Acute cholecystitis

Indar, A. A

doi:10.1136/bmj.325.7365.639

Cited by 227 publications

(186 citation statements)

References 23 publications

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“…Diagnozo akutnega holecistitisa postavimo na osnovi simptomov in kliničnih znakov pri bolnikih z bolečino v desnem zgornjem kvadrantu trebuha pod desnim rebrnim lokom (DRL) (16). Akutni holecistitis ločimo od biliarnih kolik na podlagi stalno prisotne boleči-ne pod DRL in pozitivnega Murphyevega znaka (ob pritisku v predel pod DRL ob globokem vdihu izzovemo bolečnino v tem predelu).…”

Section: Klinična Slika In Diagnosticiranjeunclassified

“…Akutni holecistitis ločimo od biliarnih kolik na podlagi stalno prisotne boleči-ne pod DRL in pozitivnega Murphyevega znaka (ob pritisku v predel pod DRL ob globokem vdihu izzovemo bolečnino v tem predelu). Bolnik z akutnim holecistitisom ima lahko v anamnezi že napade biliarnih kolik ali pa je bil doslej brez težav (16). V laboratorijskih izvidih ugotavljamo pri bolnikih z izraženim Tabela 1: razdelitev akutnega holecistitisa v skladu z japonskimi smernicami (angl.…”

Section: Klinična Slika In Diagnosticiranjeunclassified

“…6. trombocitopenija (< 100.000/mm3). strokoVni čLanek akutnim holecistitisom povišane vnetne kazalce (levkocitoza, povišan C-reaktivni protein, CRP), medtem ko so pri bolnikih z napadom biliarnih kolik vnetni kazalci praviloma v mejah normalnih vrednosti (3,4,16). Od slikovnih preiskav pride v prvi vrsti v poštev ultrazvočni pregled (UZ) trebuha.…”

Section: Klinična Slika In Diagnosticiranjeunclassified

“…Novejša priporočila svetujejo poskus zgodnje laparoskopske holecistektomije pri vseh bolnikih z akutnim holecistitisom, če so sposobni za operacijo, in če ni minilo od pričetka težav več ko 72-96 ur (16). Pri teh bolnikih so opazovali manj zapletov, krajšo ležalno dobo v bolnišnici in manj preklopov v klasič-no operacijo kot pri bolnikih, ki so bili operirani odloženo (intervalna holecistektomija) (16).…”

Section: Izsledki Kliničnih šTudij In Metaanalizunclassified

“…Pri teh bolnikih so opazovali manj zapletov, krajšo ležalno dobo v bolnišnici in manj preklopov v klasič-no operacijo kot pri bolnikih, ki so bili operirani odloženo (intervalna holecistektomija) (16). Pri zgodnji operaciji (znotraj 72 ur od pričetka simptomov) imamo manj preklopov v klasično operacijo kot po odloženi operaciji, ki se je lotimo po nekaj dneh neuspešnega konzervativnega zdravljenja.…”

Section: Izsledki Kliničnih šTudij In Metaanalizunclassified

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Akutno vnetje žolčnika – zgodnja operacija ali poskus konzervativnega zdravljenja?

Janež¹

2018

SlovMedJour

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IzvlečekAkutno vnetje žolčnika oziroma akutni holecistitis je pogosta bolezen, ki večkrat zahteva sprejem v bolnišnico in kirurško zdravljenje. Najpogosteje se pojavlja pri ljudeh, ki imajo žolčne kamne, pojavi pa se lahko tudi v odsotnosti žolčnih kamnov. Diagnozo akutnega holecistitisa postavimo na osnovi klinične slike, laboratorijskih izvidov in ultrazvoka trebuha. Algoritmi za bolnike, ki imajo akutno vnetje žolčnika brez pridruženih bolezni, so znani; odločitev za kirurški poseg pri bolnikih s pridruženimi boleznimi pa je odvisna od več dejavnikov. Laparoskopska holecistektomija je metoda izbire zdravljenja bolnikov z akutnim holecistitisom. Rezultati zdravljenja so bistveno boljši, kadar kirurški poseg napravimo znotraj 72 ur od nastopa kliničnih znakov.V prispevku so predstavljena najnovejša priporočila za obravnavo bolnikov z akutnim holecistitisom, povzeta po smernicah iz Tokia ter smernicah Svetovnega združenja za urgentno kirurgijo iz leta 2016 ter na koncu še izsledki in izkušnje nekaterih kliničnih študij in metaanaliz. AbstractAcute cholecystitis is a common disease, which often requires admission to hospital and surgical treatment. Acute cholecystitis is defined as inflammation of the gallbladder and usually occurs due to cystic duct obstruction from stones or sludge. It is a relatively common complication of gallstones, but it can also occur without gallstones. A combination of relevant clinical symptoms and ultrasound evidence is required to make a diagnosis of acute cholecystitis. Early surgery is recommended for all patients that are in good physical condition. There is still a debate how to treat high-risk and critically ill patients. Laparoscopic cholecystectomy is the method of choice for treatment of patients with acute cholecystitis. Early laparoscopic cholecystectomy should be done within 72 hours from the onset of symptoms. This article presents current guidelines according to the Tokyo guidelines and the World Society of Emergency Surgery guidelines, and at the end, experiences of some clinical trials. UvodAkutno vnetje žolčnika oziroma akutni holecistitis je pogosto bolezen, ki velikokrat zahteva bolnišnično zdravljenje in operacijo. Najpogosteje se pojavlja pri ljudeh z žolčnimi kamni, lahko pa tudi brez njih (1). Vnetje žolčnika brez prisotnosti kamnov je pogostejše pri kritično bolnih, ki so dlje časa na parenteralni prehrani, pri politravmatiziranih bolnikih, pri večjih opeklinah in pri bolnikih po srčnih operacijah (2). Akutni holecistitis je še posebej pogost vzrok

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Section: Klinična Slika In Diagnosticiranjeunclassified

Section: Izsledki Kliničnih šTudij In Metaanalizunclassified

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Akutno vnetje žolčnika – zgodnja operacija ali poskus konzervativnega zdravljenja?

Janež¹

2018

SlovMedJour

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Risk Factors for Acute Cholecystitis and a Complicated Clinical Course in Patients With Symptomatic Cholelithiasis

Cho

Han²,

Yoon³

et al. 2010

Arch Surg

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Acute Cholecystitis

Gallaher

Charles

2022

JAMA

212

125

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cute cholecystitis is an acute inflammatory disease of the gallbladder that is caused by gallstone obstruction of the cystic duct in approximately 90% to 95% of people diagnosed with this condition. 1 Less commonly, acalculous cholecystitis, in which acute inflammation of the gallbladder develops without gallstones, is present in approximately 5% to 10% of people diagnosed with acute cholecystitis.Gallbladder disease affects approximately 20 million individuals in the US and results in estimated direct annual costs of more than $6.3 billion, with more than 200 000 people diagnosed with acute cholecystitis each year. [2][3][4] Of the 10% to 15% of adults in the US general population with cholelithiasis, approximately 80% are asymptomatic. 5 Twenty percent of patients with gallstones will eventually develop gallstone-related complications at an incidence rate of 1% to 4% annually, with calculous acute cholecystitis as the first clinical presentation in 10% to 15% of all patients with gallstones. 6 In contrast, the etiology of acalculous acute cholecystitis, defined as an acute inflammatory disease of the gallbladder in the absence of cholelithiasis, is multifactorial. Factors associated with acalculous acute cholecystitis include critical illness, diabetes, HIV infection, atherosclerosis, and total parenteral nutrition. 7,8 Acalculous acute cholecystitis is present in approximately 5% to 10% of patients presenting with acute cholecystitis. Acalculous IMPORTANCE Gallbladder disease affects approximately 20 million people in the US. Acute cholecystitis is diagnosed in approximately 200 000 people in the US each year.OBSERVATIONS Gallstone-associated cystic duct obstruction is responsible for 90% to 95% of the cases of acute cholecystitis. Approximately 5% to 10% of patients with acute cholecystitis have acalculous cholecystitis, defined as acute inflammation of the gallbladder without gallstones, typically in the setting of severe critical illness. The typical presentation of acute cholecystitis consists of acute right upper quadrant pain, fever, and nausea that may be associated with eating and physical examination findings of right upper quadrant tenderness. Ultrasonography of the right upper quadrant has a sensitivity of approximately 81% and a specificity of approximately 83% for the diagnosis of acute cholecystitis. When an ultrasound result does not provide a definitive diagnosis, hepatobiliary scintigraphy (a nuclear medicine study that includes the intravenous injection of a radiotracer excreted in the bile) is the gold standard diagnostic test. Following diagnosis, early (performed within 1-3 days) vs late (performed after 3 days) laparoscopic cholecystectomy is associated with improved patient outcomes, including fewer composite postoperative complications (11.8% for early vs 34.4% for late), a shorter length of hospital stay (5.4 days vs 10.0 days), and lower hospital costs. During pregnancy, early laparoscopic cholecystectomy, compared with delayed operative management, is associated with a lower risk of ...

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Acute cholecystitis

Cited by 227 publications

References 23 publications

Akutno vnetje žolčnika – zgodnja operacija ali poskus konzervativnega zdravljenja?

Akutno vnetje žolčnika – zgodnja operacija ali poskus konzervativnega zdravljenja?

Risk Factors for Acute Cholecystitis and a Complicated Clinical Course in Patients With Symptomatic Cholelithiasis

Acute Cholecystitis

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