Introduction
Inflammation of the gallbladder is cholecystitis. The main cause of this inflammation is blockage of the cystic duct. The condition is independent of the presence of gallstones. It can be both acute and chronic. The symptoms include extensive venous congestion and swelling. Gradually there is fibrosis and chronic inflammation. The treatment depends on the severity of the infection as it can be treated by surgery and conservatively.
What Are the Causes of Cholecystitis?
The etiology behind cholecystitis is blockage of the cystic duct, which causes inflammation and infections in the future. The gallbladder is the storage organ for the bile, produced in the liver and travels down through the bile duct. After intake of certain spicy and greasy food items, the gallbladder releases the bile to the duodenum through the cystic duct. About 95 % of cases of cholecystitis are associated with gallstones.
When a stone causes a blockage in the cystic duct, it is known as acute calculous cholecystitis. Sometimes, the obstruction can be temporary due to gallstones, known as biliary colic. The biliary colic is considered acute calculous cholecystitis if the pain does not resolve within six hours. Cholecystitis without any stone as a cause of blockage is known as acute acalculous cholecystitis.
How Is Gallstone Formed?
The gallbladder can not secrete bile, but it can collect it, which becomes concentrated. This concentrated bile forms gallstones through precipitation when the homeostasis is disrupted. The disruption can occur due to the following reasons:
-
Abnormalities in the process of concentration of the bile.
-
Bile Stasis: Obstruction in the pathway of bile flow.
-
Supersaturation of cholesterol and lipids in the liver.
-
Growth and nucleation of cholesterol crystals in the bile occur rapidly after the aggregation of supersaturated vesicles.
Which Population Is More Prone to Cholecystitis?
The cases of cholecystitis are more in women than men. Women who are obese, pregnant, or around the age of 40 are more prone to disease.
What Are the Symptoms of Cholecystitis?
-
In the early phase of the disease, the gallbladder reveals extensive venous congestion (feeling of stuffiness or stress) and edema (swelling).
-
Gradually there is fibrosis (formation of fibrous connective tissue response to an injury on damage) and inflammation in the gallbladder.
-
There can be gallbladder perforation, sepsis, and death in some severe cases.
-
Pain in the upper abdominal region followed by bloating. Bloating is a feeling of tightness and fullness in the abdomen due to gas.
-
Intolerance to oily and spicy foods.
-
Nausea, vomiting, and gas in the abdomen.
-
There can be pain in the mid-back and shoulder region in some cases.
-
Murphy's sign is a classic feature of this disease. The patient is asked to breathe in and hold the right subcostal area of the abdomen. If there is pain on inspiration, the inflamed gallbladder comes into contact with the examiner's hand. It depicts Murphy's sign.
-
The onset of an acute attack is generally followed by intake of some oily or spicy food.
What Are the Complications in the Gallbladder in Severe Cases?
The gallbladder walls swell, and there is a lack of oxygen supply (ischemia), which leads to gangrene formation. If the gangrene persists for a long time without treatment, there is infection from gas-forming organisms causing acute emphysematous cholecystitis. The infection can further cause perforation, which is life-threatening.
How to Diagnose Cholecystitis?
-
Blood Tests: A complete blood test is important to evaluate the white blood cells count. In cases of cholecystitis, the white blood cells count is always elevated.
-
Liver Function Test: The evaluation of enzymes of the liver is important as they help diagnose the presence of stone or any obstruction in the biliary duct. In cholecystitis, there is an elevation in liver enzymes. Also, it is observed that an increase in levels of bilirubin above two signifies the presence of stone in the bile duct.
-
Amylase and Lipase Test: Amylase and lipase elevation is important to rule out chances of pancreatitis.
-
Computed Tomography (CT) Scan: Gallstones or cholecystitis is visible in the imaging.
-
Ultrasound: The swelling on the gallbladder wall and gallstones can be located with an ultrasound procedure.
-
Hepatobiliary Iminodiacetic Acid (HIDA) Scan: This method is recommended in cases of acute cholecystitis. It helps to observe the functions of the gallbladder and any cystic duct obstructions. In this scan, a radioactive tracer is injected inside a vein in the arm. The trace travels through the blood to the liver, where it is absorbed by bile-producing cells. These cells then carry the tracer with the bile to the gallbladder and then to the intestine.
-
In cases of acalculous cholecystitis, cholecystokinin (CCK) helps to diagnose.
What Is the Treatment of Cholecystitis?
-
The treatment of choice for cholecystitis is laparoscopic cholecystectomy. It is the least invasive cholecystectomy removal of the gallbladder performed through four small incisions, a camera that helps to visualize inside the abdomen, and a few long tools to remove the gallbladder. The surgery is done after anesthesia administration. The patient can return home either on the same day or the next day of surgery.
-
In some cases of acute illness and poor surgical condition, treatment can be temporary percutaneous drainage of the gallbladder.
-
A proper diet with low-fat and low spices can be advised in cases of mild chronic cholecystitis.
What Are the Complications of Cholecystitis?
-
Hepatic Injury: The perforation of the biliary duct or gallbladder walls can also infect the liver. It can lead to injury in the liver.
-
Biloma: Biloma can be defined as an abnormal, circumscribed collection of bile outside the biliary duct.
-
Retained Stones in the Bile Duct: The gallstones can travel to the biliary duct and get stuck there, thus causing bile obstruction.
-
Bleeding: Infections such as gangrene and perforations in the gallbladder can lead to bleeding from the walls.
What Are Similar Diseases to Cholecystitis?
-
Cholangitis: Inflammation of the bile duct system due to any bacterial infection. The bile duct carries bile from the liver to the gallbladder and the intestine.
-
Mesenteric Ischemia: A shortage of blood in a portion of the intestine due to blockage in an artery. The sudden loss of blood flow leads to the formation of a clot which should be treated immediately by surgery.
-
Biliary Colic: Abdominal pain due to obstruction by the stone in the biliary tube's common bile duct or cystic duct.
-
Appendicitis: Inflammation of the appendix causing severe abdominal pain on the right side of the abdomen.
-
Peptic Ulcer Disease: Inflammatory lesion on the lining of the stomach and intestines with bleeding and infection.
Conclusion:
Cholecystitis is the inflammation of the gallbladder due to cystic duct blockage mainly. Most cases are related to a gallstone (calculous); however, a few could be independent of it (acalculous). The major symptoms include abdominal pain and bloating of the stomach; in some severe cases, there can be perforation of the gallbladder, sepsis (infection throughout the body), and death. The treatment is less invasive than laparoscopic cholecystectomy, whereas in some cases, only gallbladder draining can cure the disease.
