f Post graduate mcqs and discussion : CHRONIC CHOLECYSTITIS

Monday, April 2

CHRONIC CHOLECYSTITIS

 It is chronically inflamed, thickened gallbladder, which is nonfunctioning and nondistending.

Fig: CHRONIC CHOLECYSTITIS
Causes

Gallstones.
Cholecystoses.
Chronic acalculous cholecystitis.

Pathology

Gallbladder is shrunken, contracted, small, non-functioning and fi brotic with thickened gallbladder wall.

Mucosa prolifer￾ates into the lumen creating deep clefts in the wall projecting into the muscular wall of the gallbladder being lined by epithe￾lium. It is called as Rokitansky-Ashchoff’s sinuses.

Muscular wall is atrophied and is often replaced by
fibrous tissue.

Histologically it shows dense chronic inflammation with fibrous tissue.



Clinical Features


Pain in right hypochondrium, may be colicky, or persistent.

Positive Murphy’s sign, where in sitting position during deep inspiration, while palpating in right hypochondrium, patient winces with pain at the summit of the inspiration.

Same sign elicited in lying down position is called as Moynihan’s sign. It may also be elicited in acute—on chronic cholecystitis.

Flatulent dyspepsia.

Intolerance to fatty meals.

Biliary dyspepsia.



Complications

CBD stone.
Cholangitis.
Pancreatitis.
Mirizzi’s syndrome.


Differential Diagnosis

Peptic ulcer.
Pancreatitis.
Hiatus hernia.


Investigations

Ultrasound of abdomen may show stone with posterior acoustic shadowing. Gallbladder wall will be thickened.

Isotope study may help to confirm the infection.

 Liver Functions Test .

Total count may be raised if there is an acute recurrent infection.



Treatment

Cholecystectomy (Laparoscopic or open method).