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Acute cholecystitis

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Acute cholecystitis

  1. 1. Acute cholecystitis Dr/ Hytham Nafady
  2. 2. Etiology
  3. 3. U/S • Stones (echogenic with back shadow). • Stone impacted in cystic duct. • Sludge. • Gall bladder distension • Mural thickening > 3 mm. • Mural haziness (poor definition). • Mural striations (3 layered appearance with sonolucent middle layer due to edema). • Peri-cholecystic fluid collection. • Sonographic Murphy’s sign.
  4. 4. Stones Stone at fundus Obstructing stone at gall bladder neck
  5. 5. Sludge
  6. 6. Mural thickening
  7. 7. Duplex Hypervascularity of the gall bladder wall
  8. 8. CT 1. Stones. 2. Gallbladder distension (> 5 cm in transverse diameter). 3. Mural thickening. 4. Mural hyper-enhancement. 5. Peri-cholecystic fluid collection. 6. Peri-cholecystic inflammatory fat stranding. 7. Enhancement of the adjacent liver parenchyma due to reactive hyperaemia.
  9. 9. Reactive hyperemia of the adjacent liver parenchyma
  10. 10. MRCP • Impacted stone at the gall bladder neck or cystic duct. • The stone appears as a filling defect of signal void withing the high signal intensity bile.
  11. 11. HIDA scan • Non visualized gall bladder after 60 minutes. Causes of false positive HIDA scan: Total parentral nutrition (fasting). Sphincerotomy. Sever liver disease.
  12. 12. Dilated cardiomyopathy with hepatic congestion & gall bladder wall thickening
  13. 13. Gall bladder mural thickening in a patient with pancreatitis
  14. 14. Complication Definition Signs Emphysematous cholecystitis Acute cholecystitis, with secondary infection of the gall bladder wall. Intramural or intraluminal air. Hemorrhagic cholecystitis Acute cholecystitis, with intraluminal hemorrhage. Intraluminal hemorrhage. Gangrenous cholecystitis Acute cholecystitis, with ishemia & necrosis of the gall bladder wall. Mucosal defects. Sloughed membrane. Gall bladder perforation Acute. Acute peritonitis. Subacute. Pericholecystic abscess. Chronic. Internal biliary fistula. Vascular complications Cystic artery pseudo- aneurysm. Portal vein thrombosis.
  15. 15. Gangrenous cholecystitis
  16. 16. Sloughed membrane Sludge
  17. 17. stone Hemorrhagic cholecystitis
  18. 18. Hemorrhagic cholecystitis
  19. 19. Emphysematous cholecystitis
  20. 20. U/S • Sagittal sonogram shows a curvilinear echogenic interface in the gallbladder fossa with reverberation artifact
  21. 21. Supine view
  22. 22. Upright view CT
  23. 23. Gall bladder perforation
  24. 24. Subacute perforation (contained peforation) Pericholecystic abscess defect
  25. 25. Subacute perforation (contained peforation) Pericholecystic abscess defect
  26. 26. Cholecysto-enteric fistula BL = dilated loops of proximal small intestine
  27. 27. Gall stone ileus
  28. 28. Cholecystoenteric fistula & gall stone ileus
  29. 29. Cholecysto-duodenal fistula
  30. 30. Bouveret syndrome duodenal obstruction by a gall stone
  31. 31. Cystic artery pseudo-aneurysm
  32. 32. Portal vein thrombosis
  33. 33. DD of Rt upper quadrant pain • Acute cholecystitis. • Acute pancreatitis. • Hepatitis. • Acute right pyelonephritis. • Perforated duoedenal ulcer.

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