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GALLSTONE PANCREATITIS and GALLSTONE ILEUS

GALLSTONE PANCREATITIS and ILEUS

ACALCULOUS CHOLECYSTITIS

 

  1. acute or chronic cholecystitis in the absence of stones
  2. usually diabetic, immunosuppressed or post-op

Etiology

  1. dehydration
  2. systemic disease (e.g. MOSF-Multi-Organ System Failure)
  3. generalized sepsis
  4. kinking or fibrosis of the gallbladder
  5. thrombosis of the cystic artery
  6. sphincter spasm with obstruction of the biliary and
  7. pancreatic ducts
  8. prolonged fasting
  9. collagen vascular disease

 

Treatment : cholecystectomy or cholecystostomy


GALLSTONE PANCREATITIS

 

  1. Mechanism: gallstone impacted in common pancreatic duct
  2. Signs and symptoms : epigastric, back pain

 

Diagnostic investigation

 

  1. high amylase, lipase
  2. high liver enzymes
  3. most cases mild Ranson's criteria
  4. U/S may show multiple stones (may have passed spontaneously), edematous pancreas
  5. CT if severe to evaluate for complications

 

Treatment

  1. supportive
  2. cholecystectomy during same admission after acute attack subsided

 


GALLSTONE ILEUS

 

  1. mechanism - cholecystoenteric fistula (usually duodenal) with large gallstone impacting most commonly at the ileocecal valve not an ileus, but a true partial or complete small bowel obstruction

 

Clinical presentation

 

  1. crampy abdominal pain, nausea, vomiting

 

Diagnostic investigation

 

  1. 3 views abdomen shows dilated small intestine, gallstone in RLQ and air in biliary tree (15%)
  2. upper GI if unclear

Treatment

  1. hydrate, operate to remove stone; (enterotomy) usually don't have to remove gallbladder (30% cholecystectomy)
  2. only if chronic symptoms
  3. fistula usually closes spontaneously

 

Mortality 10-15%

GALLSTONE PANCREATITIS and GALLSTONE ILEUS GALLSTONE PANCREATITIS and GALLSTONE ILEUS Reviewed by Radiology Madeeasy on September 02, 2010 Rating: 5
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