|
|
| (38 intermediate revisions by 2 users not shown) |
| Line 1: |
Line 1: |
| __NOTOC__ | | __NOTOC__ |
| {{CMG}}; {{AE}} {{VR}}
| |
|
| |
|
| ==Cholecystitis==
| |
| ===Definitions===
| |
| {|class="wikitable"
| |
| ! Terms!! Definitions
| |
| |-
| |
| | Cholecystitis|| Cholecystitis is an inflammatory disease of the gallbladder.
| |
| |-
| |
| | Acute cholecystitis|| Acute cholecystitis is an acute inflammatory disease of the gallbladder, most often attributable to gallstones.<ref name="Strasberg-2008">{{Cite journal | last1 = Strasberg | first1 = SM. | title = Clinical practice. Acute calculous cholecystitis. | journal = N Engl J Med | volume = 358 | issue = 26 | pages = 2804-11 | month = Jun | year = 2008 | doi = 10.1056/NEJMcp0800929 | PMID = 18579815 }}</ref><ref name="Reiss-1993">{{Cite journal | last1 = Reiss | first1 = R. | last2 = Deutsch | first2 = AA. | title = State of the art in the diagnosis and management of acute cholecystitis. | journal = Dig Dis | volume = 11 | issue = 1 | pages = 55-64 | month = | year = 1993 | doi = | PMID = 8443956 }}</ref>
| |
| |-
| |
| | Acute calculous cholecystitis|| Acute calculous cholecystitis is an acute inflammatory disease of the gallbladder in the presence of cholelithiasis.<ref name="Strasberg-2008">{{Cite journal | last1 = Strasberg | first1 = SM. | title = Clinical practice. Acute calculous cholecystitis. | journal = N Engl J Med | volume = 358 | issue = 26 | pages = 2804-11 | month = Jun | year = 2008 | doi = 10.1056/NEJMcp0800929 | PMID = 18579815 }}</ref>
| |
| |-
| |
| | Acute acalculous cholecystitis|| Acute acalculous cholecystitis is an acute necroinflammatory disease of the gallbladder in the absence of cholelithiasis and has a multifactorial pathogenesis.<ref name="Huffman-2010">{{Cite journal | last1 = Huffman | first1 = JL. | last2 = Schenker | first2 = S. | title = Acute acalculous cholecystitis: a review. | journal = Clin Gastroenterol Hepatol | volume = 8 | issue = 1 | pages = 15-22 | month = Jan | year = 2010 | doi = 10.1016/j.cgh.2009.08.034 | PMID = 19747982 }}</ref>
| |
| |-
| |
| | Chronic cholecystitis|| Chronic cholecystitis is a chronic inflammatory disease of the gallbladder with histological evidence of chronic inflammation like large range of related inflammatory epithelial changes including mononuclear infiltrate, fibrosis, thickening of muscular layer, dysplasia, hyperplasia and metaplasia.<ref name="Zhou-2013">{{Cite journal | last1 = Zhou | first1 = D. | last2 = Guan | first2 = WB. | last3 = Wang | first3 = JD. | last4 = Zhang | first4 = Y. | last5 = Gong | first5 = W. | last6 = Quan | first6 = ZW. | title = A comparative study of clinicopathological features between chronic cholecystitis patients with and without Helicobacter pylori infection in gallbladder mucosa. | journal = PLoS One | volume = 8 | issue = 7 | pages = e70265 | month = | year = 2013 | doi = 10.1371/journal.pone.0070265 | PMID = 23936177 }}</ref>
| |
| |-
| |
| |}
| |
|
| |
|
| ===Acute Calculous Cholecystitis Diagnostic Criteria===
| | '''[[Acute cholecystitis resident survival guide|Click here for acute cholecystitis.]]''' |
| According to Tokyo guidelines,<ref name="Takada-2007">{{Cite journal | last1 = Takada | first1 = T. | last2 = Kawarada | first2 = Y. | last3 = Nimura | first3 = Y. | last4 = Yoshida | first4 = M. | last5 = Mayumi | first5 = T. | last6 = Sekimoto | first6 = M. | last7 = Miura | first7 = F. | last8 = Wada | first8 = K. | last9 = Hirota | first9 = M. | title = Background: Tokyo Guidelines for the management of acute cholangitis and cholecystitis. | journal = J Hepatobiliary Pancreat Surg | volume = 14 | issue = 1 | pages = 1-10 | month = | year = 2007 | doi = 10.1007/s00534-006-1150-0 | PMID = 17252291 }}</ref><ref name="Hirota-2007">{{Cite journal | last1 = Hirota | first1 = M. | last2 = Takada | first2 = T. | last3 = Kawarada | first3 = Y. | last4 = Nimura | first4 = Y. | last5 = Miura | first5 = F. | last6 = Hirata | first6 = K. | last7 = Mayumi | first7 = T. | last8 = Yoshida | first8 = M. | last9 = Strasberg | first9 = S. | title = Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. | journal = J Hepatobiliary Pancreat Surg | volume = 14 | issue = 1 | pages = 78-82 | month = | year = 2007 | doi = 10.1007/s00534-006-1159-4 | PMID = 17252300 }}</ref> presence of one local symptom or sign with one systemic sign and confirmatory imaging finding diagnosis acute calculous cholecystitis.
| | <br> |
| | '''[[Chronic cholecystitis resident survival guide|Click here for chronic cholecystitis.]]''' |
| | <br> |
| | <br> |
| | <br> |
|
| |
|
| ===Causes===
| |
| ====Life Threatening Causes====
| |
| Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
| |
|
| |
| ====Common Causes====
| |
|
| |
| ===Management===
| |
| {{familytree/start |summary=Cholecystitis}}
| |
| {{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | |A01=<div style="float: left; text-align: left; line-height: 150% ">'''Characterize the symptoms'''<br>❑ Abdominal pain</div>}}
| |
| {{familytree | | | | | | | | | |,|-|-|-|+|-|-|-|.| | | | | | | | | | | | | | | | | }}
| |
| {{familytree | | | | | | | | | B01 | | B02 | | B03 | | | | | | | | | | | | | | | |B01=<div style="float: left; text-align: left; line-height: 150% ">❑ Acute biliary type abdominal pain<div class="mw-collapsible-content"> <div class="mw-collapsible mw-collapsed">
| |
| :❑ Right upper quadrant or epigastric pain
| |
| :❑ Sharp, severe and steady pain
| |
| :❑ Pain for >6 hours
| |
| :❑ Pain radiating to right shoulder blade
| |
| :❑ Pain after food intake
| |
| :❑ Pain aggravated by movements
| |
| :❑ Pain associated with nausea & vomiting
| |
| :❑ Pain associated with diaphoresis
| |
| :❑ Pain associated with fever
| |
| :❑ Pain associated with anorexia
| |
| :❑ Pain associated with mass in the RUQ</div></div><br>❑ Sx suggestive of sepsis<br>❑ Sx suggestive of Mirizzi syndrome<div class="mw-collapsible-content"> <div class="mw-collapsible mw-collapsed">
| |
| :❑ RUQ pain with fever & jaundice</div></div><br>❑ Sx suggestive of gallstone ileus<div class="mw-collapsible-content"> <div class="mw-collapsible mw-collapsed">
| |
| :❑ Transient abdominal pain with nausea & vomiting
| |
| :❑ Hematemesis</div></div></div>|B02=<div style="float: left; text-align: left; line-height: 150% ">❑ Acute vague abdominal pain<br>❑ RUQ mass<br>❑ Jaundice</div>|B03=<div style="float: left; text-align: left; line-height: 150% ">❑ Recurrent biliary type abdominal pain<br>❑ Recurrent abdominal bloating<br>❑ Unstable stool with constipation/diarrhea</div> }}
| |
| {{familytree | | | | | | | | | |!| | | |!| | | |!| | | | | | | | | | | | | | | |}}
| |
| {{familytree | | | | | | | | | C01 | | C02 | | C03 | | | | | | | | | | | | | | | |C01=<div style="float: left; text-align: left; line-height: 150% ">'''Examine the patient:'''<BR>❑ Febrile<BR>❑ Tachycardia<BR>❑ Dehydrated<BR>❑ Abdominal guarding<BR>❑ Murphy's sign<BR>❑ Abdominal creps<BR>❑ Abdominal tenderness<BR>❑ Reduced bowel sounds<BR>❑ Increased bowel sounds<BR>❑ Abdominal distension<BR>❑ Signs of sepsis</div>|C02=Consider Dx of '''acute acalculous cholecystitis'''|C03=Consider Dx of '''chronic cholecystitis'''}}
| |
| {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}}
| |
| {{familytree | | | | | | | | | D01 |,| D02 |-| D03 |-|-| | | | | | | | | | | | | | | |D01=<div style="float: left; text-align: left; line-height: 150% ">'''Order laboratory tests:'''<br>❑ CBC<br>❑ BMP<br>❑ Total bilirubin<br>❑ Direct bilirubin<br>❑ Albumin<br>❑ AST<br>❑ ALT<br>❑ Alkaline phosphatase<br>❑ GGT<br>❑ Amylase<br>❑ Lipase</div>|D02=No GBS/GB edema|D03=Consider evaluation for alternate diagnosis of abdominal pain}}
| |
| {{familytree | | | | | | | | | |!| |!| | | | | | | | | |!| | | | | | | | | | |}}
| |
| {{familytree | | | | | | | | | F01 |+| F02 |-| F03 |-| F04 | | | | | | | | | | | | | | |F01='''Order urgent transabdominal USG (TAUSG)'''|F02=GBS w/o GB edema/GB edema w/o GBS}|F03=HIDA scan|F04=GB visualized}}
| |
| {{familytree | | | | | | | | | |!| |!| | | | | |!| | | | | | | | | | | | |}}
| |
| {{familytree | | | | | | | | | |!| |`| H01 | | H02 | | | | | | | | | | | | | | | | |H01=GBS w/ GB edema|H02=GB not visualized}}
| |
| {{familytree | | | | | | | | | |!| | | |!| | | |!| | | | | | | | | | | | | |}}
| |
| {{familytree | | | | | | | | | |!| | | |!| | | |!| | | | | | | | | | | | | | |}}
| |
| {{familytree | | | | | | | | | H01 |-|-|'|-|-|-|'| | | | | | | | | | | | | | | |H01=<div style="float: left; text-align: left; line-height: 150% ">'''Diagnostic criteria:'''<br>❑ Local symptoms & signs<div class="mw-collapsible-content"> <div class="mw-collapsible mw-collapsed">
| |
| :❑ Murphy’s sign
| |
| :❑ Pain or tenderness in RUQ
| |
| :❑ Mass in RUQ</div></div><br>❑ Systemic signs<div class="mw-collapsible-content"> <div class="mw-collapsible mw-collapsed">
| |
| :❑ Fever
| |
| :❑ Leukocytosis
| |
| :❑ Elevated CRP</div></div><br>❑ Imaging findings<div class="mw-collapsible-content"> <div class="mw-collapsible mw-collapsed">
| |
| :❑ TAUSG confirmatory finding of GBS & GB edema
| |
| :❑ HIDA scan confirmatory finding of GBS & GB edema </div></div></div>}}
| |
| {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}}
| |
| {{familytree | | | | | | | | | G01 | | | | | | | | | | | | | | | | | | | | | | |G01='''Acute calculous cholecystitis'''}}
| |
|
| |
| ==References==
| |
| {{Reflist|2}}
| |
|
| |
| [[Category:Help]]
| |
| [[Category:Projects]] | | [[Category:Projects]] |
| [[Category:Resident survival guide]] | | [[Category:Resident survival guide]] |
| [[Category:Templates]] | | [[Category:Up-To-Date]] |
| | [[Category:Gastroenterology]] |
|
| |
|
| {{WikiDoc Help Menu}} | | {{WikiDoc Help Menu}} |
| {{WikiDoc Sources}} | | {{WikiDoc Sources}} |