Acute cholecystitis - amateurdoctor

[ArchivalUser]

In acute cholecystitis , what is the managment ?

Do we wait to cool off for 4-6 weeks and than cholecystectomy ?

Or I seen some protocols saying that if onset of symptoms less than 72 hours since pain began --> emergent cholecystectomy is treatment of choice. I was suprised that even in emedicine.com : "" Early operation within 72 hours of admission has both medical and socioeconomic benefits and is the preferred approach for patients treated by surgeons with adequate experience in laparoscopic cholecystectomy ""

I had Kaplan question, and there is wait till elective surgery.

What do you think? Please contribute. I would like to clear this up.

Thanks

[ArchivalUser]

My concept from kaplan is the same as you.
.First..Conservative Tm... if response, do elective laparoscopic cholecystectomy.

....if no response within 48hrs, Emergency Cholecystectomy

OR Percutaneous Transhepatic Cholecystostomy in severe case

But, I found something latest..

[ArchivalUser]

Step 3 Pocket

72hrs or less since pain begin...Emergency Cholecystectomy

More than 72 hrs after pain begin,....allow cool off period... Conservative TM first, then cholecystectomy in 4-6 wks.
I think it makes sense. What do u think?

[ArchivalUser]

The same with Wikipedia....

For most patients, in most centres, the definitive treatment is surgical removal of the gallbladder. Supportive measures are instituted in the meantime and to prepare the patient for surgery. These measures include fluid resuscitation and antibiotics.


In cases of severe inflammation, shock, or if the patient has higher risk for general anesthesia (required for cholecystectomy), the managing physician may elect to have an interventional radiologist insert a percutaneous drainage catheter into the gallbladder ('percutaneous cholecystostomy tube') and treat the patient with antibiotics until the acute inflammation resolves. The patient may later warrant ......cholecystectomy if their condition improves.

[ArchivalUser]

I have Pocket medicine too, and was suprised about reading the managment under 72 hours that cholecystectomy is treatment of choice.

And than also in emedicine. I know UW Q bank says also wait. So still not sure

[ArchivalUser]

Hey, what I found in Harrison :


The optimal timing of surgical intervention in
patients with acute cholecystitis depends on stabilization of the patient.
The clear trend is toward earlier surgery, and this is due in part to requirements
for shorter hospital stays. Urgent (emergency) cholecystectomy or
cholecystostomy is probably appropriate in most patients in whom a complication
of acute cholecystitis such as empyema, emphysematous cholecystitis,
or perforation is suspected or confirmed. In uncomplicated cases
of acute cholecystitis, up to 30% of patients fail to resolve their symptoms
on appropriate medical therapy, and progression of the attack or a supervening
complication leads to the performance of early operation (within
24“72 h). The technical complications of surgery are not increased in patients
undergoing early as opposed to delayed cholecystectomy. Delayed
surgical intervention is probably best reserved for (1) patients in whom the
overall medical condition imposes an unacceptable risk for early surgery
and (2) patients in whom the diagnosis of acute cholecystitis is in doubt.
Early cholecystectomy is the treatment of choice for most patients with
acute cholecystitis. Mortality figures for emergency cholecystectomy in
most centers approach 3%, while the mortality risk for elective or early
cholecystectomy ~0.5% in patients under age 60. Of course, the operative
risks increase with age-related diseases of other organ systems and with
the presence of long- or short-term complications of gallbladder disease.
Seriously ill or debilitated patients with cholecystitis may be managed with
cholecystostomy and tube drainage of the gallbladder. Elective cholecystectomy
may then be done at a later date.

[ArchivalUser]

So if patient is stabilized, one can do cholecystectomy , no need to wait 4- 6 weeks, right?

( this is so hard figuring out the right managments, when each hospital/ region has own protocols )

[ArchivalUser]

Yes, i understand like you. Thank you for info.