### 날짜 : 2024-02-13 20:32 ### 주제 : #medicine #간담췌 #internalmedicine ---- Cholecystitis is an inflammation of the gallbladder, often caused by gallstones blocking the cystic duct. It can lead to severe pain and complications if left untreated. To better understand cholecystitis, let's discuss it through academic knowledge and a hypothetical example case. ### Academic Background **Pathophysiology:** Cholecystitis is typically caused by the obstruction of the cystic duct, usually due to gallstones (cholelithiasis). This obstruction leads to bile accumulation in the gallbladder, increased pressure, and inflammation. In some cases, the inflammation can be due to other causes such as tumors, infections, or even prolonged fasting. **Types:** - **Acute Cholecystitis:** Rapid onset of gallbladder inflammation, characterized by severe pain in the upper right abdomen. It can be complicated by infection, perforation, or gangrene of the gallbladder. - **Chronic Cholecystitis:** Long-standing inflammation, usually due to repeated episodes of acute cholecystitis, leading to a thickened gallbladder wall and decreased function. **Symptoms:** Classic symptoms include right upper quadrant abdominal pain, fever, nausea, vomiting, and tenderness on palpation of the gallbladder area (Murphy's sign). The pain may radiate to the right shoulder or back. **Diagnosis:** Diagnosis is typically based on clinical presentation, laboratory tests (e.g., white blood cell count, liver function tests), and imaging studies. Ultrasound is the preferred initial imaging modality, showing gallstones, gallbladder wall thickening, and pericholecystic fluid. CT scan and HIDA (hepatobiliary iminodiacetic acid) scan are other diagnostic tools. **Treatment:** Management depends on the severity and type of cholecystitis. Acute cases often require hospitalization, intravenous antibiotics, pain management, and sometimes emergency surgery (cholecystectomy). Chronic cholecystitis usually necessitates elective cholecystectomy. ### Example Case **Patient:** A 45-year-old female presents to the emergency department with a 6-hour history of severe right upper quadrant abdominal pain that started after eating a fatty meal. The pain is sharp, continuous, and radiates to her back. She also reports nausea but no vomiting. **Clinical Findings:** On examination, her temperature is 38.2°C (100.8°F), and her right upper abdomen is tender with a positive Murphy's sign. Her white blood cell count is elevated. **Imaging:** An abdominal ultrasound reveals multiple gallstones, a thickened gallbladder wall, and pericholecystic fluid, consistent with acute cholecystitis. **Management:** The patient is admitted to the hospital for intravenous antibiotics and fluids. After initial conservative management, she undergoes a laparoscopic cholecystectomy once the inflammation subsides. Pathology confirms acute cholecystitis with cholelithiasis. ### Discussion Points - **Decision for Surgery:** The decision between immediate surgery and initial conservative treatment depends on the patient's clinical condition, the presence of complications, and surgical risk assessment. - **Antibiotic Therapy:** Antibiotics are chosen based on the likely infecting organisms and local antibiotic resistance patterns. - **Postoperative Care:** Focuses on pain management, early mobilization, and monitoring for complications. This case exemplifies how clinical presentation, diagnostic imaging, and laboratory tests are integrated to diagnose and manage cholecystitis. Surgical intervention, specifically cholecystectomy, is often necessary to prevent recurrent episodes and complications.