新疆醫(yī)科大學(xué)研究生復(fù)試英語急性膽囊炎

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