Akut Kolesistit
Özet
Bu belgede, akut taşlı ve akut taşsız (akalkülöz) kolesistitin tanımı, kliniği, fizyopatolojisi, tanısı, komplikasyonları ve güncel tedavisi ele alınmaktadır. Safra kesesinin akut iltihabi hastalığı olan akut kolesistit olgularının %90-95'i safra taşlarına bağlı gelişirken, %5-10'u taşsız kolesistit olarak ortaya çıkar. Sistik kanalın tıkanmasıyla başlayan süreçte sağ üst kadranda keskin ağrı, ateş ve bulantı en sık görülen semptomlardır; fizik muayenede ise Murphy bulgusu karakteristiktir. Tanıda ilk seçilecek altın standart yöntem ultrasonografidir. Hastalığın şiddeti Tokyo kılavuzlarına göre gradelenerek hidrasyon ve geniş spektrumlu antibiyoterapi başlanır. Kesin tedavi semptom süresinden bağımsız olarak erken laparoskopik kolesistektomidir; cerrahiye uygun olmayan hastalarda ise perkütan kolesistostomi ile safra dekompresyonu %90 oranında başarı sağlar. Daha ağır seyreden akut taşsız kolesistit ise genellikle yoğun bakım hastalarında, majör travma, yanık veya sepsis sonrası gelişir ve iskemi ile safra stazından kaynaklanır. Teşhisi daha zor olan bu klinik tabloda da temel yaklaşım kolesistektomi olup, yüksek riskli hastalarda perkütan kolesistostomi katateri ve antibiyoterapi hayat kurtarıcıdır.
This document addresses the definition, clinical presentation, pathophysiology, diagnosis, complications, and current treatment of acute calculous and acute acalculous cholecystitis. Acute cholecystitis, an acute inflammatory disease of the gallbladder, develops due to gallstones in 90-95% of cases, while 5-10% manifest as acalculous cholecystitis. In the process initiated by the obstruction of the cystic canal, sharp pain in the right upper quadrant, fever, and nausea are the most common symptoms, and Murphy's sign is characteristic during physical examination. Ultrasonography is the gold standard imaging method preferred for diagnosis. The severity of the disease is graded according to the Tokyo Guidelines, and hydration along with broad-spectrum antibiotherapy is initiated. The definitive treatment is early laparoscopic cholecystectomy, independent of the duration of symptoms; for patients unfit for surgery, bile decompression via percutaneous cholecystostomy achieves a 90% success rate. Acute acalculous cholecystitis, which follows a more severe course, typically develops in intensive care patients following major trauma, burns, or sepsis, and originates from ischemia and bile stasis. In this clinical scenario, which is more difficult to diagnose, the primary approach remains cholecystectomy, whereas percutaneous cholecystostomy catheter placement and antibiotherapy are life-saving for high-risk patients.
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