ACALCULOUS CHOLECYSTITIS acute or chronic cholecystitis in the absence of stones usually diabetic, immunosuppressed or po...
ACALCULOUS CHOLECYSTITIS
- acute or chronic cholecystitis in the absence of stones
- usually diabetic, immunosuppressed or post-op
Etiology
- dehydration
- systemic disease (e.g. MOSF-Multi-Organ System Failure)
- generalized sepsis
- kinking or fibrosis of the gallbladder
- thrombosis of the cystic artery
- sphincter spasm with obstruction of the biliary and
- pancreatic ducts
- prolonged fasting
- collagen vascular disease
Treatment : cholecystectomy or cholecystostomy
GALLSTONE PANCREATITIS
- Mechanism: gallstone impacted in common pancreatic duct
- Signs and symptoms : epigastric, back pain
Diagnostic investigation
- high amylase, lipase
- high liver enzymes
- most cases mild Ranson's criteria
- U/S may show multiple stones (may have passed spontaneously), edematous pancreas
- CT if severe to evaluate for complications
Treatment
- supportive
- cholecystectomy during same admission after acute attack subsided
GALLSTONE ILEUS
- mechanism - cholecystoenteric fistula (usually duodenal) with large gallstone impacting most commonly at the ileocecal valve not an ileus, but a true partial or complete small bowel obstruction
Clinical presentation
- crampy abdominal pain, nausea, vomiting
Diagnostic investigation
- 3 views abdomen shows dilated small intestine, gallstone in RLQ and air in biliary tree (15%)
- upper GI if unclear
Treatment
- hydrate, operate to remove stone; (enterotomy) usually don't have to remove gallbladder (30% cholecystectomy)
- only if chronic symptoms
- fistula usually closes spontaneously
Mortality 10-15%
