ACUTE CHOLECYSTITIS

 

 

Essentials of Diagnosis :-
-Constant, severe pain and tenderness in right hypo- chondrium or epigastrium.
-Nausea, vomiting, fever, chills.
-Jaundice.
-Leucocytosis.
-Positive Murphy’s sign.
-Plain X-ray shows gallstones in 15 per cent cases.
Treatment:- 

-Rest in bed.
-Nothing to be taken orally.
-IV fluids 5 per cent Dextrose/ringer solution.

• Patient develops peritonitis.
• Failure of medical treatment for 48 hours.
Operative

-Analgesics/sedatives like Fortwin 30 mg slow IV or IM or Phenargan (Morphine is contraindicated as it causes spasm of sphincter of oddi).
-Antibiotics are needed.
Injection Ampicillin 500 mg, 6 hourly IV or IM and injection Gentamycin 60 mg 12 hourly IV or IM
and injection Metrogyl 100 mg 8 hourly IV
-Injection B complex 2 ml IM or IV on alternate day
-Once acute attack subsides allow fat free liquid diet
and later on fat free soft diet may be taken.
Surgery is indicated if
If conservative treatment fails to bring relief or the pain, tenderness and systemic sysmptoms are aggravated indicating perforation/gangrene-immediate chole- cystectomy is advised. Elective cholecystectomy is per- formed in those who respond to conservative treatment.

 

DrAmit kumar
Medical officer

Bangalore

 

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