hepatic and biliary disorders
Acute Cholecystitis
Treatment of Acute Cholecystitis
Supportive care (hydration, analgesics, antibiotics) Cholecystectomy Management includes hospital admission, IV fluids, and analgesics, such as a nonsteroidal anti-inflammatory drug (NSAID;ketorolac) or opioid. Nothing is given orally, and nasogastric suction is instituted if vomiting or an ileus is present. Parenteral antibiotics are usually initiated to treat possible infection, but evidence of benefit is lacking. Empiric coverage, directed at gram-negative enteric organisms, involves IV regimens such asceftriaxoneplusmetronidazole,piperacillin/tazobactam, or ticarcillin/clavulanate. Cholecystectomy cures acute cholecystitis and relieves biliary pain. Early cholecystectomy is generally preferred, best done during the first 24 to 48 hours in the following situations: The diagnosis is clear and patients are at low surgical risk. Patients are older or have diabetes and are thus at higher risk of infectious complications. Patients have empyema, gangrene, perforation, or acalculous cholecystitis. Surgery may be delayed when patients have an underlying severe chronic disorder (eg, cardiopulmonary disease or severe liver disease) that increases the surgical risks. In such patients, cholecystectomy is deferred until medical therapy stabilizes the comorbid disorders or until cholecystitis resolves. If cholecystitis resolves, cholecystectomy may be done≥6 weeks later. Delayed surgery carries the risk of recurrent biliary complications. Percutaneous cholecystostomy is an alternative to cholecystectomy for patients at very high surgical risk, such as those who are older, those with acalculous cholecystitis, those with severe liver disease, and those in an intensive care unit because of burns, trauma, or respiratory failure. 