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home - Biliary - Gallstone Disease - Acalculous Cholecystitis Written by Dr Sebastian Zeki
Knowledge


Knows the physiology and biochemistry of bile and the pathogenesis
of gallstones

Is familiar with the normal anatomy and the anatomical variations of
the biliary tree

Recognises the symptoms and signs of the potential complications of
galllstone disease including biliary colic acute cholecystitis jaundice
due to calculous bile duct obstruction cholangitis and carcinoma

Knows the various techniques of diagnostic imaging including
ultrasound CT MRI ERCP EUS radionuclide techniques

Knows the various treatment options the indications for operative and
non-operative management and the risks of each

Knows the current national guidelines for use of ERCP and the risks
of the technique

Knows the ways in which gallbladder polyps are diagnosed and
managed

Knows that gallbladder and sphincter of Oddi dysfunction (SOD) may
account for otherwise unexplained abdominal pain

Recognises different types of SOD how they may present and how
they are investigated

Skills
Can select the most appropriate diagnostic and therapeutic
techniques for each clinical situation

Recognises possibility of diagnostic uncertainty in biliary dysmotility
and shows thoughtful judgement in each individual situation

Behaviours
Makes appropriate assessment stratifies urgency and plans
management of patients who have complications of gallstones

Acalculous Cholecystitis

Written by Dr Sebastian Zeki Treatment A)— Antibiotics: for secondary infection with enteric pathogens.B)----Cholecystectomy. Both open and laparoscopic cholecystectomy have been used. The gallbladder is often encased in an inflammatory mass, which makes the laparoscopic approach more complicated because of a higher risk of bile ductular and vascular injuries. Percutaneous cholecystostomy if very ill. C) Cholecystotomy- Complications include: Hepatic bleeding, Dislodgement of the catheter, Mortality related to peritonitis. Subsequent cholecystectomy often unnesecessary if patient fully recovers D)--Transpapillary endoscopic drainage of the gallbladder- rarely done. These are uncommon findings in calculous cholecystitis. Physical examination Lab results:Leukocytosis occurs in 70 to 85 %.Cholestatic LFTs - these are more common in acalculous than calculous cholecystitis. DiagnosisUSS shows no gallstones, but acute cholecystitis features are seen. Clinical Manifestation:Unexplained fever, leukocytosis, or vague abdominal discomfort.A palpable right upper quadrant mass.Partial biliary duct obstruction (inflammatory) causing jaundice in 20%. CausesMultiple risk factors are present in the majority of patients with acalculous cholecystitis. ComplicationsThere is a high risk of perforation and gangrene.Complications a remore common in the elderly with high WCC. PathophysiologyGallbladder stasis and ischaemia occurs.Stasis results in the concentration of bile salts and eventually necrosis of the gallblad-der tissue. Acalculous cholecystitis

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