Advertisement

Source Control pp 142-149 | Cite as

The Gallbladder and Biliary Tree

  • Peter Götzinger
  • Reinhold Függer
Chapter

Abstract

• Early cholecystectomy is the treatment of choice in acute cholecystitis. • Endoscopic sphincterotomy is the treatment of choice in ascending cholangitis. Acute Cholecystitis Acute Calculous Cholecystitis (ACC) Approximately 90% of cases of acute cholecystitis are associated with cholelithiasis. The clinical findings of acute cholecystitis may include symptoms of local inflammation — such as right upper quadrant tenderness or mass, peritoneal signs, hypoactive bowel sounds, positive Murphy's sign — and systemic toxicity (fever, leukocytosis). Jaundice is noted in approximately 15% of patients even in the absence of associated choledocholithiasis [1]. Hyperbilirubinemia may result from local edema and inflammation secondary to a stone impacted in the cystic duct, or from compression of the common hepatic duct or common bile duct (Miriz-zi's syndrome). In the event of prolonged cystic duct obstruction, the gallbladder may become distended with clear mucoid fluid, resulting in a hydrops.

Keywords

Laparoscopic Cholecystectomy Acute Cholecystitis Bile Duct Stone Acute Cholangitis Hepatobiliary Scintigraphy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Voyles CR, Sanders DL, Hogan R (1994) Common bile duct evaluation in the era of laparoscopic cholecystectomy: 1050 cases later. Ann Surg 219:744–750PubMedGoogle Scholar
  2. 2.
    Bortoff GA, Chen MY, Ott DJ, Wolfman NT, Routh WD (2000) Gallbladder stones: imaging and intervention. Radiographics 20:751–766PubMedGoogle Scholar
  3. 3.
    Chatziioannou SN, Moore WH, Ford PV, Dhekne RD (2000) Hepatobiliary scintigraphy is superior to abdominal ultrasonography in suspected acute cholecystitis. Surgery 127:609–613PubMedCrossRefGoogle Scholar
  4. 4.
    Mirvis SE, Vainright JR, Nelson AW, et al (1986) The diagnosis of acute acalculous cholecystitis: A comparison of sonography, scintigraphy and CT. AJR 147:1171–1175PubMedGoogle Scholar
  5. 5.
    Westphal JF, Brogard JM (1999) Biliary tract infections: a guide to drug treatment. Drugs 57:81–91PubMedCrossRefGoogle Scholar
  6. 6.
    Brook I (1989) Aerobic and anaerobic microbiology of biliary tract disease. J Clin Microbiol 27:2373–2375PubMedGoogle Scholar
  7. 7.
    Eliopoulos GM, Moellering RC (1982) Azlocillin, mezlocillin, and piperacillin: new broad spectrum penicillins. Ann Intern Med 97:755–760PubMedGoogle Scholar
  8. 8.
    Schwesinger WH, Sirinek KR, Srodel WE 3rd (1999) Laparoscopic cholecystectomy for biliary tract emergencies: state of the art. World J Surg 23:334–342PubMedCrossRefGoogle Scholar
  9. 9.
    Cuschieri A (1993) Approach to the treatment of acute cholecystitis: open surgical, laparoscopic or endoscopic? Endoscopy 25:397–398PubMedCrossRefGoogle Scholar
  10. 10.
    Garber SM, Korman J, Cosgrove JM, Cohen JR (1997) Early laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc 11:347–350PubMedCrossRefGoogle Scholar
  11. 11.
    Lillemoe KD (2000) Surgical treatment of biliary tract infections. Am Surg 66:138–144PubMedGoogle Scholar
  12. 12.
    Habib FA, Kolachalam RB, Khilnani R, Preventza O, Mittal VK (2001) Role of laparoscopic cholecystectomy in the management of gangrenous cholecystitis. Am J Surg 181:71–75PubMedCrossRefGoogle Scholar
  13. 13.
    Chandler CF, Lane JS, Ferguson P, Thompson JE, Ashley SW (2000) Prospective evaluation of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg 66:896–900PubMedGoogle Scholar
  14. 14.
    Lo CM, Lai EC, Fan ST, Liu CL, Wong J (1996) Laparoscopic cholecystectomy for acute cholecystitis in the elderly. World J Surg 20:983–986PubMedCrossRefGoogle Scholar
  15. 15.
    Willsher PC, Sanabria JR, Gallinger S, Rossi L, Strasberg S, Litwin DE (1999) Early laparoscopic cholecystectomy for acute cholecystitis: a safe procedure. J Gastrointest Surg 3:50–53PubMedCrossRefGoogle Scholar
  16. 16.
    Liu CL, Fan ST, Lai EC, Lo CM, Chu KM (1996) Factors affecting conversion of laparoscopic cholecystectomy to open surgery. Arch Surg 131:98–101PubMedCrossRefGoogle Scholar
  17. 17.
    Ransom KJ (1998) Laparoscopic management of acute cholecystitis with subtotal cholecystectomy. Am Surg 64:955–957PubMedGoogle Scholar
  18. 18.
    Michalowski K, Bornman PC, Krige JE, Gallagher PJ, Terblanche J (1998) Laparoscopic subtotal cholecystectomy in patients with complicated acute cholecystitis or fibrosis. Br J Surg 85:904–906PubMedCrossRefGoogle Scholar
  19. 19.
    Traverso LW (1993) Clinical manifestations and impact of gallstone disease. Am J Surg 165:405–409PubMedCrossRefGoogle Scholar
  20. 20.
    Berber E, Engle KL, String A, Garland AM, Chang G, Macho J, Pearl JM, Siperstein AE (2000) Selective use of tube cholecystostomy with interval laparoscopic cholecystectomy in acute cholecystitis. Arch Surg 135:341–346PubMedCrossRefGoogle Scholar
  21. 21.
    Snow LL, Weinstein LS, Hannon JK, Lane DR (2001) Evaluation of operative cholangiography in 2043 patients undergoing laparoscopic cholecystectomy. Surg Endosc 15:14–20PubMedCrossRefGoogle Scholar
  22. 22.
    Monson JRT, Guillon PJ, Keane FBV, Tanner WA, Brennan TG (1991) Cholecystectomy is safer without drainage: the result of a prospective, randomized clinical trial. Surgery 109:740–746PubMedGoogle Scholar
  23. 23.
    Fritsch A, Függer R (1993) Drainage in hepatobiliary surgery. Chirurg 64:85–89PubMedGoogle Scholar
  24. 24.
    Raraty MG, Finch M, Neoptolemos JP (1998) Acute cholangitis and pancreatitis secondary to common duct stones: management update. World J Surg 22:1155–1161PubMedCrossRefGoogle Scholar
  25. 25.
    Lai EC (1990) Management of severe acute cholangitis. Br J Surg 77:604–6055PubMedCrossRefGoogle Scholar
  26. 26.
    Huang MH, Ker CG (1988) Ultrasonic guided percutaneous transhepatic bile drainage for cholangitis due to intrahepatic stones. Arch Surg 123:106–109PubMedCrossRefGoogle Scholar
  27. 27.
    Rattner DW, Ferguson C, Warshaw AL (1993) Factors associated with successful laparoscopic cholecystectomy. Ann Surg 218:129–137CrossRefGoogle Scholar
  28. 28.
    Kiviluoto T, Siren J, Luukkonen P, Kivilaakso E (1998) Randomized trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 351:321–325PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • Peter Götzinger
  • Reinhold Függer

There are no affiliations available

Personalised recommendations