The Gallbladder and Biliary Tree

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.