Introduction
First of all, cholecystitis is usually an inflammation of the gall bladder wall, often without any infection. It is important to realize that it comes from the closing of the cystic duct. This can lead to 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
In the first place, symptoms are very similar to the symptoms described under cholelithiasis (gall stones). Furthermore, there is evidence the two travel side by side. In like manner, it appears that cholecystitis is caused from the presence of gall stones or sludge. This can lead to intermittent obstruction of the cystic duct, in the meantime. A typical attack would start in due time with a colicky pain (biliary colic) following a fatty meal. At the same time, the pain is severe and nausea and vomiting may also occur. This pain typically locates in the right upper abdomen. But it can travel to the right lower shoulder blade. Probably the pain then subsides in about 2 or 3 days and is often gone in 1 week. As a matter of fact, during the peak of the pain the patient likely is hospitalized and tests are performed.
Cholecystitis
Diagnosis
Cholescintigraphy (gallbladder scan) is done without delay 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. To summarize, this would be a positive test to indicate the presence of acute cholecystitis. In addition, ultrasound (=sonography) studies show the thickening of the gall bladder wall. There is also 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. A surgeon does a laparotomy immediately. Acute acalculous cholecystitis (=cholecystitis without the presence of gall stones) is another serious illness. It is treated by intravenous feeding of the patient and cholecystectomy as soon as this can be done safely.
Treatment
As shown above, the physician is hospitalizing a patient with cholecystitis and and treating with intravenous rehydration. In any event, there is no oral feeding and a nasogastric tube removes all of the digestive secretions. Overall, if the clinical presentation and the blood tests suggest infection, the physician administers intravenous antibiotics. As said before, the patient usually settles within 3 days. The surgeon will decide whether to do an early or a delayed cholecystectomy. In essence, 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. But they may now experience them for the first time. The common denominator is that all these patients have evidence of chronic gall bladder disease. 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). Then they become symptom free. It still makes sense to go on a low fat diet. It also makes sense to aim for a normal weight. And it is advisable to regulate the bowel habits by high fiber food intake (salads, vegetables, full grain products).
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