Gallstones and Acute Cholecystitis - Understanding Causes, Symptoms, and Management

Introduction:

The gallbladder, situated in the upper right region of the abdomen below the liver, takes the form of a sac-like organ. Bile, a liquid made and released by the liver, is stored in the gallbladder. From the liver, bile enters the gallbladder, where it gets concentrated or gets delivered into the intestine. Before eating, the gallbladder is filled with bile. Once the person consumes food, the gall bladder receives the signal to contract and release the stored bile. Bile enters the small intestine through tubes called bile ducts from the gallbladder. Bile is helpful in the digestion of fats. Removal of the gallbladder from a healthy individual makes no major difference in the functioning of the body.

What Are Gallstones?

Gallstones are also known as cholelithiasis. They are hard substances usually made of cholesterol or bilirubin. Gallstones or biliary stones can be found within the gallbladder or bile ducts, varying in size from as tiny as a grain of sand to as large as a golf ball. The small size gallstones are more troublesome. Gallstones are made up of:

• Cholesterol - These gallstones are most commonly seen. They are greenish in color.

• Bilirubin - These are known as pigmented stones. Bilirubin is formed due to the normal process of the breakdown of red blood cells. It is yellowish in color.

Gallstones found in the bile duct can block the duct and cause a condition called cholangitis.

They can also affect the pancreas and lead to pancreatitis.

What Causes Gallstones to Develop?

The cause of the development of gallstones can be many.

• If the gallbladder does not empty itself completely.

• Presence of too much cholesterol and bilirubin in the bile.

• When there is a sudden loss in body weight.

• Conditions like blood disorders and cirrhosis of the liver (in this condition, the healthy liver tissue is replaced with scar tissue leading to permanent liver damage) can also cause gallstones.

What Is Acute Cholecystitis?

The gallbladder experiences inflammation in a condition known as acute cholecystitis. The gallstones block the cystic duct causing swelling and irritation of the gallbladder and severe pain in the abdomen.

When the bile duct gets blocked temporarily and occurs regularly, it is called chronic cholecystitis. Acute cholecystitis is of two types:

• Calculous Cholecystitis - It is the inflammation of the gallbladder in patients with gallstones. It is more common and is not much severe. About 95 % of all cases suffer from this type. Patients usually suffer from excruciating pain, and the pain worsens with deep breaths. Calculous cholecystitis occurs when the cystic duct gets blocked by a gallstone or biliary sludge, a mixture of bile, small cholesterol, and salt crystals. These blockages cause bile to accumulate in the gallbladder, which increases the pressure in the gallbladder, causing inflammation.

• Acalculous Cholecystitis - This occurs when gallstones are absent. It is less common and more severe than calculous cholecystitis. It develops as a complication of some serious condition or injury, or infection that damages the gallbladder. It can be caused by accidental damage to the gall bladder during major surgery, serious injuries or burns, sepsis, severe malnutrition, human immunodeficiency virus (HIV), or acquired immune deficiency syndrome (AIDS). Some of the signs of acalculous cholecystitis are increased white blood cell count (leukocytosis), gallbladder abscess, gangrene, and decreased intestinal muscle contraction.

What Are the Symptoms of the Gallstones and Acute Cholecystitis?

Gallstones and acute cholecystitis have almost similar symptoms. The symptoms typically vary according to the size of the stones. When there is the presence of stones without any symptoms, such stones are called silent stones, and they do not require any treatment. The following are the signs and symptoms:

• The upper right area of the abdomen is afflicted by an abrupt, intense, agonizing, and enduring pain.

• Associated or referred pain in the right shoulder.

• High body temperature (fever).

• Chest pain.

• Sweating.

• Yellow coloration of skin and sclera (jaundice).

• A bulge in the abdomen.

• Clay-colored or light-colored stools.

• Loss of appetite.

How to Diagnose Gallstones and Acute Cholecystitis?

A few steps in the diagnosis of gallstones and acute cholecystitis are similar and some different. On visiting the doctor, medical history is taken, and the patient is asked about symptoms.

• Physical Examination - Physical examination is done to look for Murphy's sign (the patient is asked to breathe deeply, and the doctor’s hand is on the patient's belly below the rib cage. The doctor would feel the gallbladder moving downwards as the patient breaths, and if cholecystitis is present, the patient will feel sudden pain).

• Blood Tests - Blood tests are done to check for signs of inflammation and rule out any other infection.

Blood tests include:

1. Liver function test.

2. Bilirubin.

3. Complete blood count.

4. Amylase and lipase.

• Ultrasound of the Abdomen - Ultrasound is done to check for gallstones and other problems of the gallbladder.

• CT Scan of the Abdomen - For a detailed examination of the gallbladder.

• X-ray of the Abdomen - A small amount of ionizing radiation is utilized in this examination to generate visual representations of the interior of the abdominal cavity.

• Oral Cholecystography- It is an X-ray procedure to evaluate the gallbladder. A special diet is consumed by the patient before the test, and contrast tablets are also swallowed to help visualize the gallbladder on X-ray.

• Gallbladder Radionuclide Scan - This test uses radioactive material to check gallbladder function. This test is also used to look for bile duct blockage or leak.

• Endoscopic Ultrasound (EUS) - This is a minimally invasive procedure that provides high-resolution images of the gallbladder.

• Cholescintigraphy (HIDA Scan) - This test is done to check whether the gall bladder squeezes properly. This test is done using radioactive material.

• Endoscopic Retrograde Cholangiopancreatography (ERCP) - This procedure is both a diagnostic test and a treatment procedure. An adaptable tube containing a light and camera is introduced into the throat, alongside the introduction of a dye. If stones are present, they can be removed using this same endoscope.

• Magnetic Resonance Cholangiopancreatography (MRCP) - The bile ducts are examined using magnetic resonance imaging (MRI). This test is only a diagnostic test and examines only bile duct stones.

What Is the Treatment of Gallstones And Acute Cholecystitis?

• Silent gallstones need no treatment as they do not show any symptoms. For patients with symptoms, the preferred treatment is the surgical removal of the gallbladder. Though medications are also available to dissolve the stones, this takes a lot of time.

• The best-suited treatment is the surgical removal of gallstones or the infected gallbladder. Cholecystectomy is the medical term for the removal of the gallbladder. This procedure is usually done laparoscopically, which is minimally invasive. The prognosis of the procedure is also very impressive.

• Percutaneous cholecystostomy is an alternative treatment method involving the insertion of a needle into the abdominal area to alleviate the accumulation of fluid in the gallbladder.

What Are the Complications of Gallstones and Acute Cholecystitis?

• Inflammation of gallbladder.

• Blockage of the bile duct.

• Blockage of the pancreatic duct.

• Gallbladder cancer.

Conclusion:

Gallstones and acute cholecystitis can be prevented by having a healthy balanced diet containing low cholesterol and doing regular physical exercise. People should avoid reducing weight drastically and should also avoid skipping meals. Individuals who have an increased susceptibility to this condition, such as females, pregnant women, individuals undergoing hormone therapy, the elderly, individuals who are overweight, and those with diabetes, should exercise additional caution in maintaining a healthy lifestyle. The prevalence of gallstones is higher in northern European people and native Americans and lower in Asians and African Americans.