Identify complications of Acute cholecystitis, state the investigations dome to confirm acute cholecystitis, outline management of acute cholecystitis?

Complications of acute cholecystitis include:

1. Gangrenous cholecystitis: This occurs when the gallbladder becomes necrotic due to lack of blood supply, leading to tissue death.

2. Empyema: This is the accumulation of pus within the gallbladder.

3. Perforation: This is when the gallbladder ruptures, leading to leakage of bile and potentially causing peritonitis.

4. Biliary obstruction: In severe cases, inflammation of the gallbladder can lead to obstruction of the bile ducts.

Investigations done to confirm acute cholecystitis include:

1. Blood tests: Elevated white blood cell count and markers of inflammation such as C-reactive protein.

2. Ultrasound: This imaging test can show signs of inflammation in the gallbladder, such as thickening of the gallbladder wall and presence of gallstones.

3. CT scan: This may be done to further evaluate the extent of inflammation and to look for complications such as perforation or abscess formation.

Management of acute cholecystitis typically involves:

1. Pain management: Painkillers such as NSAIDs or opioids may be prescribed to relieve pain.

2. Antibiotics: Antibiotics are usually given to treat the infection and prevent complications.

3. Fluids and electrolyte replacement: IV fluids may be given to prevent dehydration and maintain electrolyte balance.

4. Cholecystectomy: Surgical removal of the gallbladder is usually recommended to prevent recurrence of acute cholecystitis and its complications. This can be done either laparoscopically or through open surgery, depending on the severity of the condition.

5. Drainage: In cases of severe inflammation or complications such as abscess formation, drainage of the gallbladder may be necessary.

Overall, prompt diagnosis and treatment of acute cholecystitis are essential to prevent complications and improve outcomes.

Complications of Acute Cholecystitis

- Empyema
- Gangrene
- Perforation
- Fistula formation (cholecystenteric)
- Cholangitis
- Pancreatitis

Confirmation of Acute Cholecystitis

Investigations:

- Ultrasound: Most sensitive and specific test, showing gallstones and gallbladder wall thickening
- Cholescintigraphy (HIDA scan): Functional test demonstrating gallbladder filling and emptying
- CT scan: May be used for confirmation or to rule out other conditions (e.g., pancreatitis)

Management of Acute Cholecystitis

Initial Management:

- Pain control: Analgesics, opioids
- Hydration: Intravenous fluids
- Antibiotics: Broad-spectrum antibiotics to cover Gram-negative and anaerobic bacteria
- Diet: Clear liquid diet
- Cholecystectomy: Definitive treatment, usually performed laparoscopically

Definitive Management:

- Laparoscopic cholecystectomy: Minimally invasive surgery to remove the gallbladder
- Open cholecystectomy: Open abdominal surgery, reserved for cases where laparoscopic surgery is not feasible

Other Management Considerations:

- Endoscopic retrograde cholangiopancreatography (ERCP): May be necessary to remove common bile duct stones or stents
- Percutaneous cholecystostomy: Placement of a drain into the gallbladder to drain bile or pus
- Interval cholecystectomy: Surgery performed after the acute inflammation has resolved, typically within 6-8 weeks