Elderly urine check for the presence of pyuria diagnosis and treatment Discussion: Acute cholecystitis or need surgical treatment?
A 84 -year-old obese female patients grandmother brought by the Indonesian maid emergency room, the patient complained of chest tightness ( in fact, the psychological discomfort ) , routine examination of white blood cells in the blood is high nearly twenty thousand, urinalysis pyuria (> 100 / HPF ) , the emergence of physical examination found the right flank pain and knock pain, the diagnosis of urinary tract infection, and antibiotics and referral to Nephrology hospitalization.
After the result of normal abdominal X- ray whitening display full right upper quadrant soft tissue infiltration ( reference 1) , and then further arranged abdominal computed tomography, the report is accompanied by acute cholecystitis and abdominal water ( reference 2) . Nephrology consultation on himself, because the patient continued to have fever situation coupled with the developer computer tomography appears developing gallbladder wall discontinuity in the diagnosis of suspected gallbladder wall necrosis with concurrent gallbladder abscess, giving arrangements for emergency surgery, gallbladder surgery has been found and accompanied by the rupture of liver abscess, the abscess which mixed with a lot of dark green Suixiao gallstones, but fortunately these abscess and rupture of the gallbladder patients are living their own limitations omentum, surgery and use in priority clearance abscess after a lot of physiological saline rinse abscess, the patient heart rate and blood pressure back to normal soon, after consultation with the anesthesiologist, he also believes that the patient's condition improved significantly after clearing abscess, should continue to be represented cholecystectomy, then re-excision homeopathy gallbladder, in patients 10 and discharged stitches days.
Figure II computer tomography reports of acute cholecystitis and accompanied by abdominal water. Red arrow gallbladder wall portion of the developing discontinuity, may represent ischemic necrosis, surgical findings confirmed; blue arrow ascites, but it is found that overflow surgery with broken rubble gallbladder and gallbladder abscess content was the same; the patient was green arrow to protect themselves omentum
Symptoms and diagnosis of acute cholecystitis
Mainly occurs as a complication of cholelithiasis, and typically form in patients who have a history of symptomatic gallstones. In a systematic review of the literature for patients with symptomatic gallstones track 7 Dao 11 years, saw about 6 to 11% of patients with acute cholecystitis, gallstones can be simply interpreted as symptomatic patients, ten years of the eleventh about a patient of acute cholecystitis occur.
Symptoms often appear right upper quadrant pain, fever and increased white blood cells, the patient's right upper quadrant pain, we are not obvious, as I asked in detail about the past have often appear abdominal pain and even vomiting, gastric ulcer was all to deal with, automatically improve symptoms, should it suspect has covered up omental formed self-protection, but also leading to their obvious symptoms.
In addition to the above symptoms the diagnosis, another tenderness should appear in the right upper quadrant gallbladder outer position, can be relied upon to diagnose abdominal ultrasound, abdominal pain actuating position can be seen in the gallbladder stones and gall bladder wall thickening ( greater than . 4 ~ 5mm) .
CT in the diagnosis of acute cholecystitis often unwanted, mainly because many of the same density and bile stones not detected, but if the suspected complications of acute cholecystitis, such as emphysema or cystic cholecystitis perforated ( gas obstruct super sonic inspection ) , or to consider other diagnoses, the CT is very helpful.
No surgery have a higher risk of mortality and complications after discharge
Treatment of acute cholecystitis caused by stones should pay attention to the formation of gallbladder gangrene and perforation complications, as these are life-threatening. A Medicare database review, including nearly 3 elderly Wan acute cholecystitis track two years found that patients do not have to remove the gallbladder of a higher risk of mortality than those patients with cholecystectomy, about high 1.56 times. Another Canadian province of Ontario about 2 Wan 5 suffer a thousand generations studies of uncomplicated acute cholecystitis, in which 1 million people in their first hospitalization did not receive cholecystectomy, then 3.4 years of follow approximately 1/4 there are a gallstone-related events occur and most (88%) occurred in the first year, of which 3 into a bile duct obstruction or pancreatitis.
Low-risk patients choose laparoscopic surgery, the risk is high priority gallbladder drainage
Thus, once the patient gallstones acute cholecystitis, treatment recommendations for an hospitalized supportive treatment, including intravenous injection, electrolyte imbalance correction and pain control, as well as the use of antibiotics. Select radical treatment and time are subject to the severity of the patient's symptoms and the overall risk of the patient to decide. If you suspect gallbladder gangrene and perforation, or worsening symptoms such as fever, hemodynamic instability or pain can not be controlled excision of emergency shall gallbladder surgery, gallbladder drainage or surgery. Low-risk patients is the risk of anesthesia at 1 , 2 -class patients, who do not need emergency treatment, hospitalization in the same general tendency underwent laparoscopic cholecystectomy. High-risk patients is the risk of anesthesia in 3 to 5 class patients, who do not need emergency treatment, but supportive care no improvement is accepted gallbladder drainage surgery, and some medical conditions can be improved to an acceptable surgical patients, or consider doing cholecystectomy.
However, in some high-risk patients ( if any gangrene or perforation of the gallbladder ) , for whom the burden due to ongoing systemic effects of cholecystitis is considered to be greater than the risk of surgery, so surgery can be the beginning of preference, like our assessment of high-risk patients 4 level in the case of suspected gallbladder gangrene CT examination, and during hospitalization fixed every afternoon fever and body weakness special circumstances. Can succeed in the ten days after the patient is discharged from hospital due to surgery to grasp processing abscess and clean, with plenty of physiological saline wash the affected area to reduce the principle of systemic reactions abscess caused by bacteria, blood pressure and heart rate steady until after the quick removal of the gallbladder surgery.
After the result of normal abdominal X- ray whitening display full right upper quadrant soft tissue infiltration ( reference 1) , and then further arranged abdominal computed tomography, the report is accompanied by acute cholecystitis and abdominal water ( reference 2) . Nephrology consultation on himself, because the patient continued to have fever situation coupled with the developer computer tomography appears developing gallbladder wall discontinuity in the diagnosis of suspected gallbladder wall necrosis with concurrent gallbladder abscess, giving arrangements for emergency surgery, gallbladder surgery has been found and accompanied by the rupture of liver abscess, the abscess which mixed with a lot of dark green Suixiao gallstones, but fortunately these abscess and rupture of the gallbladder patients are living their own limitations omentum, surgery and use in priority clearance abscess after a lot of physiological saline rinse abscess, the patient heart rate and blood pressure back to normal soon, after consultation with the anesthesiologist, he also believes that the patient's condition improved significantly after clearing abscess, should continue to be represented cholecystectomy, then re-excision homeopathy gallbladder, in patients 10 and discharged stitches days.
Figure II computer tomography reports of acute cholecystitis and accompanied by abdominal water. Red arrow gallbladder wall portion of the developing discontinuity, may represent ischemic necrosis, surgical findings confirmed; blue arrow ascites, but it is found that overflow surgery with broken rubble gallbladder and gallbladder abscess content was the same; the patient was green arrow to protect themselves omentum
Symptoms and diagnosis of acute cholecystitis
Mainly occurs as a complication of cholelithiasis, and typically form in patients who have a history of symptomatic gallstones. In a systematic review of the literature for patients with symptomatic gallstones track 7 Dao 11 years, saw about 6 to 11% of patients with acute cholecystitis, gallstones can be simply interpreted as symptomatic patients, ten years of the eleventh about a patient of acute cholecystitis occur.
Symptoms often appear right upper quadrant pain, fever and increased white blood cells, the patient's right upper quadrant pain, we are not obvious, as I asked in detail about the past have often appear abdominal pain and even vomiting, gastric ulcer was all to deal with, automatically improve symptoms, should it suspect has covered up omental formed self-protection, but also leading to their obvious symptoms.
In addition to the above symptoms the diagnosis, another tenderness should appear in the right upper quadrant gallbladder outer position, can be relied upon to diagnose abdominal ultrasound, abdominal pain actuating position can be seen in the gallbladder stones and gall bladder wall thickening ( greater than . 4 ~ 5mm) .
CT in the diagnosis of acute cholecystitis often unwanted, mainly because many of the same density and bile stones not detected, but if the suspected complications of acute cholecystitis, such as emphysema or cystic cholecystitis perforated ( gas obstruct super sonic inspection ) , or to consider other diagnoses, the CT is very helpful.
No surgery have a higher risk of mortality and complications after discharge
Treatment of acute cholecystitis caused by stones should pay attention to the formation of gallbladder gangrene and perforation complications, as these are life-threatening. A Medicare database review, including nearly 3 elderly Wan acute cholecystitis track two years found that patients do not have to remove the gallbladder of a higher risk of mortality than those patients with cholecystectomy, about high 1.56 times. Another Canadian province of Ontario about 2 Wan 5 suffer a thousand generations studies of uncomplicated acute cholecystitis, in which 1 million people in their first hospitalization did not receive cholecystectomy, then 3.4 years of follow approximately 1/4 there are a gallstone-related events occur and most (88%) occurred in the first year, of which 3 into a bile duct obstruction or pancreatitis.
Low-risk patients choose laparoscopic surgery, the risk is high priority gallbladder drainage
Thus, once the patient gallstones acute cholecystitis, treatment recommendations for an hospitalized supportive treatment, including intravenous injection, electrolyte imbalance correction and pain control, as well as the use of antibiotics. Select radical treatment and time are subject to the severity of the patient's symptoms and the overall risk of the patient to decide. If you suspect gallbladder gangrene and perforation, or worsening symptoms such as fever, hemodynamic instability or pain can not be controlled excision of emergency shall gallbladder surgery, gallbladder drainage or surgery. Low-risk patients is the risk of anesthesia at 1 , 2 -class patients, who do not need emergency treatment, hospitalization in the same general tendency underwent laparoscopic cholecystectomy. High-risk patients is the risk of anesthesia in 3 to 5 class patients, who do not need emergency treatment, but supportive care no improvement is accepted gallbladder drainage surgery, and some medical conditions can be improved to an acceptable surgical patients, or consider doing cholecystectomy.
However, in some high-risk patients ( if any gangrene or perforation of the gallbladder ) , for whom the burden due to ongoing systemic effects of cholecystitis is considered to be greater than the risk of surgery, so surgery can be the beginning of preference, like our assessment of high-risk patients 4 level in the case of suspected gallbladder gangrene CT examination, and during hospitalization fixed every afternoon fever and body weakness special circumstances. Can succeed in the ten days after the patient is discharged from hospital due to surgery to grasp processing abscess and clean, with plenty of physiological saline wash the affected area to reduce the principle of systemic reactions abscess caused by bacteria, blood pressure and heart rate steady until after the quick removal of the gallbladder surgery.
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