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Alimentary Tract Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Ryan Lamm, Arturo J. Rios-Diaz, Priyadarshini Koduri, Francesco Palazzo
Acute cholecystitis is inflammation of the gallbladder. A diagnosis of acute cholecystitis should be made on the basis of characteristic history and physical examination. The 2018 Tokyo Guidelines diagnostic criteria can be followed to make a diagnosis of acute cholecystitis (Table 12.2) [21]. Murphy's sign is a physical examination finding of increased abdominal rigidity on inspiration and right upper quadrant tenderness. This sign can also be elicited on a right upper quadrant ultrasound examination with visualization of the gallbladder being compressed. This sign is pathognomonic for acute cholecystitis, but may not always be present on exam, depending on gestational age and body habitus.
Acute Cholecystitis
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Takanori Morikawa, Michiaki Unno
Acute cholecystitis is one of the common diseases that requires emergent treatment, and presents in 3–9% of all patients with acute abdominal symptoms who visit the emergency department [1]. The primary etiology of acute cholecystitis is gallstones (90–95% of the cases). However, only 10% of the patients with gallstones experience acute cholecystitis. The mechanism of acute calculous cholecystitis is bile stasis and activation of inflammation due to obstruction of the cystic duct by an impacted gallstone [2]. Less commonly, patients may develop acute cholecystitis in the absence of stones. This entity, referred to as acalculous cholecystitis, is encountered in critically ill patients, especially related to trauma, surgery, burn, long intensive care unit (ICU) stays, and prolonged fasting. Acute acalculous cholecystitis is defined as an acute necro-inflammatory disease of the gallbladder, accounts for 3.7%–14% of acute cholecystitis [3], and is reported to result from bile stasis and/or ischemia due to the underlying disease state [4].
Disorders of the digestive tract
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Acute cholecystitis occurs when gallstones irritate the mucous membrane of the gall bladder, resulting in inflammation that causes considerable pain. It is rare in pregnancy, with appendicitis being four to five times more likely (Blackburn, 2007). Diagnosis is usually by ultrasound (Ghumman, et al., 1997). Pain is usually described as colicky, and pyrexia and shock may be present, depending on the degree of infection (Nelson-Piercy, 2006). Although surgery can be done in pregnancy, for most women conservative treatment (fasting, nasogastric drainage, intravenous hydration, antibiotics and analgesia) is effective.
Distinct lipid profile in haemolytic anaemia-related gallstones compared with the general gallstone
Published in Annals of Medicine, 2023
Ziqi Wan, Xiaoyin Bai, Chengqing He, Yueyi Zhang, Ying Wang, Kaini Shen, Li Meizi, Qiang Wang, Wu Dongsheng, Yunlu Feng, Aiming Yang
Patients in the case group were diagnosed with gallstones after 9 (0–52) years of anaemia diagnosis. Thirty-eight patients had acute cholecystitis pertinent to gallstones, including five cases complicated by cholangitis and six by acute pancreatitis. Total bilirubin was 81.0 ± 52.9 μmol/L and 463.7 ± 383.3 μmol/L in the absence and presence of acute gallstone-related diseases, respectively (p < 0.001). Direct bilirubin was 12.7 ± 6.3 μmol/L and 311.0 ± 278.6 μmol/L, respectively (p < 0.001). The ratio of direct/total bilirubin was 0.21 ± 0.12 and 0.60 ± 0.22 for asymptomatic cases and acute cases (p < 0.001), respectively. GGT and LDH were also significantly higher in acute cases than in asymptomatic cases (p < 0.001 and p = 0.02, respectively). Other parameters were not significantly different. Seventy-seven patients in the control group experienced acute diseases. The ratio of direct/total bilirubin for acute cases was not significantly different from that of the case group (p = 0.827), whereas the level of total bilirubin was significantly lower than that of the case group (p < 0.001).
Regional variations in Sweden over time regarding the surgical treatment of acute cholecystitis: a population-based register study
Published in Scandinavian Journal of Gastroenterology, 2022
Jakob Holmberg Larsson, Johanna Österberg, Gabriel Sandblom, Lars Enochsson
Acute cholecystitis is caused by an obstruction of the gallbladder neck or the cystic duct, in most cases due to gallstones, leading to distension and an ensuing bacterial or chemical inflammation of the gallbladder. If left untreated, it can cause perforations, fistulae, abscess formation or chronic cholecystitis. In the early stages of acute cholecystitis, the gallbladder is surrounded by oedema, making it easier to identify the different tissue layers, resulting in generally less complicated surgery [3,4]. If surgery is delayed, the local inflammation causes a gradual replacement of the oedema with regenerative tissue, which makes it more problematic to identify the tissue layers and the surgical dissection thus more challenging. According to the WSES updated guidelines [5] as well as the 2018 Tokyo guidelines [6], early laparoscopic cholecystectomy is the standard of care for patients with acute calculous cholecystitis.
Assessment of the optimal timing for early laparoscopic cholecystectomy in acute cholecystitis: a prospective study of the Club Coelio
Published in Acta Chirurgica Belgica, 2019
L. Brunée, P. Hauters, J. Closset, G. Fromont, S. Puia-Negelescu
The diagnosis of acute cholecystitis was based on a combination of clinical criteria: persistent right upper quadrant pain, positive Murphy’s sign, temperature exceeding 37.5 °C, elevated C-reactive protein (CRP), white blood cell (WBC) count greater than 10,000/µL and ultrasonography criteria: presence of gallstones on ultrasound in combination with wall thickening. In all patients, antibiotic treatment according to the different institutional guidelines was given systematically once diagnosis was established and was continued postoperatively at the discretion of each surgeon according to the intraoperative findings. Only senior surgeons with high level of expertise in laparoscopy performed the operations. When required the gallbladder was first aspirated. Diathermy coagulation was used to dissect the Calot’s triangle and obtain the critical view of safety. Cholangiography was performed routinely.