CHOLECYSTITIS.pptx

cholecystitis

1. CHOLECYSTITIS

2. DEFINITION Inflammation of gall bladder

3. PATHOPHYSIOLOGY When Gallstones Form Most gallbladder problems are caused by gallstones.   These form when substances in the bile crystallize and become solid.  In some cases, the stones don't cause any symptoms.  In others, they irritate the wall of the gallbladder.  Most serious problems occur if the stones move into nearby ducts and cause blockages. 

4. CHOLECYSTITIS obstruction of the neck of the gallbladder or cystic duct caused by stones impacted in Hartmann's pouch Direct pressure of the calculus on the mucosa ischemia, necrosis, and ulceration with swelling, edema, and impairment of venous return. increase and extend the intensity of the inflammation.

5. RISK FACTORS Obesity Women Frequent changes in weight Rapid weight loss Treatment with high dose estrogen Cystic fibrosis Diabetes mellitus

6. CLINICAL MANIFESTATIONS Pain & biliary colic felt in the right hypochondrium and often radiates through the back close to tip of the right scapula Changes in urine & stool colour Vitamin deficiency

7. DIAGNOSIS General appearance The patient is distressed by pain and lies quietly. Shallow breathing. Tachycardia and pyrexia … Jaundice may be present and the patient may be sweating.

8. Inspection Zackary Cope’s sign Palapation Murphy’s sign Empyema Boa’s sign

9. Percussion Guarding Auscultation Infracted or ruptured gallbladder and caused billiary peritonitis absent bowel sound.

10. Investigation LFT U/S : it is the most diagnostic and it shows wall thickening, pericholecystic fluid, CBD evaluation . C/T : Sensitivity for gallstones = 55-65% . Cholangiography Mapping of the bile ducts by instilling contrast into the biliary tree : ERCP MRCP PTC CBC : shows infection by an elevated white blood cell count .

11. MEDICAL MANAGEMENT Nutritional & supportive therapy Pharmacologic therapy

12. SURGICAL MANAGEMENT A- Laparoscopic cholecystectomy : early (w/in 2 days after onset of symptoms) B- Elective cholecystectomy : Delayed (6-8 wks to allow “cool off” of GB) give him antibiotics and after 6 weeks we do it .

13. Advantage of laparoscopy : 1- less post-operation pain . 2- short hospital stay . 3- rapid return to activity and work . 4- less post-operation adhesion .

14. NURSING MANAGEMENT Relieving pain Improving respiratory status Promoting skin care & biliary drainage Improving nutritional status Monitoring and managing potential compications