Differences between Acute and Chronic Cholecystitis and stages of Chlecystectomy скачать в хорошем качестве

Differences between Acute and Chronic Cholecystitis and stages of Chlecystectomy

Cholecystitis occurs when inflammation presents in the gallbladder. The gallbladder is an organ found under the liver and it stores bile. Bile helps with the digestion of fats and help bilirubin exit the body via the stool. Cholecystitis most commonly occurs due to gallstones (cholelithasis). It can also occur in very sick patients or after a trauma or surgery even though gallstones are not presenting (acalculous). Signs and symptoms of cholecystitis include upper GI pain (epigastric) that travels to the right shoulder blade (this pain tends to increase after a heavy greasy/fatty/spicy meal), positive Murphy's Sign, nausea, vomiting, steatorrhea, fever, and tachycardia. Treatment for cholecystitis includes cholecystectomy (removal of gallbladder), ERCP (to remove the gallstones), pain medication, nausea medication, IV fluids, nasogastric tube, T-Tube, or cholecystostomy (for patients who can't immediately have the gallbladder removed). Please see the video for nursing care for a patient with cholecystitis. Ninja Nerds! In this lecture, Professor Zach Murphy will present on Biliary Tract Diseases. We will discuss the pathophysiology, focusing on conditions such as cholelithiasis, cholecystitis, and cholangitis, and their impact on bile flow and liver function. The session will transition to a digital presentation focused on the diagnostic approach, including ultrasonography, MRCP (Magnetic Resonance Cholangiopancreatography), and ERCP (Endoscopic Retrograde Cholangiopancreatography). Finally, we will review the management strategies for Biliary Tract Diseases, emphasizing medical management, endoscopic procedures, and surgical options like cholecystectomy. Enjoy the lecture and support us below! "I ate pork chops and gravy last night." Progressing Right upper stomach pain with Bloating. Pain radiates to mid back and in the right shoulder. The pain may be exacerbated by fatty food intake, also food intolerances (especially greasy and spicy foods). Often the symptoms occur in the evening or at night. Sometimes Nausea, vomiting, and occasionally fever. This pain could be present for years until diagnosis. This condition is Chronic cholecystitis. symptoms can be accompanied by acute exacerbations of more pronounced symptoms, which is called - acute biliary colic. or it can progress to a more severe form of cholecystitis requiring urgent intervention it is acute cholecystitis). Cases of acute cholecystitis have similar symptoms only more severe. More than 90% of the time acute cholecystitis is caused from blockage of the cystic duct by a gallstone. Treatment is usually with laparoscopic gallbladder removal, within 24 hours if possible. While Chronic cholecystitis is a prolonged, subacute condition caused by the mechanical or functional dysfunction of the emptying of the gallbladder. Chronic cholecystitis can be two types. Calculous, it means stones in the gallbladder. Called cholelithiasis, and acalculous (without gallstones). However most cases of chronic cholecystitis are commonly associated with cholelithiasis. Gallstones, by causing intermittent obstruction of the bile flow, most commonly by blocking the cystic duct lead to inflammation and edema in the gall bladder wall. Chronic irritation from gallstones invoking an inflammatory response in the gallbladder wall. Sometimes resulting from dysfunction in the emptying of the gallbladder. This overlaps with Sphincter of Oddi dysfunction and is best referred to as biliary or gallbladder dyskinesia. It has been proposed that lithogenic bile, leads to increased free radical-mediated damage from hydrophobic bile salts. That, in association with reduced mucosal protection due to lower levels of prostaglandin E2 results in a continuous inflammatory state. When the cholecystokinin receptors of the smooth muscle are affected, there is impaired gall bladder contraction that leads to stasis and worsens the permissive environment where lithogenic bile promotes inflammation. Risk factors for cholelithiasis include: Female gender Obesity Rapid weight loss Pregnancy Advanced age Hispanic or Pima Indians. Gallstone disease is very common. About 10-20% of the world population will develop gallstones at some point in their life and about 80% of them are asymptomatic. There are other common medical conditions that can mimic the presentation of chronic cholecystitis. Including: Gall bladder cancer: Peptic ulcer disease: GERD; Gastric cancer: Myocardial infarction. Mesenteric ischemia and Mesenteric vasculitis. Treatment: The preferred treatment for chronic cholecystitis is elective laparoscopic cholecystectomy. conservatively. A low-fat diet can help reduce the frequency of symptoms. In patients with symptomatic cholelithiasis, the use of ursodeoxycholic acid (UDCA or ursodiol) has been shown to decrease rates of biliary colic and acute cholecystitis. Prognosis: The majority of uncomplicated cases of cholecystitis have an excellent outcome.