1 / 34

Examination. Has tenderness to deep palpation Muscle guarding

A 43 yr old obese mother of six children has right upper quadrant abdominal pain that began 6 hour ago. the pain was colicky at first ,radiated to right shoulder and was accompanied by nausea and vomiting. for the past two hours the pain has been constant. Examination.

hanne
Download Presentation

Examination. Has tenderness to deep palpation Muscle guarding

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A 43 yr old obese mother of six children has right upper quadrant abdominal pain that began 6 hour ago. the pain was colicky at first ,radiated to right shoulder and was accompanied by nausea and vomiting. for the past two hours the pain has been constant.

  2. Examination. • Has tenderness to deep palpation • Muscle guarding • Rebound tenderness in right upper quadrant.

  3. Investigation • TEMP 101 F • WBC count 12000 • LFT are normal

  4. Differential Diagnosis • Acute appendicitis • Perforated peptic ulcer • Acute pancreatitis • Acute cholecystitis • Pneumonia right liver lobe

  5. Diagnosis ??????????

  6. ACUTE CHOLECYSTITIS

  7. CHOLECYSTITIS BY • Atif Nasrullah Ranjah

  8. The fundus of the gall-bladder lies where the lateral border of the rectus abdominis cuts the costal margin; this is at the tip of the 9th costal cartilage

  9. DevelopmentA diverticulum grows out from ventral wall of duodenum which grows out into liver and hepatic ducts.Another diverticulum from side of hepatic grows and form the gall bladder and cystic duct

  10. The gall-bladder is supplied by the cystic artery (a branch usually of the right hepatic artery) which lies in the triangle made by the liver, the cystic duct and the common hepatic duct. Other vessels derived from the hepatic artery pass to the gall-bladder from its bed in the liver

  11. VEINS • There is no accompanying vein to the cystic artery. Small veins pass from the gall-bladder through its bed directly into tributaries of the right portal vein within the liver. LYMPHATICS • Sumucosal and subserosal pass to cystic lymph node that drains into coeliac • Subserosal also connects to subcapsular lymphatics of liver so spread of carcinoma to liver

  12. Normal gallbladder histology.The undulating mucosal epithelium overlies a delicate lamina and only one smooth muscle layer. This is different from elsewhere in the gut,where two muscle layers exist (muscularis mucosa and muscularispropria).

  13. Functions • Storage • Concentration • Mucus secretion

  14. BILE REGULATION

  15. Types Of Gallstones • Three types • Cholestrol stones • Pigmented stones • Mixed stones

  16. RISK FACTORS FOR GALLSTONES CHOLESTEROL STONES • Demography: Northern Europeans • Age • Female sex hormones Female gender

  17. Obesity • Oral contraceptives • Pregnancy Pigment Stones • Asian more than Western, • Rural More Than Urban • Chronic hemolytic syndromes • Biliary infection: Gastrointestinal disorders: ileal disease (e.g., Crohn disease),

  18. Cholestrol Stones

  19. They Are Formed due to bacterial infection hemolytic anemias Pigmented stones

  20. Cholecystitis Types • ACUTE, • Acute Calculous Cholecystitis • Acute Non-Calculous Cholecystitis • CHRONIC • ACUTE SUPERIMPOSED ON CHRONIC ACUTE EMPHYSEMATOUS CHOLECYSTITIS

  21. ACUTE ACALCULOUS CHOLECYSTITIS • In serious illness • Multiple trauma • Following major surgical procedures • Extensive burns • Severe sepsis

  22. Cause • Gallbladder distension • Bile stasis • Hypersensitivity to antibiotic Investigation of choice • 1 CT SCAN • 2 USG

  23. BILIARY COLIC • Occurs when a stone temporarily occludes the cystic duct. • Colicky pain in right upper quardant ;radiating to right upper shoulder • Triggered by fatty food • Accompanied by nausea and vomiting • Relieved by itself or easily aborted by antispasmodics

  24. Acute cholestitisStart as biliary colic stone remains at the cystic duct and leads to inflammatory process in gallbladder pain become constant greater than 6 hour fever

  25. Examination Inspection • Zackrary cope sign • Fullness in right hypochondrium Palpation • Gallbladder is palpable in early stages • Murphy sign • Boas sign hyperaesthesia by a pin in back of pts chest Percussion • A Dull Area Beneath Costal Margin

  26. The diagnostic study of choice is ultrasound. Findings AreCholelithiasisthickened gallbladder walldistended gallbladderpericholecysticfluid.

  27. a radionuclide HIDA scan is used to determine if the cystic dust is obstructed. • HIDA with nonvisualized gallbladder or decreased ejection fraction (<30%) • is highly associated with cholecystitis

  28. Complications • 1 biliary colic • 2 empyema of gallbladder • 3 mucocele • 4 perforation In bile ducts • 1biliary obstruction • 2acute cholangitis • 3 acute pancreatitis In the intestine • 1 Intestinal obstruction(gall stone ileus)

  29. Why early diagnosis important

  30. Chronic Cholecystitis • Patients with chronic cholecystitis usually complain of mild, intermittent right • upper quadrant pain or epigastric pain. This may be clinically indistinguishable from biliary colic, • Often complain of intolerance to fatty food

  31. Chr cholecystitis with cholesterol stones.The gallbladder wall is thickened and gray-white, owing to fibrosis and inflammation. The mucosa is effaced. Multiple facetedcholesterol gallstones are present within the lumen. The exterior of the specimen is black as a result of India ink application.

  32. ??????????????????????

More Related