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Cholecystitis

Introduction

Although gallbladder infection can occasionally occur in certain circumstances, cholecystitis is usually an inflammation of the gall bladder wall, often without any infection.

It comes from the closing of the cystic duct, which can lead to a swelling of the gall bladder wall and fluid in the surrounding area (inflammatory exudate).

The word “cholecystitis” is doctor language, but is easy to understand: the first part”chole-” means “gall”, the second part “cystitis” means “bladder inflammation” or “bladder infection”. In this case it would mean “gall bladder inflammation”.

Gall bladder symptoms

Symptoms are very similar to the symptoms described under cholelithiasis (gall stones) and there is evidence the two travel side by side. It appears that cholecystitis is caused from the presence of gall stones or sludge that leads to intermittent obstruction of the cystic duct. A typical attack then would start with a colicky pain (biliary colic) perhaps following a fatty meal. The pain is severe and nausea and vomiting may also occur at the same time. This pain in the right upper abdomen may also be felt in the right lower shoulder blade. The pain then subsides in about 2 or 3 days and is gone in 1 week. During the peak of the pain the patient likely has to be hospitalized and tests are performed.

 Cholecystitis

Cholecystitis

Diagnosis

Cholescintigraphy (gallbladder scan) is done with intravenous iminodiacetic acid compounds that are labeled with radioactive technetium 99m. This compound is metabolized by the liver and sent through the bile ducts into the gall bladder and the duodenum.

However, with acute cholecystitis the gall bladder is not visualized, whereas the liver and bile ducts are normal. This would be a positive test to indicate the presence of acute cholecystitis. Ultrasound (=sonography) studies show the thickening of the gall bladder wall, and the fluid in the surrounding area of the gall bladder (inflammatory exudate).

The differential diagnosis (= considering alternative diagnoses) of cholecystitis should include such things as gangrene and perforation of the gall bladder. This is a life threatening condition, where peritonitis ensues. Immediate intervention by a surgeon through a laparotomy needs to be done. Acute acalculous cholecystitis (=cholecystitis without the presence of gall stones) is another serious illness, which is treated by intravenous feeding of the patient and cholecystectomy as soon as this can be safely done.

Treatment

As mentioned before patients are hospitalized and intravenous rehydration is done. No oral feeding is given and a nasogastric tube removes all the digestive secretions. If infection is suspected from the clinical presentation and the blood tests, intravenous antibiotics are given. As said before, the patient usually settles within 3 days. The surgeon will decide whether to do an early or a delayed cholecystectomy. This depends on the clinical presentation.

Chronic cholecystitis

This condition is associated with a chronically diseased gall bladder. The gall bladder wall is thick and fibrotic and it may contain sludge or gall stones. The patients may have had the typical gall stone symptoms or may now experience them for the first time. The common denominator is that all these patients have evidence of chronic gall bladder disease and that they need gall bladder surgery to stop the gall bladder attacks. Many patients suffer quietly and try to remedy their symptoms with a”gall bladder diet”. However, these patients need a laparoscopic gall bladder surgery (cholecystectomy) and will then be symptom free. It still makes sense to go on a low fat diet, aim for a normal weight and to regulate the bowel habits by high fiber food intake (salads, vegetables, full grain products).

 

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Last modified: September 12, 2014

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.