EXPLAINING OF ACALCULAR CHOLECYSTITIS

EXPLAINING OF ACALCULAR CHOLECYSTITIS

Acalcular or non calcular cholecystitis

Definition
It is mean acute or chronic inflammation of the gall bladder due to other causes rather than gall stones

  Acalculous cholecystitis typically develops in critically ill patient in the intensive care unit

gall bladder anatomy

 Risk factors are

• Patients on parenteral nutrition with severe burns
• sepsis
•  major operations
• multiple trauma
• prolonged illness with multiple organ system failure 

    The cause is unknown, but gall bladder distention with bile stasis and ischemia have been implicated as causative factors

Pathologic examination of the gallbladder

reveals edema of the serosa and muscular layers, with patchy thrombosis of arterioles and venules

Other causes of non calcular cholecystitis

Bacterial infection Typhoid gall bladder Salmonella typhi can infected the gall bladder leading to acute or chronic cholecystitis Biliary dyskinesia which due to achalasia or dilatation of the sphincter of Oddi leading to marked dilatation of the fall bladder The cholecystoses which include the following conditions Cholesterosis or called also Strawberry gall bladder this is due to an error in cholesterol metabolism which causes deposition of cholesterol crystals in the mucosa of the gall bladder which become red and studded with yellow specks of cholesterol esters giving strawberry appearance later on forming lipoid polpi called cholesterol polyposis of the gall bladder and ending in cholesterol stone formation Cholecystic Glandularis Proliferans which include a varieties of conditions affecting the gall bladder by polps adenomyomatosis intramural or diverticular stones which can be complicated by an intra or extra mural abscess and fistua form

المصدر : http://best-medical-surgical.blogspot.com/2014/01/chronic-cholecystitis-causes-treatment.html#.UtjP-85b7XQ
Content Copyrighted to Hobby to Money

Bacterial infection Typhoid gall bladder Salmonella typhi can infected the gall bladder leading to acute or chronic cholecystitis Biliary dyskinesia which due to achalasia or dilatation of the sphincter of Oddi leading to marked dilatation of the fall bladder The cholecystoses which include the following conditions Cholesterosis or called also Strawberry gall bladder this is due to an error in cholesterol metabolism which causes deposition of cholesterol crystals in the mucosa of the gall bladder which become red and studded with yellow specks of cholesterol esters giving strawberry appearance later on forming lipoid polpi called cholesterol polyposis of the gall bladder and ending in cholesterol stone formation Cholecystic Glandularis Proliferans which include a varieties of conditions affecting the gall bladder by polps adenomyomatosis intramural or diverticular stones which can be complicated by an intra or extra mural abscess and fistua form

المصدر : http://best-medical-surgical.blogspot.com/2014/01/chronic-cholecystitis-causes-treatment.html#.UtjP-85b7XQ
Content Copyrighted to Hobby to Money

Bacterial infection Typhoid gall bladder Salmonella typhi can infected the gall bladder leading to acute or chronic cholecystitis Biliary dyskinesia which due to achalasia or dilatation of the sphincter of Oddi leading to marked dilatation of the fall bladder The cholecystoses which include the following conditions Cholesterosis or called also Strawberry gall bladder this is due to an error in cholesterol metabolism which causes deposition of cholesterol crystals in the mucosa of the gall bladder which become red and studded with yellow specks of cholesterol esters giving strawberry appearance later on forming lipoid polpi called cholesterol polyposis of the gall bladder and ending in cholesterol stone formation Cholecystic Glandularis Proliferans which include a varieties of conditions affecting the gall bladder by polps adenomyomatosis intramural or diverticular stones which can be complicated by an intra or extra mural abscess and fistua form

المصدر : http://best-medical-surgical.blogspot.com/2014/01/chronic-cholecystitis-causes-treatment.html#.UtjP-85b7XQ
Content Copyrighted to Hobby to Money

Bacterial infection Typhoid gall bladder Salmonella typhi can infected the gall bladder leading to acute or chronic cholecystitis Biliary dyskinesia which due to achalasia or dilatation of the sphincter of Oddi leading to marked dilatation of the fall bladder The cholecystoses which include the following conditions Cholesterosis or called also Strawberry gall bladder this is due to an error in cholesterol metabolism which causes deposition of cholesterol crystals in the mucosa of the gall bladder which become red and studded with yellow specks of cholesterol esters giving strawberry appearance later on forming lipoid polpi called cholesterol polyposis of the gall bladder and ending in cholesterol stone formation Cholecystic Glandularis Proliferans which include a varieties of conditions affecting the gall bladder by polps adenomyomatosis intramural or diverticular stones which can be complicated by an intra or extra mural abscess and fistua form

المصدر : http://best-medical-surgical.blogspot.com/2014/01/chronic-cholecystitis-causes-treatment.html#.UtjP-85b7XQ
Content Copyrighted to Hobby to Money

Bacterial infection Typhoid gall bladder Salmonella typhi can infected the gall bladder leading to acute or chronic cholecystitis Biliary dyskinesia which due to achalasia or dilatation of the sphincter of Oddi leading to marked dilatation of the fall bladder The cholecystoses which include the following conditions Cholesterosis or called also Strawberry gall bladder this is due to an error in cholesterol metabolism which causes deposition of cholesterol crystals in the mucosa of the gall bladder which become red and studded with yellow specks of cholesterol esters giving strawberry appearance later on forming lipoid polpi called cholesterol polyposis of the gall bladder and ending in cholesterol stone formation Cholecystic Glandularis Proliferans which include a varieties of conditions affecting the gall bladder by polps adenomyomatosis intramural or diverticular stones which can be complicated by an intra or extra mural abscess and fistua form

المصدر : http://best-medical-surgical.blogspot.com/2014/01/chronic-cholecystitis-causes-treatment.html#.UtjP-85b7XQ
Content Copyrighted to Hobby to Money

• Bacterial infection Typhoid gall bladder Salmonella typhi can infected the gall bladder leading to acute or chronic cholecystitis 
• Biliary dyskinesia which due to achalasia or dilatation of the sphincter of Oddi leading to marked dilatation of the fall bladder
• The cholecystoses which include the following conditions
• Cholesterosis or called also Strawberry gall bladder this is due to an error in cholesterol metabolism which causes deposition of cholesterol crystals in the mucosa of the gall bladder which become red and studded with yellow specks of cholesterol esters giving strawberry appearance  later on forming lipoid polpi called cholesterol polyposis of the gall bladder and ending in cholesterol stone formation
• Cholecystic Glandularis Proliferans which include a varieties of conditions affecting the gall bladder by polyps adenomyomatosis intramural or diverticular stones which can be complicated by an intra or extra mural abscess and fistula formation

symptoms and signs

•   The symptoms and signs depend on the condition of the patient
•   in the alert patient they are similar to acute calcular cholecystitis see here
• with right upper quadrant pain and tenderness, fever
•    in full blood count reveal leukocytosis 
•  In the sedated or unconscious patient the clinical features are often masked
•    presence of fever and elevated white blood cell count, as well as elevation of alkaline phosphatase and bilirubin are indications for further investigation

Investigations

Abdominal ultrasonography

Ultrasonography is usually the diagnostic test of choice

as it can be done bedside in the intensive care unit

 It can demonstrate the distended gallbladder with thickened wall, biliary sludge, peri­cholecystic fluid, and the presence or absence of abscess formation

Abdominal CT

 

 Abdominal CT scan is as sensitive as ultrasonography and additionally allows imaging of the abdominal cavity and chest

HIDA scan

A HIDA scan will not visualize the gallbladder

MRI scanning

 

 very good for diagnosis

Cholecystokinin cholecystogtaphy
 

To diagnosis acalculous cholecystitis and biliary dyskinesia

Oral cholecystography

  But rare used nowadays and it is replaced by ultrasound

Treatment

Acalculous cholecystitis quires urgent intervention

 Percutaneous ultrasound or CT-guided cholecystostomy is the treatment of choice for these patients they are usually unfit for surgery 

   percutaneous cholecystostomy is both diagnostic and therapeutic

 

 About 90% of patients will improve with the percutaneous cholecystostomy

 if they do not improve

  open cholecystostomy or cholecystectomy, may required

 If needed, cholecytectomy is performed after the patient
has recovered from the underlying disease

You can see also

• Gallbladder anatomy
• Biliary duct anatomy including the common bile duct common hepatic duct and its branches and cystic duct anatomy
• Diagnosis or investigations of biliary channels
• Gallbladder function
• Gallbladder stones causes types diagnosis and treatment
• Acute cholecystitis causes types diagnosis and treatment
• Chronic cholecystitis causes types diagnosis and treatment
• Acaclular or non calcular cholecystitis causes diagnosis and treatment
• Ascending cholangitis causes diagnosis and treatment
• Sclerosing cholangitis  types causes diagnosis and treatment
•    Gallbladder cancer causes diagnosis and treatment
• Bile duct cancer or cholangiocarcinoma causes diagnosis and treatment
• Bile duct cysts or choledochal cysts causes types diagnosis and treatment
• Bile ducts injury or strictures causes types diagnosis and treatment
• Problems after gall bladder removal or postcholecystectomy complications

tags:acalcular,explaining,cholecystitis