Is Cholecystitis an Emergency? | Gastroenterology


What is cholecystitis?

Cholecystitis is an inflammation of the gallbladder. The gallbladder is a small, pear-shaped organ on the right side of your abdomen, just below the liver. The gallbladder contains digestive fluid that is released into the small intestine (bile).

In most cases, gallstones that block the tube that exit the gallbladder cause cholecystitis. This outcome is the development of bile can cause aggravation. Other causes of cholecystitis include bile duct problems, tumors, serious illnesses, and some infections.

If left untreated, cholecystitis can lead to serious, sometimes life-threatening complications, such as a rupture of the gallbladder. Cholecystitis treatment often includes cholecystectomy.

Types of cholecystitis

There are two types of cholecystitis:

  • Acute cholecystitis is a sudden inflammation of the gallbladder that causes noticeable pain in the abdomen and is often accompanied by nausea, vomiting, and fever.
  • Chronic cholecystitis is a long-lasting and less severe inflammation of the gallbladder. It may be caused by recurring episodes of acute cholecystitis. Chronic cholecystitis may cause dull, intermittent pain in the abdomen, or it may cause no symptoms at all. Damage to the walls of the gallbladder leads to the gallbladder thickening and scarring. At last, the gallbladder can contract and lose its capacity to store and deliver bile.

Symptoms of cholecystitis

Symptoms may include acute cholecystitis:

  • You may feel discomfort in the middle of the upper abdomen, just below the breastbone, or in the upper right part of the abdomen, near the gallbladder and liver. In certain individuals, the torment reaches out to the correct shoulder. Symptoms usually start after eating.
  • Fever and possibly chills
  • Nausea and/or vomiting
  • Jaundice (yellowing of the skin or eyes), dark and pale urine, and grey bowel movements. These symptoms appear when gallstones exit the gallbladder into the common bile duct, blocking the flow of bile out of the liver.

When gallstones in the common bile duct block the flow of bile from the liver into the intestine, a patient may develop a serious infection of the bile ducts called cholangitis. Typical symptoms of cholangitis are fever, right upper abdomen pain, and jaundice. Another potential problem that may occur when gallstones pass into the common bile duct is acute pancreatitis (inflammation of the pancreas). Since the duct from the pancreas also flows into the common bile duct, a gallstone can block the pancreas, causing it to become inflamed. Like cholangitis, acute pancreatitis can be dangerous.

The main symptom of chronic cholecystitis is usually intermittent pain. However, some people do not have any symptoms. In the event that there is torment, it is normally gentle and goes back and forth. These somewhat nonspecific symptoms accompany many other diseases, so you may not be diagnosed with chronic cholecystitis until you develop an episode of severe symptoms during a sudden attack.

What causes cholecystitis?

Cholecystitis is usually caused by gallstones blocking the cystic duct, preventing bile from leaving the gallbladder. The gallbladder becomes swollen and may become infected with bacteria. Less common causes include blockage of the bile ducts due to scarring, decreased blood flow to the gallbladder, tumors that block the flow of bile from the gallbladder, or viral infections that cause cholecystitis.

How is cholecystitis diagnosed and evaluated?

Your doctor may order blood tests to see if you have a gallbladder infection. Often times, the number of white blood cells in our blood may increase as a sign of infection. One or more of the following imaging tests may also be done:

  • Abdominal ultrasound: This is often the first test done to evaluate for cholecystitis. Ultrasound uses sound waves to produce images of your gallbladder and bile ducts. It is used to identify signs of inflammation in the gallbladder and is very good at showing gallstones.
  • Abdominal CT: A computerized tomography (CT) scan uses X-rays to produce detailed images of the abdomen, liver, gallbladder, bile ducts, and intestine to help identify cholecystitis or blockage of bile flow. Sometimes (but not always) gallstones can also appear. See the radiation dose page for more information on the CT scan.
  • Magnetic resonance cholangiopancreatography (MRCP): MRCP is a type of magnetic resonance imaging scan that makes detailed images of the liver, gallbladder, bile ducts, pancreas, and pancreatic duct. It is very good at showing gallstones and inflammation of the gallbladder or bile duct and by preventing the outflow of bile. See the MRI Safety page for more information.
  • Hepatobiliary nuclear imaging: This nuclear medicine test uses an injected radioactive tracker to help evaluate disorders of the liver, gallbladder, and bile duct (biliary system). In acute cholecystitis, it can detect the blockage of the cystic duct (the duct that is always blocked by acute cholecystitis).

Risk factors for cholecystitis

You have a higher chance of developing this disease if you are:

  • She was a woman over 50 years old
  • I was a man over 60 years old
  • Are overweight
  • Have diabetes
  • pregnant

Or if you have it:

  • Heart disease
  • Kidney disease in the final stage
  • Hyperlipidemia (when your blood contains a lot of fats)
  • Lose weight quickly

You also have a higher chance of getting it if your diet is high in fat and cholesterol or your ancestors are Native American, Hispanic, or Scandinavian.

Cholecystitis treatment

  • A patient with this disease will be hospitalized and may not be allowed to eat any solid or liquid foods for some time. They will be given fluids intravenously while fasting. Pain medications and antibiotics may also be given.
  • Surgery is recommended for acute cholecystitis due to the high frequency of inflammation associated with gallstones. However, if there is a low risk of complications, surgery may be performed as an outpatient procedure.
  • If there are complications, such as gangrene or gallbladder perforation, the patient will need immediate surgery to remove the gallbladder. On the off chance that the patient has a disease, a cylinder might be embedded through the skin into the gallbladder to deplete the contamination.
  • Cholecystectomy can be performed by open or laparoscopic laparotomy.
  • Laparoscopic cholecystectomy involves several small incisions in the skin. A camera is inserted into one incision to help the surgeon see inside the abdomen and tools to remove the gallbladder and insert it through other incisions.
  • The benefit of laparoscopy is that the incisions are small, so the patient usually feels less pain after the procedure and less scarring.
  • After your gallbladder is surgically removed, bile will flow directly into the small intestine from the liver. This does not usually affect the patient’s general health and digestive system. Some patients may have repeated episodes of diarrhea.

Complications of cholecystitis

Sometimes, It can cause different issues including:

  • Infection and accumulation of pus in the gallbladder
  • Tissue death in the gallbladder (gangrene)
  • An injury to the bile duct that could affect the liver
  • Infection and inflammation of the pancreas (pancreatitis)
  • Infection and inflammation of the lining of your abdomen (peritonitis)

If your gallbladder isn’t removed and you have more bouts of cholecystitis, you may develop long-term (chronic) cholecystitis.

Chronic cholecystitis may not cause any symptoms. But it can damage the gallbladder walls. The walls can be deformed and become thicker. Your gallbladder will begin to shrink. Over time, you’ll be less able to store and excrete bile. You will need surgery to remove your gallbladder.

Prevention of cholecystitis

You can reduce your risk of developing this disease by taking the following steps to prevent gallstones:

  1. Lose weight slowly: Quick weight reduction can expand the danger of gallstones. If you need to lose weight, aim to lose 1 or 2 pounds (0.5 to about 1 kg) per week.
  2. Maintain a healthy weight: Being overweight makes you more likely to develop gallstones. To achieve a healthy weight, reduce calories, and increase your physical activity. Maintain a healthy weight by continuing to eat healthy food and exercise.
  3. Choose a healthy diet: Diets high in fat and low in fibre may increase the risk of developing gallstones. To reduce your risk, choose a diet rich in fruits, vegetables, and whole grains.

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