Cholecystitis

Cholecystitis

Cholecystitis is inflammation of the gallbladder, usually resulting from a gallstone blocking the cystic duct.

• Gallbladder inflammation usually results from a gallstone blocking the flow of bile.
• Typically, people have abdominal pain that lasts more than 6 hours, fever, and nausea.
• Ultrasonography can usually detect signs of gallbladder inflammation.
• The gallbladder is removed, often using a laparoscope.

Cholecystitis is the most common problem resulting from gallbladder stones. It occurs when a stone blocks the cystic duct, which carries bile from the gallbladder.

Cholecystitis is classified as acute or chronic.

Acute Cholecystitis: Acute cholecystitis begins suddenly, resulting in severe, steady pain in the upper abdomen. At least 95% of people with acute cholecystitis have gallstones. The inflammation almost always begins without infection, although infection may follow later. Inflammation may cause the gallbladder to fill with fluid and its walls to thicken.

Rarely, a form of acute cholecystitis without gallstones (acalculous cholecystitis) occurs. Acalculous cholecystitis is more serious than other types of cholecystitis. It tends to occur after the following:

• Major surgery
• Critical illnesses such as serious injuries, major burns, and bodywide infections (sepsis)
• Intravenous feedings for a long time
• Fasting for a prolonged time
• A deficiency in the immune system

It can occur in young children, perhaps developing from a viral or another infection.

Chronic Cholecystitis: Chronic cholecystitis is gallbladder inflammation that has lasted a long time. It almost always results from gallstones. It is characterized by repeated attacks of pain (biliary colic). In chronic cholecystitis, the gallbladder is damaged by repeated attacks of acute inflammation, usually due to gallstones, and may become thick-walled, scarred, and small. The gallbladder usually contains sludge (microscopic particles of materials similar to those in gallstones), or gallstones that either block its opening into the cystic duct or reside in the cystic duct itself.

Symptoms of Cholecystitis

The list of signs and symptoms mentioned in various sources for Cholecystitis includes the 21 symptoms listed below:

• Upper right-side abdominal pain
• Biliary colic - spasmodic upper abdominal pain
• Biliary colic after a fatty meal
• Abdominal discomfort
• Pain under right shoulder blade
• Fever
• Nausea
• Vomiting
• Flatulence
• Jaundice
• Itching skin
• Pale stool
• Thickening of gallbladder
• Shrinking of gallbladder
• Gallbladder inflammation
• Back pain
• Indigestion
• Yellow skin
• Yellow membranes
• Yellow whites of the eyes

Diagnosis

Cholecystitis is usually diagnosed by a history of the above symptoms, as well examination findings:

• fever (usually low grade in uncomplicated cases)
• tender right upper quadrant +/- Murphy's sign

Subsequent laboratory and imaging tests are used to confirm the diagnosis and exclude other possible causes.

Ultrasound can assist in the differential.

Differential diagnosis

Acute cholecystitis

• This should be suspected whenever there is acute right upper quadrant or epigastric pain.
  • Other possible causes include:
    • Perforated peptic ulcer
    • Acute peptic ulcer exacerbation
    • Amoebic liver abscess
    • Acute amoebic liver colitis
    • Acute pancreatitis
    • Acute intestinal obstruction
    • Renal colic
    • Acute retrocolic appendicitis

Chronic cholecystitis

• The symptoms of chronic cholecystitis are non-specific, thus chronic cholecystitis may be mistaken for other common disorders:
  • Peptic ulcer
  • Hiatus hernia
  • Colitis
  • Functional bowel syndrome

It is defined pathologically by the columnar epithelium has reached down the muscular layer.

Treatment

People with acute or chronic cholecystitis need to be hospitalized. They are not allowed to eat or drink and are given fluids and electrolytes intravenously. A doctor may pass a tube through the nose and into the stomach, so that suctioning can be used to keep the stomach empty and reduce fluid accumulating in the intestine if the intestine is not contracting normally. Usually, antibiotics are given intravenously, and pain relievers are given.

If acute cholecystitis is confirmed and the risk of surgery is small, the gallbladder is usually removed within 24 to 48 hours after symptoms start. If necessary, surgery can be delayed for 6 weeks or more while the attack subsides. Delay is often necessary for people with a disorder that makes surgery too risky (such as a heart, lung, or kidney disorder). If a complication such as an abscess, gangrene, or perforated gallbladder is suspected, immediate surgery is necessary.

In chronic cholecystitis, the gallbladder is usually removed after the acute episode subsides.

In acalculous cholecystitis, immediate surgery is necessary to remove the diseased gallbladder.

Surgical removal of the gallbladder (cholecystectomy) is usually done using a flexible viewing tube called a laparoscope. After small incisions are made in the abdomen, the laparoscope and other tubes are inserted, and surgical tools are passed through the incisions and used to remove the gallbladder.

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