Тақырыбы: Acute cholecystitis
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COЖ СД21 АНГЛ
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- ТАҚЫРЫБЫ: Acute cholecystitis Made by
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ҚАЗАҚСТАН РЕСПУБЛИКАСЫ БІЛІМ ЖӘНЕ ҒЫЛЫМ МИНИСТРЛІГІ ҚАЗАҚСТАН РЕСПУБЛИКАСЫ ДЕНСАУЛЫҚ САҚТАУ МИНИСТРЛІГІ БАТЫС ҚАЗАҚСТАН ЖОҒАРЫ МЕДИЦИНАЛЫҚ КОЛЛЕДЖІ СӨЖ ТАҚЫРЫБЫ: Acute cholecystitis Made by:Murat Zh. Mynzhasarova D. Ruslanova A. Samenova A. Saraeva A. Serik A. Turegeldieva A. Shaihieva A. Group: Mi-21 Checed by: Gabdullina G.S. Acute cholecystitis is the most common complication of cholelithiasis. Conversely, ≥ 95% of patients with acute cholecystitis have cholelithiasis. When a stone becomes impacted in the cystic duct and persistently obstructs it, acute inflammation results. Bile stasis triggers release of inflammatory enzymes (eg, phospholipase A, which converts lecithin to lysolecithin, which then may mediate inflammation). The damaged mucosa secretes more fluid into the gallbladder lumen than it absorbs. The resulting distention further releases inflammatory mediators (eg, prostaglandins), worsening mucosal damage and causing ischemia, all of which perpetuate inflammation. Bacterial infection can supervene. The vicious circle of fluid secretion and inflammation, when unchecked, leads to necrosis and perforation. If acute inflammation resolves then continues to recur, the gallbladder becomes fibrotic and contracted and does not concentrate bile or empty normally—features of chronic cholecystitis. Acute acalculous cholecystitis Acalculous cholecystitis is cholecystitis without stones. It accounts for 5 to 10% of cholecystectomies done for acute cholecystitis. Risk factors include the following: Critical illness (eg, major surgery, burns, sepsis, or trauma) Prolonged fasting or TPN (both predispose to bile stasis) Shock Immune deficiency Vasculitis (eg, SLE, polyarteritisnodosa) The mechanism probably involves inflammatory mediators released because of ischemia, infection, or bile stasis. Sometimes an infecting organism can be identified (eg, Salmonella sp or cytomegalovirus in immunodeficient patients). In young children, acute acalculous cholecystitis tends to follow a febrile illness without an identifiable infecting organism. Symptoms and Signs Most patients have had prior attacks of biliary colic or acute cholecystitis. The pain of cholecystitis is similar in quality and location to biliary colic but lasts longer (ie, > 6 h) and is more severe. Vomiting is common, as is right subcostal tenderness. Within a few hours, the Murphy sign (deep inspiration exacerbates the pain during palpation of the right upper quadrant and halts inspiration) develops along with involuntary guarding of upper abdominal muscles on the right side. Fever, usually low grade, is common. In the elderly, the first or only symptoms may be systemic and nonspecific (eg, anorexia, vomiting, malaise, weakness, fever). Sometimes fever does not develop. Acute cholecystitis begins to subside in 2 to 3 days and resolves within 1 wk in 85% of patients even without treatment.
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