What is Cholecystitis?: Acute Cholecystitis & Chronic Cholecystitis

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What is Cholecystitis?

Cholecystitis that is an inflammation of the gallbladder. It is a small pear-shaped organ attached to the liver on the right side of the stomach, which stores the bile and excretes it in the small intestine to aid digestion of fat.

This disease is caused by the gall bladder blocking the gallbladder due to stimulation and pressure produced in the gall bladder. It can reach inflammation and infection.

How to diagnose cholecystitis ?
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Table of Contents

Acute cholecystitis

The inflammation of the gall bladder is called acute cholecystitis. It causes severe belly pain, sudden swelling and irritation of the gallbladder. If the gall bladder remains trapped, then the gall bladder begins to swell.

Acute cholecystitis causes

The gall bladder is a type of tube that carries substances in and out of the gallbladder. When the stone closes these bile ducts, the bile begins to accumulate, leading to increased pressure in the gall bladder and other problems.

Other Causes

  • HIV or Diabetes
  • Tumors of the gallbladder
  • Serious illnesses
  • Obesity
  • Hormone Therapy
  • Pregnancy

Acute cholecystitis symptoms

The feeling of sharp pain on the right side of the upper abdomen is the main symptom of acute inflammation of the gall bladder; this pain spreads slowly to the shoulder. The pain in this condition is felt continuously and does not heal even for a few hours.

There are other symptoms of gallbladder inflammation such as

  • Stomach bloated feeling
  • Cold
  • Yellowing of skin and white part of the eye
  • Loss of appetite
  • Nausea and vomiting
  • Excessive sweating

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Chronic cholecystitis

Chronic cholecystitis is irritation and swelling of the gallbladder that continues over time. The gallbladder is located under your liver. 

Chronic Cholecystitis Cause

Mainly, chronic cholecystitis is caused by attacks from acute cholecystitis. Most of these attacks are due to gallstones.

Chronic cholecystitis happens more often in women than in men. More common after age 40. Pregnancy and birth control pills are factors that increase the risk for gallstones.

Chronic Cholecystitis Symptoms

Acute cholecystitis is a painful situation that leads to chronic cholecystitis. It is not clear whether chronic cholecystitis causes any symptoms.

  • Fever
  • Clay-colored stools
  • Nausea and vomiting
  • Steady pain lasting about 30 minutes
  • jaundice
To learn more, you can also read: Chronic Cholecystitis With Cholelithiasis

Classification of cholecystitis

Calculus cholecystitis

  • It is the result of cholelithiasis. 
  • In cholelithiasis, there is the formation of gall stones in the gall bladder.
  • This gallstone is formed of the solid constituents of bile and varies significantly in size, shape, and composition.
  • There are two main types of gall stones:
  • Pigment stones. 
  • Cholesterol stones.
  • Risk factors of pigment stones are cirrhosis and infection of the biliary tract. These stones cannot dissolve and should be removed by surgically.
  • Risk fact for cholesterol stones is women’s gender, oral contraceptives, estrogen, and women whose age is more than 40 years; women who are obese.

 Acalculus cholecystitis 

  • In the absence of gall stones, cholecystitis may occur due to severe trauma, burns, cystitic duct obstruction, multiple blood transfusions, and the gall bladder’s primary bacterial infections. 

Causes of Cholecystitis of Cholecystitis

  • Cholelithiasis.
  • Severe trauma.
  • Burns.
  • Primary bacterial infection of the gall bladder.
  • Multiple blood transfusion.
  • Cystic duct obstruction.

Pathophysiology

     Formation of gall stone(pigment stone or cholesterol stone)

                                           ⇓

                                                    Gall stone

                                           ⇓

                                    Obstruction of bile outflow

                                           ⇓

                             Retention of bile in the gall bladder

                                           ⇓

                 Initiation of chemical reaction in the gall bladder

                                           ⇓

                                                       Edema

                                           ⇓

                                     Compression on vessels

                                           ⇓

                             Lack of average blood circulation

                                           ⇓

                                                    Gangrene

Signs and symptoms of Cholecystitis

  • Pain may be silent.
  • Sometimes only mild GI symptoms.
  • Epigastric distress like fullness, abdominal distension, vague upper right quadrant pain, and pain may follow a decadent meal in fried or fatty foods.
  • If the cystic duct is obstructed, the gall bladder becomes distended, inflamed, and eventually infected.
  • Fever
  • Palpable abdominal mass.
  • Excruciating upper right quadrant pain, which is radiating to the back or right shoulder.
  • Nausea and vomiting after heavy meals.
  • Restlessness.
  • Constant or colicky pain.
  • Jaundice accompanied by marked itching with obstruction of the common bile duct in a small percentage of patients.
  • Very dark urine 
  • Grayish colored stool or clay-colored stool.
  • Deficiencies of vitamin A, D, E, K are fat-soluble vitamins.

Assesssment and diagnosis

  • Cholecystogram.
  • Cholengiogram.
  • Celiac axis arteriography.
  • Laparoscopy.
  • Ultrasonography.
  • Endoscopic ultrasonography.
  • CT scans.
  • Endoscopic retrograde cholangiopancreatography(ERCP).
  • Magnetic resonance imaging.
  • Blood tests of serum alkaline phosphatase, gamma-glutamyl, gamma-glutamyl transpeptidase.
  • Cholesterol levels.

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Medical management

  • Medical management’s primary objectives are to reduce acute episodes of gall bladder pain and cholecystitis by supportive and dietary therapy.
  • Nutritional and supportive therapy.
  • Rest.
  • Intravenous fluids.
  • Nasogastric suction.
  • Analgesia and antibiotics.
  • Low-fat diet.
  • Low-fat liquids.
  • High proteins and carbohydrates.
  • Avoid eggs, pork, cream, fried foods, cheese, gas-forming vegetables, and alcohol.

       

Non-surgical removal of gallstones

  • Intracorporeal lithotripsy.
  • Extracorporeal shock wave therapy.
  • Extracorporeal shock wave lithotripsy.

Surgical management

Laparoscopic cholecystectomy

  • It is performed through a small incision or puncture made through the abdominal wall in the umbilicus.

Cholecystectomy

  • This gall bladder is removed through an abdominal incision (usually right subcostal) after the ligation of the cystic duct and the artery.

Minicholecystectomy

  • Through a small incision.

Choledochostomy

  • Here the incision is made into the common duct for stone removal.

Cholecystostomy

  • In this, the gall bladder is opened, and the stone, bile, or purulent drainage is removed.

When to see doctor?

If you have severe abdominal pain, high fever, body ache, or stomach pain causing you discomfort, contact your doctor soon.

conclusion

Cholecystitis is an inflammation of the gallbladder. Most often, it occurs as gall stones. It is caused due to calculous and acalculous cholecystitis, and it obstructs the bile flow.

It causes painful enlargement of the gallbladder. It can be managed by laparoscopic surgery.

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