Acalculus cholecystitis

Aclaculus choelcystitis

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Q)  True about acalculous cholecystitis is:

a) Mortality more than that of calculus cholecystitis

b) GB rupture chances are more

c) Immediate cholecystectomy is the treatment of choice

d) Only A & B are correct

 A12) d

The disease  process  is  generally  more  fulminant  than  that  of  calculous cholecystitis  and  may  progress  to  gangrene  and  perforation  of  the gallbladder.

Treatment  of  acalculous  cholecystitis  is  similar  to  that  of  calculous  cholecystitis,  with  cholecystectomy  being  therapeutic. Given  the  substantial  inflammation  and  high  risk  of  gallbladder gangrene,  an  open  procedure  is  generally  preferred.

However, many  of  these  patients  are  critically  ill  and  would  not  tolerate  the physiologic  insult  of  a  laparotomy,  explaining  why  the  mortality rate  of  cholecystectomy  for  acalculous  cholecystitis  is  up  to  40%. Accordingly,  percutaneous  drainage  of  the  distended  and  inflamed gallbladder  is  carried  out  in  patients  unable  to  tolerate  a  laparotomy.

Approximately  90% of  patients  will  improve  with  percutaneous  drainage,  and  the  tube  can  eventually  be  removed.  If  follow-up  imaging  continues to  demonstrate  no  stones,  interval  cholecystectomy  is  generally unnecessary.

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Causes of Acalculus Cholecystitis

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Q) Which of the following is not a cause of acalculus cholecystitis? Questions on bile duct

a) Kinking of the neck of gall bladder

b) Acalculus cholecystitis Sphincter spasm

c) Thrombosis of cystic artery

d) Over eating

Ans d

Acalculus cholecystitis can be both acute and chronic in the absence of stones. Although it can present acutely, acalculous cholecystitis typically presents more insidiously.

Mostly the acute form is recognized and chronic form is called biliary dyskinesia.

The cause of acalculus cholecystitis are

  1. Kinking or fibrosis of neck of gall bladder.
  2. Thrombosis of cystic artery
  3. Sphincter of Oddi spasm
  4. Prolonged fasting
  5. Dehydration
  6. Sepsis
  7. Systemic diseases MODS

Ref: By Jarrell - NMS Surgery (National Medical Series for Independent) (Sixth Edition) (2015-07-30) [Paperback]

Jaundice in acalculus cholecystitis  is known to occur because of ischemia and inflammation cystic duct gets obstructed due to edema

Diagnosis

Chronic acalculus cholecystitis is a cholescintigraphy nuclear scan (HIDA) with the administration of cholecystokinin (CCK). After the . A calculated ejection fraction of 35% or less may be indicative of hypokinetic functioning of the gallbladder. An ultrasound of the gallbladder may also be useful. If this shows a thickened gallbladder wall of over 3.5 mm, this may be due to cholecystitis.

Acute acalculus cholecystitis - USG CT or HIDA

 

BEST BOOKSMCQ practise 

MRCS Part A: Essential Revision Notes: Book 1

MRCS Part A: Essential Revision Notes: Book 2

 

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