MANAGEMENT

1. MANAGEMENT ACUTE CHOLECYSTITIS

2. Medical Therapy • Intravenous fluids • Analgesia  Meperidine or NSAIDs • Intravenous Antibiotics • Third Generation Cephalosporin • Second Generation Cephalosporin + Metronidazole • Aminoglycoside + Metronidazole • Imipenem/Meropenem

3. Surgical Therapy • Urgent / Emergency Cholecystectomy or Cholecystostomy • With complication of acute cholecystitis such as empyema, emphysematous cholecystitis, or perforation is suspected or confirmed • In uncomplicated cases of acute cholecystitis • 30% of patients fail to resolve on medical therapy  progression of the attack or a supervening complication  Early cholecystectomy (within 24–72 h). • The technical complications of surgery are not increased in patients undergoing early as opposed to delayed cholecystectomy. • Delayed surgical intervention is probably best reserved for: • Patients in whom the overall medical condition imposes an unacceptable risk for early surgery • Patients in whom the diagnosis of acute cholecystitis is in doubt • Early cholecystectomy - the treatment of choice for most patients with acute cholecystitis • Mortality Risk for Emergency cholecystectomy = 3% • Mortality Risk for Elective or early cholecystectomy = 0.5% • Operative risks: • Age-related diseases • Long or short term complications of gallbladder disease • Seriously ill or debilitated patients with cholecystitis • Cholecystostomy and Tube drainage • Elective cholecystectomy done at a later date