A Clinical Study on Diagnosis, Clinicopathological Correlation and Management of Acute Cholecystitis at K.A.P.V Government Medical College and Annal Gandhi Memorial Government Hospital, Trichy

Mohandhas, G (2010) A Clinical Study on Diagnosis, Clinicopathological Correlation and Management of Acute Cholecystitis at K.A.P.V Government Medical College and Annal Gandhi Memorial Government Hospital, Trichy. Masters thesis, K.A.P. Viswanatham Government Medical College, Tiruchirappalli.

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Abstract

INTRODUCTION: Acute cholecystitis is the most common complication of gallstone disease, and a frequent cause of abdominal emergency, especially among middle aged women and the elderly. They are mainly classified into two types: 1. Acute calculous cholecystitis, 2. Acute acalculous cholecystitis. Acute Calculous Cholecystitis: Acute inflammation of the gall bladder is associated with cystic duct obstruction, which commonly occur due to impacted gall stone in calculous cholecystitis. The combination of cystic duct occlusion and altered biliary lipid composition appears to initiate a series of events culminating in local release of inflammatory agents and ultimately resulting in acute cholecystitis. Acute Acalculous Cholecystitis: Acute acalculous cholecystitis is a treacherous and potentially lethal disease. It may occur in patients with no known biliary tract disease who are severely compromised by trauma, gastrointestinal dysfunction, prolonged intensive therapy for sepsis, burns or Multi Organ Failure (MOF). They can lead to fatal life threatening complications like empyema, perforation and gangrene of the gall bladder. The approach, diagnostic evaluation and management of acute cholecystitis has come miles away from the older days of elective cholecystectomy to the present day hurricane management like emergency open cholecystectomy ; minimally invasive cholecystectomy and laparoscopic cholecystectomy using space age tools like laser cautery. AIMS AND OBJECTIVES: 1. To study the incidence of acute cholecystitis in different age group in both sexes. 2. To study the different causes of acute cholecystitis. 3. To diagnose acute cholecystitis with the help of clinical features and different modalities of investigations. 4. Management of acute cholecystitis. 5. To study the complications, management of complications and follow up. MATERIALS AND METHODS: 50 cases diagnosed as acute cholecystitis were entered into the study by any one or more of the following methods form Govt. K.A.P. Vishwanatham Medical College and Hospital, Trichirappalli June 2008 to Oct 2009. CLINICAL FEATURES: 1. Right upper quadrant pain similar to biliary colic in onset and character but persists beyond 4-6 hrs. 2. Associated anorexia, nausea and vomiting. 3. Low grade fever. 4. Localised right upper quadrant tenderness. 5. MURPHY'S SIGN positive. 6. Presence of inflammatory mass in right upper quadrant. 7. BOAS'S SIGN POSITIVE - Hyperaesthesia in the right posterior 9-11 * intercostal space. SUMMARY AND CONCLUSIONS: 50 cases of acute cholecystitis were studied. Their agewise and sex incidence in the A.G.M. Government Hospital Tiruchirapalli was studied. The different causes of acute cholecystitis were evaluated. The different modalities of diagnosis and investigations were scrutinised. Various ways of management of acute cholecystitis were studied. The incidence of complications were observed. The following is the conclusion of the study. Age Distribution: 1. Maximum incidence of acute cholecystitis occurred in 45 - 50 age group. 2. Gallstone incidence was maximum in the middle age group 45-50 yrs. (28%) 3. No paediatric case of acute cholecystitis was found. Sex Distribution: 1. Maximum incidence of acute cholecystitis occurred in the female population of 56%. 2. Multiparous women were more prone for acute cholecystitis. Calculous or Acalculous Cholecystitis: 1. Acute calculous cholecystitis was the commonest type with incidence of 84%. 2. Acalculous cholecystitis was found to be 16%. 3. There was no predisposing factors of acute acalculoous cholecystitis demonstrated in our study. DIAGNOSIS: 1. Diagnosis was made by clinical suspicion of signs or symptoms. 2. Ultrasonographh was positive in all the patients and correlated with pathological conclusion of acute cholecystitis. MANAGEMENT: Cholecystectomy: 1. 12% of the patient underwant emergency cholecystectomy with no mortality. 2. Early cholecystectomy was done in 54% with no mortality and morbidity significantly less and providing to be superior mode of management. 3. Our study had no Laparoscopic cholecystotomy. Cholecystostomy: 1. 2% of (he patients underwent cholecystostomy because their general condition did not permit cholecystectomy. Bile Culture and Would Infection: 1. Bile culture was positive in 40% of the patients. 2. Wound infection rate was more in the bile culture positive group 10%. 3. Wound infection was less in the patients who had no organisms cultured from bile - 8%. Drains: All the patients who underwent open cholecystectomy were put on a drain in the sub - hepatic space for 3 - 4 days. No increase in the morbidity or infection was attributed only to the use of drain. Drainage is still under individual preference.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Acute Cholecystitis ; Clinical Study ; Diagnosis ; Clinicopathological Correlation and Management ; K.A.P.V Government Medical College ; Annal Gandhi Memorial Government Hospital ; Trichy.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 03 May 2018 03:30
Last Modified: 03 May 2018 09:49
URI: http://repository-tnmgrmu.ac.in/id/eprint/7407

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