Emphysematous Cholecystitis Symptoms, Causes, Ultrasound, Treatment
Emphysematous cholecystitis is an acute infection of gall bladder. It is also known as clostridial cholecystitis because of its etiology. A specific pathogen named clostridium deficile or Escherichia coli is responsible for causing emphysematous cholecystitis. These are gas forming organisms which are present in the walls of gall bladder. It is a rare and rapid growing form of cholecystitis. It started with the formation of gangrene, which leads to perforation of gall bladder walls. There is only 1 percent chance of emphysematous cholecystitis in every person suffering from acute cholecystitis. Unlike other types of acute cholecystitis, the mortality rate is greater in emphysematous cholecystitis I.e. 15 to 25 percent.
Common symptoms associated with emphysematous cholecystitis involve pain in upper quadrant of right side. Pain is localized and remains in right upper quadrant but sometimes it may radiate towards back side. Physical activity and body position do not affect emphysematous cholecystitis. Fever and generalized abdominal pain are also common symptoms of emphysematous cholecystitis. Patient may feel nausea and vomiting along with abdominal pain. Clinician during diagnosis may find some acute intra abdominal disorders. These intra abdominal disorders also show symptoms like burning sensation in stomach and intense pain.
There are four main factors which are responsible for causing emphysematous cholecystitis. These factors involve compromised vascular gall bladder, cholelithiasis, infection due to gas forming organisms i.e. clostridium deficile and impaired immune system. Cystic artery is responsible for supplying blood in gall bladder. So any kind of hindrance in blood supply may lead to emphysematous cholecystitis. Presence of stones in cystic duct will lead to blockage and results in edema. This edema will lead to compromised vascular system. Any metabolic abnormality as in case of diabetes can cause emphysematous cholecystitis. There is not any cause other than these mentioned above.
There are two main types of treatment strategies i.e. medical or surgical strategy. In medical treatment, broad spectrum antibiotics are used. Drugs having beta lactamase inhibiting activity are preferred. Fluid replacement is done to maintain electrolyte balance. Emphysematous cholecystitis is managed via surgery. It is performed when medications and fluid replacement are of no use anymore. Open laparoscopy or laparoscopic cholecystectomy is performed. But preoperative CT scan and MRI is required. It is the safe and effective surgery ever. In case of stones in bile duct, common bile duct exploration is performed. ERCP by biliary endoscopist is preferred before surgery.
Ultrasound is the common diagnostic process for gall bladder infection specially emphysematous cholecystitis. This diagnostic technique helps in diagnosing emphysematous cholecystitis earlier than any other technique can. It has 90 to 95 percent success rate. Ultrasound will show visual results in three main stages. In 1st stage, gas can be seen in the lumen of gall bladder. This gas will show a band of reflective echoes and reverberations. These reverberations is the sign of presence of cholecystitis. In stage 2, an area in gall bladder will show high reflectivity. This reflectivity will change according to body movement indicating cholecystitis. In 3rd stage, gas in seen in pericholecystic tissues showing perforation.
Emphysematous Cholecystitis Symptoms
Common symptoms associated with emphysematous cholecystitis involve pain in upper quadrant of right side. Pain is localized and remains in right upper quadrant but sometimes it may radiate towards back side. Physical activity and body position do not affect emphysematous cholecystitis. Fever and generalized abdominal pain are also common symptoms of emphysematous cholecystitis. Patient may feel nausea and vomiting along with abdominal pain. Clinician during diagnosis may find some acute intra abdominal disorders. These intra abdominal disorders also show symptoms like burning sensation in stomach and intense pain.
Emphysematous Cholecystitis Causes
There are four main factors which are responsible for causing emphysematous cholecystitis. These factors involve compromised vascular gall bladder, cholelithiasis, infection due to gas forming organisms i.e. clostridium deficile and impaired immune system. Cystic artery is responsible for supplying blood in gall bladder. So any kind of hindrance in blood supply may lead to emphysematous cholecystitis. Presence of stones in cystic duct will lead to blockage and results in edema. This edema will lead to compromised vascular system. Any metabolic abnormality as in case of diabetes can cause emphysematous cholecystitis. There is not any cause other than these mentioned above.
Emphysematous Cholecystitis Treatment
There are two main types of treatment strategies i.e. medical or surgical strategy. In medical treatment, broad spectrum antibiotics are used. Drugs having beta lactamase inhibiting activity are preferred. Fluid replacement is done to maintain electrolyte balance. Emphysematous cholecystitis is managed via surgery. It is performed when medications and fluid replacement are of no use anymore. Open laparoscopy or laparoscopic cholecystectomy is performed. But preoperative CT scan and MRI is required. It is the safe and effective surgery ever. In case of stones in bile duct, common bile duct exploration is performed. ERCP by biliary endoscopist is preferred before surgery.
Emphysematous Cholecystitis Ultrasound
Ultrasound is the common diagnostic process for gall bladder infection specially emphysematous cholecystitis. This diagnostic technique helps in diagnosing emphysematous cholecystitis earlier than any other technique can. It has 90 to 95 percent success rate. Ultrasound will show visual results in three main stages. In 1st stage, gas can be seen in the lumen of gall bladder. This gas will show a band of reflective echoes and reverberations. These reverberations is the sign of presence of cholecystitis. In stage 2, an area in gall bladder will show high reflectivity. This reflectivity will change according to body movement indicating cholecystitis. In 3rd stage, gas in seen in pericholecystic tissues showing perforation.
Emphysematous Cholecystitis Symptoms, Causes, Ultrasound, Treatment
Reviewed by Simon Albert
on
August 01, 2017
Rating:
Reviewed by Simon Albert
on
August 01, 2017
Rating:
