hi everyone welcome to researchmd.com we got another great presentation today and today we are going to teach you everything about right here a calculus choreocystitis why should we talk about a calculus scorecystite somebody tell me what is the reason it's usually seen in like ill patients okay so what like a lot of the diseases that we see in patients but what is the main reason why is it people need to know about that that's very high very high mortality okay give this man an award for that the mortality what does it say right here somebody read that right right mortality like 10 to 50 of my friends okay so if you miss this there's the complications are extremely high and always you know i tell everyone when i teach it's very important to express in numbers so you tell me the mortality rate is up in 50 that kind of tell me what's going on you know the importance of the situation you know that how the problem is the problematic how serious the problem is okay so somebody tell me what is the definition of one more time just say a calculus calling cystitis somebody tell me the definition it's an acute life-threatening necro inflammatory disorder of gallbladder and it's usually seen in critically ill patients okay so i'm going to say it again acute life-threatening remember that i'm going to underline the word okay what is the now somebody tell me the mortality in acute cortisostitis now what is the mortality in acute called cystitis just give me a number one percent one percent wrong zero point one zero point one percent it's around like one two three one three percent i would say an average mortality okay so what is the mortality again this patient up to 50 percent okay remember that life-threatening necro inflammatory disorder gallbladder and usually seen in critical inpatient and no stones right yes so we'll just write up here no stones you will not see stones okay not associated with the gallstones that is the main important thing so remember acute chordae cystitis is subtracting the cystic duct or it could be common by that also we talked about it in this situation you will now see stones okay so we'll come back to the path of physiology before now let's look at the epidemiology what is the most important thing the epidemiology we need to know what is the most important thing it's kind of common in common in males yeah what about acute causes titus what's so common in uh females right this is more three times more likely in men and to 10 percent off around the acute policy science you can say it kind of belong to this category okay so this remember the men they're if you're writing a question let's say if i'm saying like a 45 year old and they came with abdominal pain white upper core maybe like we'll come back to that or suspecting cholesterol status you have to think about a calculus body society so everybody got that now what are the like etiology mainly this type of situation mainly seen in the icu like critically ill remember that okay surgery when i talk about surgery there are a lot of incidents about somebody doing like heart surgery post surgery you can have cortisostitis i think like one to two percent a calculus cardio societies remember that okay infection cme substance uh septic shock prolonged fasting also what is going on in the society now what is everybody trying to do to lose weight intermittent fasting so somebody need to do a study what's going on these people are you know more prone to a calculus choreocystitis or something like that that's like a future study need to be done on that right it's one of the fastest growing phenomena people trying to lose weight right then then tpm that can also any type of infection viral bacterial and all of that okay we'll come back to that immunodeficiency so what are the clinical features when you talk about you know the main thing when you talk about acute cholecystitis is right upper quadrant pain so what percentage of the people in um a calculus cholecystitis can have right upper quadrant pain somebody tell me only 25 only 25 okay remember this is the number we need to know right here again we are expressing numbers so they might not have right upper quadrant thing okay so i'm going to write it up here 25 percent only remember that okay then you have the classic radiation fever nausea vomiting or murphy's sign and the problem with the murphy sign what is the problem with the murphy side in this situation right most of these patients are like where critically ill in the icu maybe they're unconscious or they cannot express themselves right they might not exhibit you may not be able to exhibit the murphy side just be careful but those are the mainly the core society changes right anybody any questions on this part okay now let's look at pathophysiology what happens right so the main thing on the pathophysiology is shock substance heart failure hemorrhage where any time when the air i mean you know the blood circulation is compromised okay especially what when you talk about the sprangling circulation right when you have a shock when you have septic shock a lot of situation the um you know the blood pressure drops and then you can have decreased planetary circulation then you got ischemia and then you have thickening of the gallbladder wall right we talked about why is it important gallbladder wall thickening why is it important what is the size of the gallbladder wall somebody tell me the number four millimeter always remember that okay we talked about it before you need to know that it's four millimeter usually so this can become more than four millimeter okay um loss of mucosal integrity bacterial invasion when you talk about the bacteria remember e coli proteins and rockers are the most the most common if you have to pick i would say e coli okay and then what does it do um it goes um gallbladder inflammation you know and then what happens is like perforation and then gangrene all of this kind of develop later okay so that is like one part the other part is dehydration dehydration intermittent fasting also what happened in the intermittent fasting right there's like a less uh i mean i mean circle circulation intravascular volume goes down so what happened while viscosity increases okay and then massive transfusion also what happens is like viscosity increases remember that um and then what it will lead to highly concentrated bile attacks toxic lysol acetylene released and then inflammation neptrosis perforation surfaces and death everybody got that okay and then you can have prolonged i see you stay um decreased cholesterol kind and that's what like stimulate gallbladder right and then um biostasis what happened was just increased by viscosity remember or you're not seeing any stone here but everything else is kind of affected okay everybody understood the pathophysiology if you look at the labs um cbc lfd and all this check remember mi lace is very very important okay most of these people like one of the diagnostic criteria is you have uh ultrasound finding and then amylase increased without pancreatitis okay lipase is usually normal so you have that's like one of the a good price i mean one of the criteria you can use to diagnose now when you look at the ultrasound right that's like the number one when you talk about the sensitivity and specific is pretty high almost like 93 95 right for um ultrasound of the gallbladder now you will not find the stone right so what are the things we're looking for somebody tell me what are the things we're looking for though that roblox thickening greater than four millimeter okay remember you see the gauntlet of wall thickening right here better than four millimeter what are the other things what is this very choreocystic fluid okay those are the finding characteristic finding you're going to find when you do an ultrasound of the gallbladder remember that and then if you and the next thing you can do is like hydroscan okay you have to be very careful up here right in acute cholesterol is how do somebody do either scan somebody tell me so how do they how do they lose either scan so initially they inject a radio tracer into the iv okay and then the patient is taken into the top feeder scan machine okay where the they observe the way the tracer is going yeah it goes from the hepatic veins hepatic ducts okay into the cystic difference because it comes over here and it goes everywhere right yes so what happened when you have a stone block right here you will not visualize the gallbladder okay in a cure called cystitis most likely right because cystic duct is abstracted the dye is not going to go non-visualization is the diagnosis what happened over here can you i mean you can still go see garbage there's no obstruction right here from the stone right so what do you do when you do haida you give something called the chord system kindness okay that's going to stimulate gallbladder and then you look at the ejection fraction that's what i'm looking for if it is like less than 25 to 30 then it's more like a diagnostic right there so you need to understand why what is the difference between ida in acute cholecystitis and a calculus cortisostitis it's important to do cordycytokinin right stimulate and all that with the high risk and probably the best thing to look at the gallbladder over here okay so you want to know this is like a stasis of the um i mean of the gallbladder okay then you can do ct of the contrast pretty much not that sensitive and specificity why do but and then treatment mainly npo iv fluids analgesic iv antibiotic these patients probably is better to give like strong antibiotic right and then cover four like you know i can use ibusin or neuropenem uh life threatening situation immediate the reason for that you know we look at the mortality anytime i treat somebody i look at the mortality there's 50 mortality i should give it the strong antibiotic to decrease anything the mortality remember that okay and then if there's uh definitely um lapros laparoscopy chord cystectomy we have to do right antibiotic laparoscopy cholecystectomy and then um high risk patient i mean you can do like a polycystostomy tube percutaneous called pct okay studies have shown the mortality rate the data is not very clear but i think that's the only thing in the situation you can do if they're high risk like you know you can't do cortisol when they're dying on the table anyway so always try the percutaneous poly system policies stores to meet you remember that but again studies have shown decreased mortality is not very significant in that patient remember that so what are the complications you can have granules for instance diaries you can have microscope perforation and a lot of complications below that right so remember the main thing remember i said like clinical first in this patient one mortality rate up to 50 percent take it very very seriously right and then number two right upper body main maybe you're only like 25 percent of the people so you might not find that if you don't a lot of our mind is like there's no right of a quantum pain right there's no politician studies right there no abdominal pain these people in the icu are critically ill my patient right so you have to remember that and then hyperamylysemia without increasing lipos okay without increase without pancreatitis okay so i'm going to write it over here usually life is not a lipase right like this is normal only amaleus is going to be increased okay so i'm just going to summarize my um the presentation a little bit uh cute no i mean acute life-threatening is the word no gallstones men three times more right and then you have to worry about broadcasting tp and any kind of sepsis right upper quadrant is going to be absent when 75 percent of the people only present in 25 percent of the patient and then we come up here we look at or where the circulation is compromised shock all of this right hemorrhage you got decreased spanking circulation guard water ischemia put the cascade down and your gallbladder is pretty much necrosis perforation then you have dehydration right then you i mean what happened increase bile um viscosity and then you have what else massive transfusion can affect we talked about prolonged icu state decreased cholecystokinin eventually all this happened is goblin inflammation necrosis in the labs pay attention to amylase without increasing lipase or without pancreatitis and the imaging study there will not be stone but four millimeter long line of thickening is more than that pericholicistic fluid is going to be there and then hydroscan please use cholecystokinin and you need to know why you're using cholecystokinin right nuclear causes to well i mean the gallbladder is going to be visualized but we're looking at the contraction okay and then treat with a good antibiotic make sure you take the goblin around cholecystectomy in high risk people do pct percutaneous cholesterol tube and then these are the clinical problems mortality right uporter and hyperdramalysemia thank you so much for watching please subscribe to our channel thank you again