2017.06.14 [消化內] 轉貼-膽囊炎

前言: 

急性膽囊炎是右上腹痛最常見原因,大多數是因為膽囊管被結石堵塞。而非結石性膽囊炎約占5-10%, 必須考慮休克、免疫抑制(CMV、Cryptosporidium、Microsporidium)等造成

症狀/徵候:

-突發右上腹痛 (好發進食後, 尤其吃富含脂肪食物後)
-N/V, Anorexia
-Fever, elevated WBC
- LFT上升並不常見,如果持續或有顯著上升,代表有膽道結石choldocholithiais
-膽囊收縮會造成反腹疼痛(止痛可予以NSAID)

影像:

Normal GB wall
-Sono下正常膽囊壁不超過3mm, 書上形容為pencil-thin echogenic line

 Thicken GB wall
-Sono下 增厚的膽囊壁會有層狀的構造(下圖左) CT 則會見到hypodense layer of subserosal edema(that mimics pericholecystic fluid)

Acute Cholecystitis

 -Acute cholecystitis is the fourth most common cause of hospital admissions for patients presenting with an acute abdomen [4], and it is the prime diagnostic concern when a thick-walled gallbladder is found at imaging. This feature, however, is not pathognomonic and additional imaging signs should be present to support the diagnosis of acute calculous cholecystitis such as an obstructing gallstone, hydropical dilatation of the gallbladder, a positive sonographic Murphy's sign ( i.e., pain elicited by pressure over the sonographically located gallbladder), pericholecystic fat inflammation or fluid and hyperemia of the gallbladder wall at power Doppler.

Acalculus Cholecystitis

-often occured in critically ill patients, presumably due to increased bile viscosity from fasting and medication that causes cholestasis. 

 Chronic Cholecystitis

Ref:
http://www.radiologyassistant.nl/en/43a0746accc5d
http://ppt.cc/VkVIU