C, Bozdag AD, Nazli O, Tansug T, Akca E |title=Diagnosis and treatment of gallbladder perforation |journal=World J. Gastroenterol. |volume=12 |issue=48 |pages=7832-6 |year=2006 |pmid=17203529 |doi=}}</ref>
 ==Histopathological Findings: Chronic Cholecystitis==