0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45
16 Actinic Keratosis Acute Acalculous Cholecystitismanagement
■Suncreens, sun protective clothing and alteration of behavior lessen
the chance of development of new lesions.
■Low-fat diet may also result in a lower rate of appearance of new
lesions.
■Smoking cessation
specific therapy
■Liquid nitrogen application (destructive)
■Curettage with desiccation
■topical application
➣5-Fluorouracil
➣imiquimod
➣diclofenac
➣tretinoin
■Photodynamic therapy
follow-up
■6–8 weeks after therapy the patient should be re-examined.
■6 months to 1 year for treatment response and examination for new
lesions
complications and prognosis
■patient population is prone to develop new lesions despite avoidance
of further ultraviolet exposure
■estimated 10% chance of at least one lesion developing into squa-
mous cell cancer after 10 years (if left untreated)Acute Acalculous Cholecystitis...........................
SUSAN A. CUMMINGS, MD
history & physical
History
■5–10% of cholecystectomies
■More fulminant than calculous cholecystitis; may present w/ gan-
grene, perforation, & empyema
■Risk factors: sepsis, ICU, TPN, immunosuppression, major trauma,
burns, diabetes, infections, mechanical ventilation, opiates, CHD
& CABG, prolonged fasting, childbirth, nonbiliary surgery, & AIDS;
rarely seen in systemic vasculitides due to ischemic injury to gall-
bladder