Acute Cholecystitis - Overview (signs and symptoms, pathophysiology, treatment)

Armando Hasudungan
29 Oct 201612:37
EducationalLearning
32 Likes 10 Comments

TLDRThe video provides an in-depth overview of acute cholecystitis, a condition characterized by the inflammation of the gallbladder due to gallstones obstructing the cystic duct. It explains the anatomy of the gallbladder and its role in storing and releasing bile, which aids in the digestion of fatty foods. The script differentiates acute cholecystitis from biliary colic and cholangitis, highlighting their respective symptoms such as fever, nausea, vomiting, and jaundice. It also discusses the complications of gallstones, including gallbladder tumors, chronic cholecystitis, and the potential for life-threatening conditions like cholangitis. Diagnostic methods like blood tests, ultrasound, and Haida scans are mentioned, along with the surgical management of acute cholecystitis through laparoscopic or open cholecystectomy. The summary emphasizes the importance of understanding the condition and its management to raise awareness and inform viewers about this common medical issue.

Takeaways
  • 📚 Acute cholecystitis is an inflammation of the gallbladder, often caused by a gallstone obstructing the cystic duct.
  • 🔍 Cholelithiasis, the formation of gallstones, is the most common cause of acute cholecystitis.
  • 📏 The gallbladder stores bile, which is produced by the liver and aids in the digestion of fatty foods.
  • 🤕 Symptoms of acute cholecystitis include right upper quadrant pain, fever, nausea, vomiting, and possibly jaundice.
  • 👩‍⚕️ Murphy's sign is a diagnostic tool used to detect acute cholecystitis, where deep breaths provoke pain due to gallbladder irritation.
  • 🧬 Differences between biliary colic, acute cholecystitis, and cholangitis are based on the presence of pain, fever, white blood cell count, and jaundice.
  • ⚠️ Complications of cholecystitis can include gallbladder tumors, chronic cholecystitis, empyema, and obstructive jaundice.
  • 🧪 Diagnostic tests for biliary tree problems may include full blood count, amylase, lipase, CRP, USS, and LFTs.
  • 🔬 An ultrasound is the primary diagnostic tool for detecting gallstones and assessing the gallbladder.
  • 🛠️ Surgical management of acute cholecystitis is common, with laparoscopic cholecystectomy being less invasive than open cholecystectomy.
  • ⚕️ Pre-surgery management includes fasting, IV fluids, antibiotics, and analgesia for pain relief.
Q & A

  • What is acute cholecystitis?

    -Acute cholecystitis is an inflammation of the gallbladder, typically caused by an obstruction of the cystic duct by gallstones.

  • What is the role of the gallbladder in the digestive system?

    -The gallbladder is an organ that stores bile, a mixture of cholesterol and other pigments produced by the liver, which is important for digesting fatty foods.

  • What is the difference between acute cholecystitis and biliary colic?

    -Biliary colic involves a temporary obstruction of a gallstone at the neck of the gallbladder, whereas acute cholecystitis is caused by a gallstone stuck in the cystic duct, leading to inflammation of the gallbladder.

  • What is the Murphy sign, and how is it related to acute cholecystitis?

    -The Murphy sign is a clinical test for acute cholecystitis where a hand is placed at the mid-inferior border of the liver, and the patient is asked to take a deep breath. If the diaphragm pushes the gallbladder down and causes pain, it can indicate acute cholecystitis.

  • What are the typical symptoms of acute cholecystitis?

    -The typical symptoms of acute cholecystitis include fever, nausea, vomiting, and right upper quadrant pain, which may radiate to the right side of the back.

  • What is the difference between cholangitis and acute cholecystitis?

    -Cholangitis is a complication of gallstones where an infection develops in the common bile duct, which can be life-threatening. It presents with right upper quadrant pain, fever, increased white cell count, and jaundice, whereas acute cholecystitis does not typically present with jaundice.

  • What are some complications of acute cholecystitis?

    -Complications of acute cholecystitis include gallbladder tumor, chronic cholecystitis, empyema, Maritza syndrome, perforation of the gallbladder, gallbladder duodenum fistula, gallstone ileus, pancreatitis, and obstructive jaundice due to bile backflow.

  • What diagnostic tests are used to detect biliary tree problems?

    -Diagnostic tests for biliary tree problems include a full blood count, amylase and lipase levels to check for pancreatitis, C-reactive protein (CRP), liver function tests (LFTs), and ultrasound, which can detect gallstones and is used to elicit Murphy's sign.

  • What is the typical management approach for acute cholecystitis?

    -The management of acute cholecystitis typically involves surgery, specifically cholecystectomy, which can be performed laparoscopically or through an open procedure. Before surgery, patients are managed with nil by mouth, IV fluids, antibiotics, and pain relief with analgesia.

  • How is a laparoscopic cholecystectomy performed?

    -A laparoscopic cholecystectomy is performed by making a few ports or holes in the abdomen. The abdominal cavity is inflated with carbon dioxide to create space for the surgeon to work. The gallbladder is exposed, the cystic artery and duct are clipped, and the gallbladder is removed. The cystic duct is also clipped to prevent bleeding or spillage.

  • When is an open cholecystectomy necessary?

    -An open cholecystectomy is necessary if there are complications from the gallstones or if there are issues during a laparoscopic surgery. It is a more invasive procedure but can be quicker in certain situations.

  • What does the term 'Courvoisier's law' refer to in the context of gallbladder disorders?

    -Courvoisier's law states that the presence of a large gallbladder with jaundice is unlikely due to gallstones; instead, it suggests a carcinoma of the head of the pancreas as a more likely cause.

Outlines
00:00
📚 Introduction to Acute Cholecystitis

This paragraph introduces acute cholecystitis, which is the inflammation of the gallbladder typically caused by an obstruction in the cystic duct by gallstones. It explains that this condition is the most prevalent complication of cholelithiasis, or the formation of gallstones. The video aims to focus on acute cholecystitis, while also touching on other related complications. The anatomy of the upper gastrointestinal tract is reviewed, highlighting the role of the gallbladder in storing bile, which is produced by the liver and essential for digesting fatty foods. The script also discusses how gallstones can cause problems when they obstruct the cystic duct, leading to acute inflammation and the characteristic symptoms of acute cholecystitis.

05:00
🤒 Symptoms and Complications of Acute Cholecystitis

The second paragraph delves into the signs and symptoms of acute cholecystitis, which include fever, nausea, vomiting, and right upper quadrant abdominal pain that may radiate to the back. It describes the Murphy sign, a diagnostic test for gallbladder inflammation. The paragraph also differentiates acute cholecystitis from biliary colic and cholangitis based on the presence of fever, increased white blood cell count, and jaundice. It outlines various complications of gallstones, such as gallbladder tumors, chronic cholecystitis, empyema, Mirizzi syndrome, gallstone ileus, and pancreatitis. Additionally, it discusses the diagnostic methods for biliary tree problems, including blood tests, ultrasound, and the HIDA scan, and the general approach to managing acute cholecystitis, emphasizing the importance of surgery for symptomatic individuals.

10:01
🔪 Surgical Management of Acute Cholecystitis

The final paragraph discusses the surgical treatment options for acute cholecystitis. It contrasts laparoscopic cholecystectomy, which involves minimally invasive surgery with several small incisions, with open cholecystectomy, which is more invasive. The paragraph explains the procedure of laparoscopic surgery, where the gallbladder is exposed, and the cystic artery and duct are clipped before removal. It also mentions that an open cholecystectomy may be necessary in cases of complications from gallstones or issues during laparoscopic surgery. The summary provides a basic understanding of the surgical process without going into the technical details of surgical techniques.

Mindmap
Keywords
💡Acute Cholecystitis
Acute Cholecystitis is the inflammation of the gallbladder, typically caused by the obstruction of the cystic duct by gallstones. It is the most common complication of cholelithiasis, which is the formation of gallstones. In the video, acute cholecystitis is the main focus and is described as leading to right upper quadrant pain and potentially other symptoms like fever and vomiting.
💡Cholelithiasis
Cholelithiasis refers to the formation of gallstones within the gallbladder. These stones are made of a mixture of cholesterol and other pigments within bile. The video explains that while many people have gallstones, they often remain asymptomatic. However, when a gallstone obstructs the cystic duct, it can lead to acute cholecystitis.
💡Cystic Duct
The cystic duct is a structure that connects the gallbladder to the common hepatic ducts. It plays a crucial role in the development of acute cholecystitis, as gallstones can become lodged in this duct, leading to inflammation of the gallbladder. The video script describes the anatomy and function of the cystic duct in the context of gallbladder diseases.
💡Murphy's Sign
Murphy's Sign is a clinical sign used to diagnose acute cholecystitis. It is elicited during a physical examination where a healthcare provider places their hand under the right lower edge of the liver and asks the patient to take a deep breath. If the patient feels pain and stops breathing due to the irritation of the inflamed gallbladder, it is considered a positive Murphy's sign. The video mentions this as a diagnostic tool for acute cholecystitis.
💡Biliary Colic
Biliary colic is a condition characterized by temporary obstruction of the gallstone at the neck of the gallbladder, causing pain. It differs from acute cholecystitis in that the obstruction is not persistent and does not necessarily lead to inflammation. The video script distinguishes biliary colic from acute cholecystitis based on the presence or absence of fever and increased white blood cell count.
💡Cholangitis
Cholangitis is a serious condition where an infection develops in the common bile duct, often as a complication of gallstones. It is life-threatening and presents with right upper quadrant pain, fever, increased white blood cell count, and jaundice. The video emphasizes that cholangitis is a distinct condition from acute cholecystitis and biliary colic, with the presence of jaundice being a key differentiator.
💡Gallbladder Complications
The video discusses various complications that can arise from gallbladder issues, including gallbladder tumor, chronic cholecystitis, empyema, and Maritza syndrome. These complications can lead to further health problems such as obstructive jaundice, gallstone ileus, pancreatitis, and cholangitis. Understanding these complications helps to appreciate the severity and breadth of gallbladder-related diseases.
💡Obstructive Jaundice
Obstructive jaundice is a condition where the flow of bile is obstructed, leading to the yellowing of the skin and eyes. It can be caused by gallstones obstructing the common bile duct or by complications such as Maritza syndrome. The video mentions obstructive jaundice as a potential outcome of gallbladder and biliary tree problems.
💡Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy is a minimally invasive surgical procedure to remove the gallbladder, typically performed for symptomatic gallstones or acute cholecystitis. The video describes the procedure involving small incisions and the use of a camera to view the abdominal cavity. It is preferred over open surgery due to its less invasive nature and quicker recovery time.
💡Open Cholecystectomy
Open Cholecystectomy is a more traditional and invasive surgical procedure to remove the gallbladder. It may be necessary in cases where there are complications from gallstones or issues during laparoscopic surgery. The video script explains that while this method is quicker in terms of the surgery itself, it results in a longer recovery period and more significant invasion to the patient's body.
💡Bile
Bile is a fluid produced by the liver that aids in the digestion of fatty foods. It is stored in the gallbladder and released into the small intestine via the common bile duct. The video script highlights the importance of bile in digestion and how its obstruction due to gallstones can lead to acute cholecystitis and other related conditions.
Highlights

Acute cholecystitis is inflammation of the gallbladder caused by obstruction of the cystic duct by gallstones.

Cholelithiasis, or formation of gallstones, is the most common cause of acute cholecystitis.

Gallbladder stores bile, which is produced by the liver and important for digesting fatty foods.

The gallbladder, cystic duct, and common hepatic ducts form the biliary system that transports bile to the small intestine.

Many people have gallstones without symptoms, but in some cases they can cause acute cholecystitis when stuck in the cystic duct.

Acute cholecystitis shares symptoms with biliary colic and cholangitis but differs in the presence of fever, increased white cell count, and jaundice.

Biliary colic involves temporary obstruction of a gallstone at the gallbladder neck.

Cholangitis is a life-threatening condition where a gallstone causes an infection in the common bile duct.

Signs and symptoms of acute cholecystitis include fever, nausea, vomiting, and right upper quadrant abdominal pain.

Murphy's sign, where deep breath triggers pain, is a key clinical finding in acute cholecystitis.

Complications of cholecystitis include gallbladder tumor, chronic cholecystitis, empyema, and Maritza syndrome.

Gallstones can cause pancreatitis by obstructing the pancreatic duct and lead to obstructive jaundice.

Diagnostic tests for suspected biliary problems include full blood count, amylase, lipase, CRP, LFTs, and ultrasound.

Surgery is the main treatment for symptomatic gallstones or recurrent disease, with laparoscopic cholecystectomy being less invasive.

Laparoscopic cholecystectomy involves making small incisions and using a camera for visualization.

During surgery, the cystic artery and duct are clipped to prevent bleeding and spillage of contents.

An open cholecystectomy may be necessary if there are complications from gallstones or during laparoscopic surgery.

Courvoisier's law states that a large gallbladder with jaundice is unlikely to be due to gallstones, suggesting a pancreatic cancer.

Transcripts

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CholecystitisGallbladderGallstonesInflammationMedical OverviewUpper Abdominal PainBiliary ComplicationsMurphy's SignLaparoscopic SurgeryHealth EducationDigestive System