Cholecystitis
Anamnese
Pijn rechter hypochonder
Aanhoudende pijn, > 6 uur
Nausea, braken, koorts (32%)
Soms icterus (20%), denk dan aan choledocholithiasis
Bronnen
Peter A D Steel et al. Acute Cholecystitis and Biliary Colic. Medscape. Jan 18, 2017
Diagnosing Biliary Colic and Acute Cholecystitis. Am Fam Physician. 2000 Sep 15;62(6):1386-1388
Ahmad M, et al. Differential diagnosis of gallstone-induced complications. South Med J. March 2000;93:261-4
Klinisch onderzoek
Defense en drukpijn
Teken van Murphy (97%)
Soms andere peritoneale tekens
Bronnen
Peter A D Steel et al. Acute Cholecystitis and Biliary Colic. Medscape. Jan 18, 2017
Diagnosing Biliary Colic and Acute Cholecystitis. Am Fam Physician. 2000 Sep 15;62(6):1386-1388
Ahmad M, et al. Differential diagnosis of gallstone-induced complications. South Med J. March 2000;93:261-4
Aanvullend onderzoek
Bloedonderzoek
Leucocyten, ALAT, bilirubine, alkalisch fosfatase
Dit zijn slechte uitsluiters!
Echografie
Sensitiviteit is 90-95%
Specificiteit is 78-80%
Bronnen
Peter A D Steel et al. Acute Cholecystitis and Biliary Colic. Medscape. Jan 18, 2017
Diagnosing Biliary Colic and Acute Cholecystitis. Am Fam Physician. 2000 Sep 15;62(6):1386-1388
Ahmad M, et al. Differential diagnosis of gallstone-induced complications. South Med J. March 2000;93:261-4
Beleid
Verwijzen voor chirurgie
Vaak is een 'cooling off period' nodig met intraveneuze antibiotica, analgesie en antiflogistica
Bronnen
Peter A D Steel et al. Acute Cholecystitis and Biliary Colic. Medscape. Jan 18, 2017
Diagnosing Biliary Colic and Acute Cholecystitis. Am Fam Physician. 2000 Sep 15;62(6):1386-1388
Ahmad M, et al. Differential diagnosis of gallstone-induced complications. South Med J. March 2000;93:261-4