CHOLECYSTITIS
Cholecystitis is an inflammation of the gallbladder.
- The gallbladder is a four-inch, pear-shaped organ on the right side of the abdomen, beneath the liver.
- The gallbladder stores bile made by the liver. Bile is a combination of fluids, fat, and cholesterol.
- The gallbladder travels through the cystic duct and delivers bile into the small intestine via the common bile duct, the bile helps to break down food in the intestine allowing for easy absorption of fat-soluble vitamins and nutrients into the bloodstream.
- The common bile duct connects the liver, gallbladder, and the pancreas to the small intestine.
- Cholecystitis can be acute or chronic.
- It can become chronic if it persists for a prolonged period of time, or if their recurring symptoms from the inflammation are present.
- If left untreated, cholecystitis can lead to serious, life-threatening complications, such as gallbladder rupture, tissue death, or infection within the gallbladder.
Causes
- Gallstones- the most common cause of the condition is gallstone obstructing the bile ducts. This blockage leads to a buildup of bile in the gallbladder, causing the gallbladder to be inflamed. About 10-15% of adults in the developed world have gallstones. Women get gallstones more often than men and more commonly after age 40. Gallstones are involved in 95% of cholecystitis. The risk factors for gallstones include female sex, obesity, increasing age, diabetes mellitus, oral contraceptives, rapid weight loss.
- Tumor – a tumor may prevent bile from draining out of the gallbladder, causing bile buildup that can lead to cholecystitis.
- Scarring of the bile duct – scarring of the bile ducts can cause bile ducts blockage that can lead to cholecystitis
- Decreased blood supply to the gallbladder especially from diabetes
- Immunodeficiency such as AIDS can trigger gallbladder inflammation
Symptoms
- Fever
- Vomiting
- Nausea
- Severe pain in the upper right or center quadrant of the abdomen
- Little or no appetite
- Tenderness over the abdomen when touched
- Chills
- Pain that spreads to the back or below the right shoulder blade
- Jaundice may occur but it is often mild. Jaundice is the yellowing of the skin and the white of the eyes.
- Loose, light-coloured stool.
These symptoms usually worsen after a meal that is high in fat.
DIAGNOSIS AND TREATMENT
The doctor will take your medical history and carry out a physical exam. The symptoms of cholecystitis are similar to those of other conditions, so the doctor must rule out those conditions.
The following test aid the doctor in making a diagnosis:
- Blood tests – these may be ordered to look for signs of infection in the bloodstream
- Ultrasound – to show any gallstones and may show the condition of the bladder
- CT scan- can be used to create an image of the gallbladder that may reveal signs of cholecystitis or stones in the bile ducts and gallbladder.
- A hepatobiliary iminodiacetic acid (HIDA) scan – creates pictures of the liver, gallbladder, biliary tract and small intestine. It tracks the production and flow of the bile from the liver to the small intestines showing blockage.
TREATMENT
Treatment option may include hospitalization to control the inflammation in the gallbladder. Sometimes surgery is needed.
- Fasting to take stress off the inflamed gallbladder
- You will be given fluids intravenously that help prevent dehydration while fasting
- Antibiotics to fight off infections and pain medications can also be given
- The doctor may remove any stones blocking the bile ducts or cystic duct using a procedure called endoscopic retrograde cholangiopancreatography (ERCP)
If complications such as gallbladder rupture is present, the patient will need immediate surgery to remove the gallbladder.
The surgical procedure involves removal of the gallbladder, termed cholecystectomy. This is done either by open abdominal excision or laparoscopically.
Open abdominal excision is rarely required.