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Pericholecystic Abscess


Presentation

  • Data were retrospectively collected from clinical case notes and a literature review is presented.[ncbi.nlm.nih.gov]
  • Presentation Nausea, vomiting, and epigastric pain. Refers medical care for about 10 days for the same symptoms. Patient Data Age: 66 Gender: Female Loading images...[radiopaedia.org]
  • The Consulting Editor of Radiologic Clinics, Frank Miller, presents a comprehensive review of Adult Body MR.[books.google.com]
  • Yeh Oxford University Press , 2015 - 760 Seiten 0 Rezensionen Gastrointestinal Imaging presents a comprehensive review of gastrointestinal pathologies commonly encountered by practicing radiologists and residents in training.[books.google.com]
  • We herein present our experience of 32 cases of gallbladder perforation that presented to our hospital from January 2012 to November 2014.[synapse.koreamed.org]
Fever
  • Expect fever to resolve in 24 hours and diarrhea within 4-5 days [NEJM 346: 334, 2002].[openanesthesia.org]
  • He was hypotensive and had high fever. On physicalexamination lockalized tenderness in the right upper quadrant was noted. CT-scanrevealed a cholecystitis complicated by an perihepatic abscess with impression onthe gastric wall.[docslide.com.br]
  • Presence of fever and leukocytosis in acute cholecystitis. Ann Emerg Med 1996; 28: 273. PMID: 8780469 Jain A et al. History, physical examination, laboratory testing and emergency department ultrasonography for the diagnosis of acute cholecystitis.[coreem.net]
  • Acalculous cholecystitis may present similiarly, but often present w/ fever and sepsis alone Elderly (esp. elderly w/ DM) may present w/o pain or fever Localized tenderness may not be present or be the only sign May progress to complicated cholecystitis[fprmed.com]
  • Symptoms include vomiting, abdominal bloating, fever, nausea, jaundice, and body chills.[healthresearchfunding.org]
Malaise
  • On the other hand patients may also show weakness, malaise and a palpable right upper quadrant mass, mimicking a malignacy.[wjes.biomedcentral.com]
Abdominal Pain
  • A 75-year-old male was admitted to the hospital because of a sudden onset of right upper abdominal pain after a lunch. Abdominal CT scan findings of the gallbladder performed preoperatively had a strange shape which seemed like a record disk.[jlc.jst.go.jp]
  • Pain Diagnostic Strategies 411 513 Imaging 413 514 Conclusion 429 References 431 Imaging of Acute Intestinal Obstruction 434 523 Diagnosis of Site 437 525 Diagnosis of Complications 446 526 Impact and Diagnostic Strategy 449 References 450 Imaging and[books.google.com]
  • Severe abdominal pain referred to the patient's back, nausea, vomiting, and high serum and urinary amylase values were compatible with acute pancreatitis.[link.springer.com]
  • Specialty General surgery , gastroenterology Symptoms Right upper abdominal pain , nausea, vomiting , fever [1] Duration Short term or long term [2] Causes Gallstones, severe illness [1] [3] Risk factors Birth control pills , pregnancy , family history[en.wikipedia.org]
  • This 60 year old woman presented to the ED with a several-day history of abdominal pain and fever.[svuhradiology.ie]
Left Lower Quadrant Pain
  • Articles will include: Evaluating the patient with right upper quadrant pain; Evaluating the patient with left upper quadrant pain; Evaluating the patient with right lower quadrant pain; Evaluating the patient with left lower quadrant pain; Acute pancreatitis[books.google.com]
Left Upper Quadrant Pain
  • Articles will include: Evaluating the patient with right upper quadrant pain; Evaluating the patient with left upper quadrant pain; Evaluating the patient with right lower quadrant pain; Evaluating the patient with left lower quadrant pain; Acute pancreatitis[books.google.com]
Tachycardia
  • On examination the patient may look septic with systemic signs of infection (pyrexia and tachycardia) and local RUQ peritonism. Murphy's sign is usually positive.[gponline.com]
Murphy's Sign
  • Cholelithiasis, sonographic Murphy sign, and GB wall thickening • CT findings Distended GB (measuring 5 cm in short axis) GB wall thickening ( 3 mm) with mural and mucosal hyperenhancement and pericholecystic fat stranding Calcified gallstones may be[clinicalgate.com]
  • sign, jaundice (15%) Murphy's sign had highest specificity (79-96%) but low sensitivity (20-87.5%) Absence of physical findings does not r/o cholecystitis Elderly and DM may present w/ vague signs, localized tenderness may or may not be present Abd/GI[fprmed.com]
  • A lump may be present in the right upper quadrant and Murphy’s sign may also be elicited. A mild leukocytosis is usually present (12,000 to 14,000 cells/mm3).[ispub.com]
  • ’s sign) Best test for diagnosis of acute cholecystitis ( Jain 2017 ) ( ) LR 15.64 (-) LR 0.40 Fever is poorly sensitive (35%) and nonspecific (80%) ( Towbridge 2003 ) Diagnostic Test Performance in Acute Cholecystitis (The Resus Room) The Resus Room:[coreem.net]
  • sign After 5 hr fast diagnosis -GB wall thicker 6 mm (diffuse or focal) -Enlarged GB with positive Murphy's sign -Diffuse homogeneous non shadowing medium level echo within GB lumen (pus) Hemorrhagic Cholecystitis Rare complication associated with gallstones[quizlet.com]
Biliary Colic
  • Biliary colic Biliary colic occurs when a gallstone impacts in the neck of the gallbladder obstructing the cystic duct. The pain resolves spontaneously as the stone falls back into the gallbladder or passes into the common bile duct (CBD).[gponline.com]
  • Pyelonephritis Presentation History Right upper quadrant (RUQ) pain History of similar, self-limited pain (biliary colic) Nausea/Vomiting Radiation of pain to the tip of the right scapula (referred pain) Physical Examination RUQ/epigastric tenderness[coreem.net]
  • Colic The pain of biliary colic occurs when the gallbladder contracts, forcing a stone and/or sludge against the gallbladder neck or opening of the cystic duct.[ahcmedia.com]
  • colic . [1] Biliary colic is abdominal pain in the right upper quadrant or epigastric region .[en.wikipedia.org]
  • colic Stages of Cholecystitis Stage 1 (edematous): 2-4 days; gallbladder tissue intact w/ edema in subserosal layer, interstitial fluid w/ dilated capillaries and lymphatics Stage 2 (necrotizing): 3-5 days; edematous w/ areas of hemorrhage and necrosis[fprmed.com]
Gallbladder Tenderness
  • In addition, inflammation leads to gallbladder tenderness and spreading inflammation to the diaphragm leads to referred pain over the acromion.[gponline.com]
Encephalopathy
  • 593 7111 Cerebral Sinovenous Thrombosis and Venous Infarction 594 7112 Arterial Infarction 595 Asparaginase Methotrexate and Cyclosporin 596 7116 EndocrineRelated Encephalopathy 597 Thoracic Emergencies 601 723 Clinical Symptoms 602 724 Imaging of Nontraumatic[books.google.com]

Workup

  • The definitive diagnosis can only be made on histological and bacteriological workup.[acgcasereports.gi.org]
  • […] other abdominal structures (can identify an alternative diagnosis), provides preoperative information such as gallbladder size, stone size, gallbladder wall status and the presence of biliary dilatation 19 The addition of a HIDA scan in the diagnostic workup[imagingpathways.health.wa.gov.au]
  • If this is the case, laboratory tests and an ultrasound should be obtained as part of the initial workup. For patients who are ultimately diagnosed with biliary colic, outpatient surgical follow-up should be arranged.[ahcmedia.com]

Treatment

  • This success demonstrates that ultrasonography by a real-time scanner can be effective for diagnosis and treatment of acute cholecystitis and pericholecystic abscess.[ncbi.nlm.nih.gov]
  • 436 Venous Anatomy 375 437 Image Interpretation 378 438 Interpretive Pitfalls 379 439 Potential Benefits of Combined CTPA and CTV 383 4310 Clinical Results 388 Imaging and Treatment of Thoracic Fluid and Gas Collections 391 443 Imaging Guidance Modalities[books.google.com]
  • Because each type of abscess received differing and successful treatments, the authors' method of classification of US findings seemed to provide a useful way to select the specific therapeutic procedure to achieve optimal results.[ncbi.nlm.nih.gov]
  • Study effectively with content that addresses contemporary medical practice emphasizing physics, clinical evaluation, and treatment following The Joint Commission and the Accreditation Council for Graduate Medical Education.[books.google.com]

Prognosis

  • Treatment and prognosis Management options for suppurative cholecystitis include both emergent cholecystectomy and percutaneous catheter drainage, also termed percutaneous cholecystostomy (which can later be followed by a cholecystectomy) 1,5-6 .[radiopaedia.org]
  • […] cultures usually positive for bacteria (50-75% of cases), bacterial proliferation may be d/t cholecystitis and not the precipitating factor Cholecystitis usually presents commonly w/ upper abdominal pain and fever, but cannot r/o even if asymptomatic Prognosis[fprmed.com]
  • Section 4: Prognosis and follow-up Complications following acute cholecystitis The complications of acute cholecystitis should be considered in any patient seeking medical advice following an attack of either cholecystitis or biliary colic.[gponline.com]
  • Delay in the diagnosis always carries bad prognosis.[jemds.com]
  • […] diabetes , liver disease , rapid weight loss [4] Diagnostic method Abdominal ultrasound [5] Differential diagnosis Hepatitis , peptic ulcer disease , pancreatitis , pneumonia , angina [6] Treatment Gallbladder removal surgery , gallbladder drainage [7] [5] Prognosis[en.wikipedia.org]

Etiology

  • […] of all cases of acute cholecystitis Occurs more often in men As opposed to gallbladder disease in general which occurs more often in women Mostly are elderly patients ( 60) with diabetes Vascular compromise of the cystic artery may play a role in the etiology[learningradiology.com]
  • .• The etiology of emphysematous cholecystitis is controversial, but it is considered to be due to ischemia of the gallbladder from primary vascular compromise, with secondary proliferation of gas-producing bacteria . 13. limited• Note:• Wall thickening[slideshare.net]
  • Focal sclerosing cholangitis -Primary liver tumor -Tumor of duct Complications of Gallstones -Porcelain GB -Milk of Calcium Bile -Cholecystitis -95% associated with gallstones -5 times more common in females -11-33% carcinomas have calcification in wall Etiology[quizlet.com]
  • […] sign • Radiography : Insensitive for detection of ectopic gas • MR : Intraluminal and intramural gas appear as signal voids on all pulse sequences PATHOLOGY • Infection of GB with gas-forming organisms such as Clostridium welchii and Escherichia coli • Etiology[radiologykey.com]
  • […] wall perforations covered up by surrounding tissue forming abscesses Biliary fistula: duodenal-gallbladder fistula formation, usually d/t erosion of wall into duodenum by large stone; stone can travel to ileocecal valve and cause SBO (gallstone ileus) Etiology[fprmed.com]

Epidemiology

  • Incidence/Prevalence No large epidemiological study to date, but estimated 10% US pop has gallstones Up to 12% develop acute cholecystitis (most frequent complication of gallstones) after 5-7 yrs Up to 6% develop severe acute cholecystitis Prevalence[fprmed.com]
  • "Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines" . Journal of Hepato-Biliary-Pancreatic Surgery . 14 (1): 15–26. doi : 10.1007/s00534-006-1152-y . ISSN 0944-1166 . PMC 2784509 .[en.wikipedia.org]
  • Contributed by Mr Joe Dawson, specialist registrar in general surgery, Basildon and Thurrock University Hospitals NHS Foundation Trust Section 1: Epidemiology and aetiology Gallstones Acute cholecystitis (inflammation of the gallbladder) is one of the[gponline.com]
  • Epidemiology of and risk factors for gallstones. In: Post TW, ed. UpToDate. Waltham: UpToDate; 2015. Acalovschi M. Gallstones in patients with liver cirrhosis: Incidence, etiology, clinical and therapeutical aspects.[ahcmedia.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Cystic duct obstruction is the proximate cause of cholecystitis Obstruction leads to gallbladder distension An inflammatory reaction occurs due to either mucosal ischemia from increased hydrostatic pressure or cytotoxic effects of bile[coreem.net]
  • This complication occurs in 2-10% of cases of acute cholecystitis. (1) With the increase in cholecystectomies in modern surgical practice, gallbladder perforation is becoming rare with a reported incidence of 0.8%. (2) The pathophysiology leading to perforation[appliedradiology.com]
  • Sleisenger & Fordtran's Gastrointestinal and liver disease pathophysiology, diagnosis, management (9 ed.). [S.l.]: MD Consult. p. 1065. ISBN 9781437727678 . Archived from the original on 2017-09-08.[en.wikipedia.org]
  • Pathophysiology• Emphysematous cholecystitis frequently affects elderly men, and it is usually associated with diabetes mellitus.• The risk of gangrene and perforation of the gallbladder is relatively high for patients with emphysematous cholecystitis[slideshare.net]
  • The exact pathophysiologic mechanism leading to oedema of the gallbladder wall in these diverse conditions is uncertain, but it is likely due to elevated portal venous pressure, elevated systemic venous pressure, decreased intravascular osmotic pressure[radiologyassistant.nl]

Prevention

  • On the contrary, the indications for such intervention are always widening, as its risks become always smaller and the requirements for prevention higher.[books.google.ro]
  • Relapses occur in 25% of cases, but 75% of these will respond to the same antibiotic if repeated [Lancet ID 5: 549, 2005] Prevention of C.difficile Prevention is primarily by rational antibiotic use and possibly the use of probiotics (in one study, 1[openanesthesia.org]
  • The gallbladder neck is usually obstructed by a calculus (or rarely from a malignant mass such as an underlying cholangiocarcinoma ) which prevents pus from draining through the cystic duct 5 .[radiopaedia.org]
  • Elective cholecystectomy may be performed after the improvement of acute illness has been achieved by gallbladder drainage Prevention General healthy lifestyle may reduce risk Cholecystectomy for prevention of recurrency Disposition Patients who have[fprmed.com]
  • Early diagnosis and prompt treatment of pancreatitis or pancreatic abscess is necessary to prevent any associated morbidity or mortality. 1. van Sonnenberg E, Wittich GR, Chon KS, D'Agostino HB, Casola G, Easter D, et al .[ijpmonline.org]

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