Cholecystitis is inflammation of the gallbladder, a small organ near the liver that plays a part in digesting food. Normally, fluid called bile passes out of the gallbladder on its way to the small intestine. If the flow of bile is blocked, it builds up inside the gallbladder, causing swelling, pain, and possible infection.
Cholecystitis is the medical word used to describe inflammation of the gall bladder. The gallbladder is a pear shaped sac lying just under the liver. It is where bile is stored. It is usually caused by obstruction of the exit duct of the gallbladder.
There may be no stone involved (acalculus).
Sometimes a semi-solid stone still in formation called sludge is the culprit.
Even though for the most times bacterial infection is associated with disease, it is believed that the infection is a consequence and not the cause of the disease. This makes sense as it is usually the stone or sludge that causes irritation before the bugs get in.
As explained in the section on gallbladder diseases, gallstones are formed when bile, which is produced in the liver and stored in the gallbladder, looses so much water and becomes very concentrated that it super saturates. Crystals are then formed.
These crystals aggregate to form gallstones.
The stones may be silent, causing no problem or symptoms.
Over time, the stones may multiply in number or grow in size or both and cause continuous irritation to gallbladder. The gallbladder then become inflamed, the same as your skin could become sore from continuous scratches and banging by a rough stone.
Bugs then get into this inflammatory soup formed.
This disease is more common in the fair, fat, fertile, female, of forty or fifty-something years old, of northern European origin.
Having said that, any body, from any age and race can suffer from this disease.
Patients with sickle-cell disease are also prone to gallstones and thus Cholecystitis from repeated haemolysis, forming lots of pigment stones from the break down products of red blood.
symptoms
Symptoms tend to develop quite quickly, over a few hours or so.
They include : -
Pain in the upper abdomen, usually worse on the right side under the ribs. The pain may radiate (travel) to the back or to the right shoulder. The pain tends to be worse if you breathe in deeply.
Nausea (feeling sick) and vomiting.
Fever (high temperature).
causes
A gallstone stuck in the cystic duct, a tube that carries bile from the gallbladder, is most often the cause of sudden (acute) cholecystitis. The gallstone blocks fluid from passing out of the gallbladder. This results in an irritated and swollen gallbladder. Infection or trauma, such as an injury from a car accident, can also cause cholecystitis.
Acute acalculous cholecystitis, though rare, is most often seen in critically ill people in hospital intensive care units. In these cases there are no gallstones. Complications from another severe illness, such as HIV or diabetes, cause the swelling.
Long-term (chronic) cholecystitis is another form of cholecystitis. It occurs when the gallbladder remains swollen over time, causing the walls of the gallbladder to become thick and hard.
symptoms
The most common symptom of cholecystitis is pain in your upper right abdomen that can sometimes move around to your back or right shoulder blade.
Other symptoms include : -
Nausea or vomiting.
Tenderness in the right abdomen.
Fever.
Pain that gets worse during a deep breath.
Pain for more than 6 hours, particularly after meals.
Diagnoses
Medical History
Clinical examination
Abdominal X-ray
Ultrasound
Treatment
Treatment for cholecystitis will depend on your symptoms and your general health. People who have gallstones but don't have any symptoms may need no treatment. For mild cases, treatment includes bowel rest, fluids and antibiotics given through a vein, and pain medicine.
The main treatment for acute cholecystitis is surgery to remove the gallbladder (cholecystectomy). Often this surgery can be done through small incisions in the abdomen (laparoscopic cholecystectomy), though sometimes it requires a more extensive operation. Your doctor may try to reduce swelling and irritation in the gallbladder before removing it.
Occasionally acute cholecystitis is caused by one or more gallstones becoming stuck in the main tube leading to the intestine, called the common bile duct. Treatment may involve an endoscopic procedure (endoscopic retrograde cholangiopancreatography, or ERCP) to remove the stones in the common bile duct before the gallbladder is removed.
In rare cases of chronic cholecystitis, you may also receive medicine that dissolves gallstones over a period of time.
complications
If treatment is delayed or not available, in some cases the gallbladder becomes severely infected and even gangrenous. This can lead to blood poisoning (septicaemia), which is very serious and can be life-threatening. Other possible complications include: the gallbladder may perforate (burst), or a fistula (channel) may form between the gallbladder and gut as a result of continued inflammation.
Q. Who gets it ?
Cholecystitis strikes twice as many women than men, particularly those between the ages of twenty and sixty. Pregnant women, or those on birth control pills or estrogen replacement therapy have a greater risk of developing cholecystitis. People who are overweight, or who lose a large amount of weight quickly are also at greater risk for developing the condition.
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