cholecystitis

Acute cholecystitis  

Cholecystitis - acute

Acute cholecystitis is a sudden inflammation of the gallbladder that causes severeabdominal pain.

Causes, incidence, and risk factors

In 90% of cases, acute cholecystitis is caused by gallstones in the gallbladder. Severe illness and, rarely, tumors of the gallbladder may also cause cholecystitis.

Acute cholecystitis causes bile to become trapped in the gallbladder. The buildup of bile causes irritation and pressure in the gallbladder. This can lead to bacterial infection and perforation of the organ.

Gallstones occur more frequently in women than men. Gallstones become more common with age in both sexes. Native Americans have a higher rate of gallstones.

Symptoms

The main symptom is abdominal pain that is located on the upper right side or upper middle of the abdomen. The pain may:

• Be sharp, cramping, or dull
• Come and go
• Spread to the back or below the right shoulder blade
• Occur within minutes of a meal

Other symptoms that may occur include:

• Abdominal fullness
• Clay-colored stools
• Fever
• Nausea and vomiting
• Yellowing of skin and whites of the eyes (jaundice)

Signs and tests

A physical exam will show that your abdomen is tender to the touch.

Your doctor may order the following blood tests:

• Amylase and lipase
• Bilirubin
• Complete blood count ( CBC) -- may show a higher than normal white blood cell count
• Liver function tests

Imaging tests that can show gallstones or inflammation include:

• Abdominal ultrasound
• Abdominal CT scan
• Abdominal x-ray
• Oral cholecystogram
• Gallbladder radionuclide scan

Treatment

Seek immediate medical attention for severe abdominal pain.

In the emergency room, patients with acute cholecystitis are given fluids through a vein and antibiotics to fight infection.

Although cholecystitis may clear up on its own, surgery to remove the gallbladder (cholecystectomy) is usually needed when inflammation continues or recurs. Surgery is usually done as soon as possible, however some patients will not need surgery right away.

Nonsurgical treatment includes pain medicines, antibiotics to fight infection, and a low-fat diet (when food can be tolerated).

Emergency surgery may be necessary if gangrene (tissue death), perforation,pancreatitis, or inflammation of the common bile duct occurs.

Occasionally, in very ill patients, a tube may be placed through the skin to drain the gallbladder until the patient gets better and can have surgery.

Expectations (prognosis)

Patients who have surgery to remove the gallbladder usually do very well.

Complications

• Empyema (pus in the gallbladder)
• Gangrene (tissue death) of the gallbladder
• Injury to the bile ducts draining the liver (a rare complication of cholecystectomy)
• Pancreatitis
• Peritonitis (inflammation of the lining of the abdomen)

Calling your health care provider

Call your health care provider if severe abdominal pain persists.

Call for an appointment with your health care provider if symptoms of cholecystitis recur after an acute episode.

Prevention

Removal of the gallbladder and gallstones will prevent further attacks. Follow a low-fat diet if you are prone to gallstone attacks.

Ultrasound Acute Cholecystitis....

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Chronic cholecystitis

Cholecystitis - chronic

Chronic cholecystitis is long-standing swelling and irritation of the gallbladder.

Causes, incidence, and risk factors

Chronic cholecystitis is usually caused by repeated attacks of acute cholecystitis. This leads to thickening of the gallbladder walls. The gallbladder begins to shrink and eventually loses the ability to perform its function, which is concentrating, storing, and releasing bile.

The disease occurs more often in women than in men. The incidence increases after age 40. The main risk factors include the presence of gallstones (in which case, the symptoms are due to gallstones).

Symptoms

Attacks of upper abdominal pain, often with nausea or vomiting.

Signs and tests

Tests that reveal gallstones or inflammation in the gallbladder:

• Abdominal CT scan
• Abdominal ultrasound
• Gallbladder scan (HIDA scan)
• Oral cholecystogram

Treatment

Surgery is the usual treatment. Surgery to remove the gallbladder (cholecystectomy) can be performed as an open or laparoscopic procedure. The open procedure requires a large cut in the upper-right part of the abdomen. Laparoscopic surgery uses instruments and a small camera inserted through a cluster of a few small cuts.

In patients who are poor candidates for surgery because of other diseases or conditions, the gallstones may be dissolved with medication taken by mouth.

Expectations (prognosis)

Cholecystectomy is a common procedure with a low risk.

Complications

• Cancer of the gallbladder (rarely)
• Jaundice
• Pancreatitis
• Worsening of the condition

Calling your health care provider

Call for an appointment with your health care provider if you develop any symptoms of cholecystitis.

Prevention

The condition is not always preventable. Eating less fatty foods may relieve symptoms in people with acute cholecystitis who have not had their gallbladder removed. However, the benefit of a low-fat diet has not been proven.