版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领
文档简介
Cholecystitis
Cholecystitisisinflammationofthegallbladderwall,usuallyresultingfromagallstoneobstructingthecysticduct.
Acutecholecystitisisthesuddenonsetofinflammationofthegallbladder,resultinginsevere,steadyupperabdominalpain(biliarycolic),whichmayoccurrepeatedly.Chroniccholecystitisislong-standinginflammationofthegallbladdercharacterizedbyrepeatedattacksofpain(gallbladderattacks)overaprolongedperiod.
Atleast95%ofpeoplewithacutecholecystitishavegallstones.Theinflammationalmostalwaysbeginswithoutinfection,althoughinfectionmayfollowlater.Rarely,acutecholecystitisoccursinapersonwithoutgallstones(acalculouscholecystitis).Acalculouscholecystitisisaseriousdisease.Ittendstooccuraftermajorinjuries,operations,burns,bodywideinfections(sepsis),andcriticalillnesses—particularlyinpeoplereceivingprolongedintravenousfeedings.Itcanoccurinyoungchildrenaswell,perhapsoriginatingasaninfection(viralorother).
Inchroniccholecystitis,thegallbladderisdamagedbyrepeatedattacksofacuteinflammation,usuallyfromgallstones,andmaybecomethick-walled,scarred,andsmall.Thegallbladdergenerallycontainssludgeorgallstonesthatoftenobstructitsoutletorthecysticduct.
Symptoms
Agallbladderattack,whetherinacuteorchroniccholecystitis,beginsassevere,steadypain(biliarycolic),usuallyintherightupperpartoftheabdomen.Thepersontypicallyfeelsasharppainwhenadoctorpressesontheupperrightpartoftheabdomen.Thepainmayworsenwhenthepersonbreathesdeeplyandoftenextendstothelowerpartoftherightshoulderblade.Thepainmaybecomeexcruciating;nauseaandvomitingareusual.Thepainusuallylastsmorethan12hours.
Withinafewhours,theabdominalmusclesontherightsidebecomerigid.Feveroccursinaboutonethirdofpeoplebutislesslikelyinolderpeople.Thefevertendstobeslightatfirst,thenrisesgraduallytoabove100°F(38°C).
Typically,anattackofcholecystitissubsidesin2to3daysandcompletelydisappearsinaweek.Iftheattackpersists,itmaysignalaseriouscomplication.Ahighfever,chills,amarkedincreaseinthewhitebloodcellcount,andacessationofthenormalpropulsivemovementsoftheintestine(ileus(seeEmergencies:Ileus)suggestformationofanabscess(apus-filledpocketofinfection),gangrene(deathoftissue),oraperforated(pierced)gallbladder.
Othercomplicationsmayoccur.Agallbladderattackaccompaniedbyjaundice(seeClinicalManifestationsofLiverDisease:Jaundice)andotherevidenceofabackupofbileintotheliver(cholestasis),suchaspassinglight-coloredstools,indicatesthatthecommonbileductisobstructed(usuallypartially)byastone.Ifbloodtestresultsrevealanincreasedlevelofapancreaticenzyme(amylaseorlipase),thepersonmayhaveinflammationofthepancreas(pancreatitis)causedbyastoneobstructingthepancreaticduct.
Inacalculouscholecystitis,typicallythepersonhasnoprevioussymptomsorotherevidenceofgallbladderdiseaseandexperiencessudden,excruciatingpainintheupperabdomen.Usually,thediseaseisverysevereandcanleadtogangreneorruptureofthegallbladder.Ifthepersonhasothersevereproblems(forexample,thepersonisintheintensivecareunit),acalculouscholecystitisatfirstmaybeoverlooked.
Diagnosis
Doctorsdiagnosecholecystitis,bothacuteandchronic,basedontheperson'ssymptomsandtheresultsofteststhatsuggestgallbladderinflammation.Increasedlevelsofwhitebloodcellssuggestinflammationorinfectionorboth.Ultrasoundscansoftenconfirmthepresenceofgallstonesinthegallbladder,whichmayberesponsiblefortheattacks.Ultrasoundscanscanalsoshowthickeningofthegallbladderwall,whichistypicalofchroniccholecystitis.
Cholescintigraphyisanimagingtechniquethatisusefulwhenacutecholecystitisisdifficulttodiagnose.Inthistest,aradioactivetracerisinjectedintravenouslyanditsmovementfromtheliverthroughthebiliarytractisfollowed.Imagesaretakenoftheliver,bileducts,gallbladder,andupperpartofthesmallintestine.Ifthetracerdoesnotfillthegallbladder,itispresumedthatthecysticductisobstructedbyagallstone.
Treatment
Apersonwithacuteorchroniccholecystitiswhoexperiencesagallbladderattackusuallyishospitalized,isgivenfluidsandelectrolytesintravenously,andisnotallowedtoeatordrink.Adoctormaypassatubethroughthenoseandintothestomach,sothatsuctioningcanbeusedtokeepthestomachemptyandreducefluidaccumulatingintheintestines,whichdonotworkproperlybecauseoftheinflammationoftheabdominalcavity.Antibioticsusuallyaregiven.
Inacutecholecystitis,ifthediagnosisiscertainandtheriskofsurgeryissmall,thegallbladderusuallyisremovedduringthefirstdayortwooftheillness.Ifnecessary,gallbladderremovalmaybedelayed;iftheattacksubsides,removalmaywait6weeksormore.Ifacomplicationsuchasanabscess,gangrene,orperforationofthegallbladderissuspected,immediatesurgeryisnecessary.
Inchroniccholecystitis,treatmentgenerallyinvolvessurgicalremovalofthegallbladder,usuallybylaparoscopiccholecystectomy,oncetheacuteepisodesubsides.
Inacalculouscholecystitis,immediatesurgeryisnecessarytoremovethediseasedgallbladder.
Aftergallbladderremovalforcholecystitiswithgallstones,asmallpercentageofpeopledevelopneworrecurringepisodesofpainthatfeellikegallbladderattackseventhoughtheynolongerhaveagallbladder.Thecauseoftheseepisodesisnotknown,butepisodesmayresultfromanabnormalfunctionofthesphincterof
温馨提示
- 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 幼儿大班班级学期工作计划三篇资料
- 2024年中秋节广播稿7篇-1
- 特殊药品使用注意事项课件
- 有关教师爱岗敬业演讲稿集锦10篇
- 市场需求调查报告
- 《三字经》读后感600字作文10篇
- 节约粮食号召倡议书范文7篇
- 外研版英语九年级上册 Module 6 Problems Unit 1同步默写练习(无答案)
- 描写形形色色的人作文600字10篇
- 红与黑读书心得五篇范文
- 质量意识培训测试试题及答案
- 点亮小灯泡说课稿市公开课金奖市赛课一等奖课件
- GB∕T 36943-2018 电动自行车用锂离子蓄电池型号命名与标志要求
- 体育与健康人教版五年级-《少年拳第二套》教学设计
- 新教材大象版四年级下册科学全册期末单元复习课件
- “双减”背景下儿童发展评价的实践探索-以南京师范大学附属小学“乐评嘉年华”实践为例
- 检验异常情况调查处理程序
- Q∕GDW 10250-2021 输变电工程建设安全文明施工规程
- T∕CFA 0203141-2021 绿色铸造设计产品 球墨铸铁管水冷金属型离心机通用技术要求
- (完整版)英国省份对应城市
- 现代检测技术教案
评论
0/150
提交评论