Cholecystitis is inflammation of the gallbladder , that small pear-shaped organ that is located in the right area of the abdomen, under the liver. Inflammation of the gallbladder is a consequence of the formation of gallstones, which, in turn, produce an obstruction of the cystic duct. In certain cases, it is caused by a chronic inflammation of the gallbladder that can trigger an infectious process.
The obstruction of the cystic duct produces an excessive accumulation of bile which, upon inflaming the gallbladder, triggers severe abdominal pain. Its treatment is of vital importance, because it can develop serious complications such as rupture of the gallbladder that, in many cases, puts the patient’s life at risk.
Types of cholecystitis
Depending on the severity of the symptoms and their duration, cholecystitis is classified as:
- Acute cholecystitis. It is a sudden inflammation of the gallbladder that causes severe pain in the upper abdomen . Sometimes, the discomfort extends to the shoulder blades.
- Chronic cholecystitis It refers to inflammation of the gallbladder that persists for a long period of time due to recurrent episodes of acute cholecystitis. It can be aggravated to such an extent that the organ loses its ability to function properly.
Causes of cholecystitis
Inflammation of the gallbladder is usually caused by the accumulation of bile, due to an obstruction of the tube through which it is released. Its main causes are:
- Gallstones. Gallstones are hard stones that obstruct the cystic duct, preventing bile from leaving the gallbladder, which triggers an inflammatory process in the organ.
- Tumor. When a tumor forms, it can also interfere with the flow of bile that releases the gallbladder. By accumulating inside, can cause cholecystitis.
- Obstruction of the bile ducts. A deformation of the bile ducts, or the formation of scars in it, can lead to obstructions.
- Infections AIDS and other infectious diseases can cause inflammation of the gallbladder.
- Problems in the blood vessels. Some chronic diseases cause damage to the blood vessels and, as the flow of blood to the gallbladder decreases, it tends to become inflamed.
Symptoms of cholecystitis
Often, the symptoms of cholecystitis manifest after eating , especially if the meals were copious or high in fat. When it becomes a chronic problem, the discomfort is more severe and recurring. Symptoms include:
- Pain in the upper right or middle of the abdomen
- Pain that extends to the right shoulder or back
- Pain with abdominal palpation
- Nausea and vomiting
- Fever (if there is infection)
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To diagnose cholecystitis the doctor performs an evaluation of the patient’s symptoms as well as imaging tests. The tests and procedures used may include:
- Blood test
- Abdominal ultrasound
- Endoscopic ultrasound
- Computed tomography
- Biliary scintigraphy
Treatment of cholecystitis
The first measure to treat patients with cholecystitis, whether acute or chronic, is hospitalization. There they are given fluids and electrolytes intravenously and are not allowed to eat or drink. In addition, the symptoms will be treated with different drugs and procedures:
- Intravenous antibiotics (in case of infection)
- Procedure to remove stones: The doctor may perform a procedure called endoscopic retrograde cholangiopancreatography to remove gallstones.
With the timely medical intervention, the symptoms are likely to disappear in two or three days. However, if the problem persists, most patients should undergo gallbladder removal surgery.
The surgery of extraction of the vesicle is a minimally invasive intervention in which small incisions are made in the abdomen (laparoscopic cholecystectomy). The doctor considers this procedure if:
- The diagnosis of acute cholecystitis is confirmed and the risk of surgery is small.
- The patient is older or diabetic
- Suspected complications such as abscess, gangrene or perforation of the gallbladder.
- In case of acalculous cholecystitis.
A small number of patients say they feel pain even when the gallbladder has already been removed. This phenomenon is known among doctors as post-cholecystectomy syndrome and its cause is unknown.
- Glasgow RE, Mulvihill SJ. Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology / Diagnosis / Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016: chap 66.
- Jackson P, Evans S. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012: chap. 55
- Wang DQH, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology / Diagnosis / Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016: chap 65