Cholecystitis

Introduction

Cholecystitis is a medical condition that involves inflammation of the gallbladder, a small organ near the liver, causing severe abdominal pain. The pain is felt more on the right side under the ribs and may also travel down to the back or the right shoulder. It usually worsens during a deep breath. Other symptoms of cholecystitis may include nausea, vomiting and fever. Women are more at risk for developing Cholecystitis. Moreover, the risk increases with advancing age.

Gall bladder – Anatomy

The gallbladder is a hollow pear shaped organ which lies just below the liver. The primary function of the gallbladder is storage and concentration of bile, a thick, yellow-green liquid produced in the liver. Bile aids in the digestion of fatty foods. Stored bile drains out from the gall bladder through a cystic duct into the common bile duct which then opens in the small intestine.

Causes

Most cases of cholecystitis are associated with the presence of gallstones in the gallbladder. Usually gallstones do not cause any problems or symptoms. However, sometimes gallstones may get stuck in the cystic duct, trapping the bile in the gall bladder. The chemicals in the trapped bile cause inflammation of the walls of the gallbladder, causing swelling and pain. The inflamed gallbladder may also get infected.

In rare cases inflammation of the gall bladder may occur due to trauma, such as an injury from a car accident, or as a complication of another severe disease such as HIV or diabetes.

Diagnosis

Usually, an abdominal ultrasound is recommended to diagnose cholecystitis. An abdominal ultrasound can detect the gallstones and also show any thickening of the gallbladder wall. A nuclear scanning test called a gallbladder scan may also be ordered to check for any blockage in the bile ducts carrying bile from the liver and gallbladder to the small intestine.

Treatment

The patient is hospitalized and given fluids and painkillers intravenously. Nothing is given by mouth as the inflamed gallbladder needs to rest. Antibiotics may also be administered intravenously if infection of the gallbladder is suspected.

Doctors wait several days and sometimes several weeks depending on the condition of the patient to let the inflammation settle, before the surgery is performed. Surgery to remove the gallbladder (cholecystectomy) is the main treatment for cholecystitis as the problem may reoccur in the future even when the inflammation has settled completely.

In case of an infection, cholecystectomy needs to be performed timely as delay in surgery may increase the risk of blood poisoning (septicemia), a serious and life-threatening condition. Other complications may also occur that include formation of a channel (fistula) between the gallbladder and gut or rupture of the gallbladder.

Surgery

Of all surgical procedures, for which laparoscopy is an option, cholecystectomy (gallbladder removal) is the most widely recognized and accepted. Where there is inflammation and infection in the gallbladder (Cholecystitis), early removal of the gallbladder may be indicated. Using advanced laparoscopic technology, it is now possible to remove the gallbladder through tiny incisions in the front of the abdomen.

Read more

Conclusion

Cholecystitis is a common condition in people above 60 years. It is treated by surgical removal of the gallbladder for which usually a laparoscopic approach is preferred. Laparoscopic approach has a number of advantages over the open approach which include smaller incision, less post-operative pain, less blood loss during the surgery, lower infection risk and faster recovery time.

After surgical removal of the gallbladder, the bile directly flows from the liver to the small intestine when required and is no longer stored in the gallbladder between meals. This causes little or no effect on the digestive process. Gallbladder removal does not cause any nutritional deficiencies and does not require any special diet after the surgery. The gallbladder is an organ people can live without.