Acute Cholecystitis - Overview (signs and symptoms, pathophysiology, treatment)

in this video we're going to talk about acute chitis this is an overview and introduction so acute cistitis is inflammation of the gallbladder um and it's usually because of obstruction of the cystic duct by G Stones acute cystitis is the most common complication of chasis which is formation of G stones in the gallbladder just to be clear col lithiasis is formation of stones in the galbladder which can lead to a few complications one of which is acute kystis the other terminology colido lithiasis is formation of stones G stones in the common bod duct but we will not focus on that here in this video we will mainly focus on acute colitis but really we will also talk about um every other comp application and hopefully we can get our head around it together so here is a guy with right upper quadrant pain of the abdomen let's look at the normal anatomy of the upper git partly so here is the galbladder now the gallbladder is an organ that stores what's called bile and bile is a mixture of cholesterol and other pigments the bile is important in in digesting fatty foods the bile is actually produced by the liver and gallbladder just stores the excess bile so back to the anatomy here is the galbladder the body the neck and the fundus of the gallbladder this is the cystic duct coming out from the gallbladder and connects to the common hepatic duct which arise from the liver the joining of the cystic duct and common hepatic ducts forms the common bile duct which runs all the way down and joins with the pancreatic duct from the pancreas before moving to the pancreas the stomach actually continues on to the small intestine here transporting the half digested food content the first part of the small intestine is the duodenum then the duodenum goes on to the judum which is the second part here is the pancreatic duct I was talking about and here is part of the pancreas and essentially the gold bladder will contract and release bile or the liver will release bile which will go down and end up in the common bile duct the common bile duct runs all the way down and joins with the pancreatic duct from the pancre the newly formed duct will then release um these this bile and the enzymes from the pancreas into the duodenum through the ampula of V to help digest food in acute colitis a gal Stone which was formed in the gallbladder gets stuck in the cystic duct now a lot of us actually have G stones in our gallbladders but they don't cause any problem s we are asymptomatic sometimes people get unlucky and the g Stones get stuck either temporarily or for some time there are many types of G stones but we won't talk about that here just think of G Stones as a mixture of cholesterol and other pigments within B so when the G Stones get stuck in the cystic duck the gallbladder will try to contract and push it out without any success and this obstruction results in inflammation to the galbladder and this is acute kystis acute kystis shares similar features to two other conditions called bolic and colangitis but these three conditions do differ we won't talk about them now but they but they differ in the pain having fever or increased white cell count and finally jaundice which is yellowing of the skin so what are actually these conditions well bolic is where there is only temporary obstruction of the G stone at the neck of the gallbladder so it can go in and out acute chitis as we mentioned is the gall stone stuck at the cystic duct causing inflammation of the gallbladder and colangitis is a complication of G Stones where infection develops in the common bile duct and this is life-threatening so the signs and symptoms of acute Chic statis specifically are fever nausea vomiting right upper quadrant pain pain which may radiate at radiate to the right side the back on examination there is a positive Murphy sign Murphy sign is where a hand is placed at the mid inferior border of the liver the patient is then asked to take a deep breath in the diaphragm lowers during inspiration and with our hand being placed where it is it will irritate the gallbladder as the diaphragm pushes the galbladder down and this will trigger pain the patient becomes startled and stop breathing in so going back to the small table we made the differences in the three condition bolic acute colitis and colangitis is that bolic only presents with right upper quadrant pain typically acute colitis right quadrant pain with fever and raised white cell count and finally colangitis presents with right upper quadrant pain fever increased white cell count and jaundice yellowing of the skin these three findings make up what's called shos Triad complication of colitis is a tumor of the core bladder chronic chitis mucose seal where mucus is secreted into the gallbladder empa where which is pass in the gallbladder thanks to infection by the bacteria there is Merit syndrome and Merit syndrome is basically when the G Stone in the cystic duct actually impacts or obstructs the hepatic duct and obstruction of the hepatic duct means that the bile being produced by the liver will go backwards will backf flow and cause what's known as obstructive jaundice other complications include perforation of the galbladder galbladder duodenal fistula allow which allows large gstes to pass through causing G stone ilas at the terminal ilium G Stones can trigger colangitis from kolasis or chasis when it obstructs the common B duct G Stones can cause pancreas itis if it obstructs the passage of contents from the pancreas into the duodenum finally obstruction at the common bile duct or above can cause backflow of bile to the liver the bile back flow can lead to obstructive jundas on this side note there's something called kavasia law and kavasia law essentially says that the presence of enlarged gallbladder with jaundice is unlikely due to G Stones rather carcinoma of the head of the pancreas investigations that can be performed with a person suspected of biler tree problems include full blood count which may show raised white cell counts amas lipase to check for pancreatitis CRP eu's and lfts and lfts are important because there will be abnormal lfts with a problem that occurs in the B tree system ultrasound is Diagnostic and can detect G stones and is used to elicit Murphy sign 2 abdominal x-ray can only pick up 10% of G Stones another Imaging technique is the hia scan which is a contrast scan that lights up the biler tree if the biler tree doesn't light up fully there there can be an obstruction the management of acute kystis is surgery again people can have G Stones normally and if there are and if they are asymptomatic there is no reason to remove the gal bladder unless they have risks factors for future complications surgery is done for symptomatic people or people with recurrent Goldstone disease the management of acute kostis before surgery is knil by mouth fluids and IV antibiotics pain relief with analgesia surgery can be done laparoscopically or open laparoscopic cystectomy is done over open cystectomy in laparoscopic Chic sectomy there are a few ports or holes in the abdomen that can be made these include the surgeon Point under the Z the zy sternum the Hassen camera Point assistant point and the accessory Point let us look inside the abdomen from a inferior view the abdominal cavity is pumped with air carbon dioxide and this makes the surgeon work easier as it creates space so here is the liver the galbladder here is the laparoscopic light that views the area from the Hassen camera point and the two assistant ports as examples of how things are assessed in the area so I'm not a surgeon but this hopefully will give you an understanding of Chis sectomy in general firstly what happens is that they want to expose the gallbladder because the galbladder and the digestive organs are surrounded by the visceral peritoneum when the gallbladder is exposed the cystic artery is clipped and the cystic duct is clipped and then incisions are made in between the clips this is in order to prevent spillage of contests within the duct once the incisions are made the galbladder can be safely removed the cystic duct is clipped and so doesn't bleed out and the cystic duct remember was clipped and so it doesn't spill anything as well when the gallbladder is removed everything is put under the visceral perenium once again it's stitched up and the surgery is done however sometimes an open colly sectomy is needed this is especially if there are complications from the gall stones or complications during laparoscopic surgery in the first place an open colis ectomy is quicker but is much more invasive