TRUE about management of acute cholecystitis
|A||Gallbladder is visible on HIDA scan|
|B||Regular follow up|
|C||Laparoscopy cholecystectomy immediately|
|D||Open cholecystectomy even if she is asymptomatic after 2 months|
a. Patients who present with acute cholecystitis will need intravenous fluids, antibiotics, and analgesia. The antibiotics should cover gram-negative aerobes as well as anaerobes. A third-generation cephalosporin with good anaerobic coverage or a second-generation cephalosporin combined with metronidazole are typical regimens.
b. For patients with allergies to cephalosporins an aminoglycoside with metronidazole is appropriate. Although the inflammation in acute cholecystitis may be sterile in some patients, more than one half will have positive cultures from the gallbladder bile.
c. Cholecystectomy is the definitive treatment for acute cholecystitis. The timing of cholecystectomy has been a matter of debate in the past. Early cholecystectomy performed within 2 to 3 days of the illness is preferred over interval or delayed cholecystectomy that is performed 6 to 10 weeks after initial medical treatment and recuperation.
d. Laparoscopic cholecystectomy is the procedure of choice for acute cholecystitis. The conversion rate to an open cholecystectomy is higher (10 to 15%) in the setting of acute cholecystitis than with chronic cholecystitis.
e. Laparoscopic cholecystectomy could be attempted, but the conversion rate is high and some prefer to go directly for an open cholecystectomy. For those unfit for surgery, a percutaneous cholecystostomy or an open cholecystostomy under local analgesia can be performed. Failure to improve after cholecystostomy usually is due to gangrene of the gallbladder or perforation. For these patients, surgery is unavoidable.