Acute-Cholecystitis-急性胆囊炎英文版

AcuteCholecystitisDepartmentofGeneralSurgeryTheFirstAffiliatedHospitalofSoochowUniversityZhaoXinAnatomyofBiliaryTractSystemDefinitionofCholecystitisChemicaland(or)bacterialinflammationofthegallbladder.Themostcommongallbladderdisorders.PrognosisgoodwithtreatmentClassificationofCholecystitisAcuteCholecystitisSubacuteCholecystitisChronicCholecystitisCholecystitisClassificationofAcuteCholecystitisTwocategories:1.acutecalculouscholecystitis(ACC)95%2.acuteacalculouscholecystitis(AAC)5%PathophysiologyGallstonesobstructthecysticduct&trapbileinthegallbladdercausingbacterialinfectionandinflammatoryresponseProgressestotissuenecrosisorGallbladderischemia:AcutegangrenouscholecystitisPerforationorRuptureofthegallbladder:PeritonitisComplication:CommonbileductstoneandCholangitisPancreatitisClinicalManifestationSuddenonsetnausea&vomiting(somecasesafterhighfatmeals)ThemostcharacteristicpainBiliarycolic:(1)Severe,colickypainintherightupperquadrantofabdomen.(2)Patientstendtomovearoundtoseekrelieffromthepain,unendurable.(3)Itcanlastforhours.Symptom:ClinicalManifestationPainradiatingtoback,betweenshoulders,orfrontofchestSymptom:ClinicalManifestationSeverecase:Highfeverandchill,indicate:empyemaorperforationofgllbladder;cholangitis;diffusiveperitonitis.Jaundice:10-25%ofallcases.Symptom:ClinicalManifestationSign(ResultsgottenfromPhysicalExaminations)EpigastricorrightupperquadranttendernessguardingreboundtendernessMurphy’ssignaninspiratorypauseonpalpationofthemidpointofrightcoastalmargin.LaboratoryTestLeukocytosisElevatedWBC＞10×109/LSerumBilirubinelevatedPancreaticStudies:AmylaseelevatedImagingexamUltrasoundScanisTheFirstChoiceEnlargementofthegallbladderGallbladderwallthickness3mmPericholecysticfluidorabscessGallstonesImagingexamCTScanEnlargedgallbladderThickenedgallbladderwallGallstonesDiagnosisHistoryTypicalclinicalmanifestationLaboratorytestImagingexamEstablishDiagnosis!TreatmentNonsurgicaltreatmentformilddiseasesPaincontrolAntispasmodics&analgesicstodeceasepainManageinfectionAntibioticsMaintainfluid&electrolytebalanceTreatmentSurgeryOpenAbdominalCholecystectomyIndicationsforsurgery1.Invalidationofnonsurgicaltreatment2.gangrene,perforation,pancreatitis,orcholangitisMethod:1.Removesgallbladder,cysticduct2.LigateVein&arteryDonebywayofendoscopy&useslaserorcauterytoremovethegallbladder.Advantages:LessinvasivewithreducedinfectionNoscarLesspainMorerapidrecoveryTreatmentSurgeryLaparoscopicCholecystectomyIfyouhaveanyquestion,pleasesendE-mailtome:[e-mail]:1.BaileyandLove’sShortPracticeofSurgery,24thedition.RCGRussell,etal.1293-1297.2.CurrentSurgicalDiagnosisandTreatment,11thedition.LawrenceW.Way,etal.351-353.QuestionsforyoutoconsiderafterclassHowtoestablishthediagnosisofacutecholecystitis?CanyousaysomeadvantagesanddisadvantagesbetweenCholecystectomyandLaparoscopicCholecystectomy?Thankyouforyourattention!