Acute cholecystitis

Cholelithiasis, cholecystitis, acute appendicitis, pancreatitis, and malignancy occur rarely... 

Contraindications The following contraindications should be observed acute cholecystitis, acute cholangitis, obstruction of the cystic duct and common bile duct as well as frequent biliary colic. 

Amylase enters the blood largely via the lymphatics. An increase in hydrostatic pressure in the pancreatic ducts leads to a fairly prompt rise in the amylase concentration of the blood. Neither an increase in volume flow of pancreatic juice nor stimulation of pancreatic enzyme production will cause an increase in senm enzyme concentration. Elevation of intraductal pressure is the important determinant. Stimulation of flow in the face of obstruction can, however, augment the entry of amylase into the blood, as can disruption of acinar cells and ducts. A functional pancreas must be present for the serum amylase to rise. Serum amylase determination is indicated in acute pancreatitis in patients with acute abdominal pain where the clinical findings are not typical of other diseases such as appendicitis, cholecystitis, peptic ulcer, vascular disease or intestinal obstruction. In acute pancreatitis, the serum amylase starts to rise within a few hours simultaneously with the onset of symptoms and remains elevated for 2 to 3 days after which it returns to normal. The peak level is reached within 24 hours. Absence of increase in serum amylase in first 24 hours after the onset of symptoms is evidence against a diagnosis of acute pancreatitis (76). 

Various conditions such as perforated peptic ulcer, cholecystitis, common bile duct and intestinal obstruction, trauma to the abdomen inducing pancreatitis and ruptured ectopic pregnancy may cause an elevated serum amylase but the levels are usually not as high as those found in acute pancreatitis. Mumps and bacterial parotitis, which block the secretion of salivary amylase are associated with mild elevations of serum amylase. 

Hepatobiliary disease occurs due to bile duct obstruction from abnormal bile composition and flow. Hepatomegaly, splenomegaly, and cholecystitis may be present. Hepatic steatosis may also be present due to effects of malnutrition. The progression from cholestasis (impaired bile flow) to portal fibrosis and to focal and multilobar cirrhosis, esophageal varices, and portal hypertension takes several years. Many patients are compensated and asymptomatic but maybe susceptible to acute decompensation in the event of extrinsic hepatic insult from viruses, medications, or other factors.7... 

Cholelithiasis, biliary sludge, acute and chronic cholecystitis, and cholestasis (can be progressive and life-threatening)... 

Acute cholecystitis First-generation cephalosporin Aminoglycoside plus ampicillin if severe infection... 

Some surgeons use presumptive antibiotics for cases of acute cholecystitis or cholangitis and defer surgery until the patient is afebrile, in an attempt to decrease infection rates further, but this practice is controversial. 

Cholecystectomy Enteric gram-negative bacilli, anaerobes Cefazolin 1 g x 1 for high-risk patients Laparoscopic None High-risk patients only (acute cholecystitis, common duct stones, previous biliary surgeiy, jaundice, age >60 years, obesity, diabetes mellitus) IA... 

Acute cholecystitis management has been based conservatively on antibiotic treatment plus relief of pain before planned open cholecystectomy. However, it has become increasingly evident that early laparoscopic cholecystectomy is safe and shortens hospital stay. 

Gurusamy KS, Samraj K. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Cochrane Database Syst Rev 2006. 

Age > 60, acute cholecystitis, prior biliary tract surgery, common duct stones, jaundice, or diabetes mellitus. 

Fire-toxin, as a pathological product as well as a pathogenic factor, can accumulate in the intestines. Fire-toxin should be eliminated as soon as possible, especially before long-term accumulation and when the blood is not strongly disturbed, in order to prevent further development of disease, such as in chronic mild infections of the intestines, or at the primary stage of acute appendicitis, acute pancreatitis, acute cholecystitis, hepatitis and ulcer perforation and inflammation. 

When downward-draining formulas are used to treat acute abdominal syndromes, such as acute intestinal obstruction, appendicitis, cholecystitis and pancreatitis, it is also important to remember that these herbs are only suitable for certain periods in the whole pathological process of the disease, or certain types of disorder. These formulas should only be prescribed by doctors after modern medical examination. 

Acute and chronic gastroenteritis, hyperchlorhydria, prolapsed stomach, dilatation of the stomach, peptic and duodenal ulcers, stress-related belching and vomiting, irritable bowel syndrome, allergies, hepatitis, cholecystitis, and the side effects of some medicines. 

Adverse reactions. Erythromycin is remarkably nontoxic, but the estolate can cause cholestatic hepatitis with abdominal pain and fever which may be confused with viral hepatitis, acute cholecystitis or acute pancreatitis. This is probably an allergy, and recovery is usual but the estolate should not be given to a patient with liver disease. Other allergies are rare. Gastrointestinal disturbances occur frequently (up to 28%), particularly diarrhoea and nausea, but, with the antibacterial spectrum being narrower than with tetracycline, opportunistic infection is less troublesome. 

Acute cholecystitis (exact visualization of the gall bladder excludes acute cholecystitis)... 

Ozaras, R., Mert, A., Yilmaz, M.H., Celik, A.D., Tabak, F., Bilir, M., Ozturk, R. Acute viral cholecystitis due to hepatitis A virus infection, (case report) J. Clin. Gastroenterol. 2003 37 79-81... 

Acute and chronic cholecystitis has been reported after floxuridine hepatic artery infusion (3). Chemotherapy in this patient was associated with persistent epigastric pain with radiation to the back which was not accompanied by any fever or white blood cell elevation. Cholecystectomy showed a shrunken, thickened fibrotic gallbladder that was filled with thick, pasty, hemorrhagic material. There were no gallstones. 

Embolization of the cystic artery can cause acute acalcu-lous cholecystitis (SEDA-15, 505). 

Studies of the relation between diuretic use and cholecystitis have yielded conflicting results. A significant association of thiazide use with acute cholecystitis was reported in a case-control study (18). However, others examined the association between the use of thiazides and cholecystectomy and failed to show a relation between the use of thiazides and gallstone disease, except possibly in women who are not overweight (19). 

Figure 13-5 Dynamic study of the liver and biliary system with a gamma camera. This is a normal study after injection of Tc-99m mebrofenin, with each image a 3-min-ute time exposure. The study was done on a patient with suspected acute cholecystitis (a blockage of the dun to the gallbladder) If the patient had acute cholecystitis, the radiotracer would not have entered the gallbladder. The arrow in frame 16 shows the normal location of the gallbladder.

The primsu7 clinical indication for this study is poscystic duct leading to the gallbladder. The galIblaU i is not visualized becau.se the radiotracer cannot cnlu < Some other clinical conditions that can be diagnosed byh... 

Biliary tract diseases, such as cholecystitis, cause up to fourfold elevations of the serum AMY activity as a result of either primary or secondary pancreatic involvement. Various intraabdominal events can lead to a significant increase in serum AMY activities up to a fourfold elevation and sometimes beyond. Such increases may be due to leakage of the P-AMY from the intestine into the peritoneal cavity and then into the circulation. Peritonitis and acute appendicitis have been reported to produce a slight elevation (up to twofold and threefold) of serum AMY activity. Serum AMY is normal in most patients with ectopic pregnancies, but increases have been seen in advanced cases of ruptured ectopic pregnancy. 

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