Acute cholecystitis

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  • 1.Acute cholecystitis Dr/ Hytham Nafady

2. Etiology 3. U/S Stones (echogenic with back shadow). Stone impacted in cystic duct. Sludge. Gall bladder distension Mural thickening > 3 mm. Mural haziness (poor definition). Mural striations (3 layered appearance with sonolucent middle layer due to edema). Peri-cholecystic fluid collection. Sonographic Murphys sign. 4. Stones Stone at fundus Obstructing stone at gall bladder neck 5. Sludge 6. Mural thickening 7. Duplex Hypervascularity of the gall bladder wall 8. CT 1. Stones. 2. Gallbladder distension (> 5 cm in transverse diameter). 3. Mural thickening. 4. Mural hyper-enhancement. 5. Peri-cholecystic fluid collection. 6. Peri-cholecystic inflammatory fat stranding. 7. Enhancement of the adjacent liver parenchyma due to reactive hyperaemia. 9. Reactive hyperemia of the adjacent liver parenchyma 10. MRCP Impacted stone at the gall bladder neck or cystic duct. The stone appears as a filling defect of signal void withing the high signal intensity bile. 11. HIDA scan Non visualized gall bladder after 60 minutes. Causes of false positive HIDA scan: Total parentral nutrition (fasting). Sphincerotomy. Sever liver disease. 12. Dilated cardiomyopathy with hepatic congestion & gall bladder wall thickening 13. Gall bladder mural thickening in a patient with pancreatitis 14. Complication Definition Signs Emphysematous cholecystitis Acute cholecystitis, with secondary infection of the gall bladder wall. Intramural or intraluminal air. Hemorrhagic cholecystitis Acute cholecystitis, with intraluminal hemorrhage. Intraluminal hemorrhage. Gangrenous cholecystitis Acute cholecystitis, with ishemia & necrosis of the gall bladder wall. Mucosal defects. Sloughed membrane. Gall bladder perforation Acute. Acute peritonitis. Subacute. Pericholecystic abscess. Chronic. Internal biliary fistula. Vascular complications Cystic artery pseudo- aneurysm. Portal vein thrombosis. 15. Gangrenous cholecystitis 16. Sloughed membrane Sludge 17. stone Hemorrhagic cholecystitis 18. Hemorrhagic cholecystitis 19. Emphysematous cholecystitis 20. U/S Sagittal sonogram shows a curvilinear echogenic interface in the gallbladder fossa with reverberation artifact 21. Supine view 22. Upright view CT 23. Gall bladder perforation 24. Subacute perforation (contained peforation) Pericholecystic abscess defect 25. Subacute perforation (contained peforation) Pericholecystic abscess defect 26. Cholecysto-enteric fistula BL = dilated loops of proximal small intestine 27. Gall stone ileus 28. Cholecystoenteric fistula & gall stone ileus 29. Cholecysto-duodenal fistula 30. Bouveret syndrome duodenal obstruction by a gall stone 31. Cystic artery pseudo-aneurysm 32. Portal vein thrombosis 33. DD of Rt upper quadrant pain Acute cholecystitis. Acute pancreatitis. Hepatitis. Acute right pyelonephritis. Perforated duoedenal ulcer.