Acute Cholecystitis – Causes, Symptoms, Diagnosis, Complications and Treatment

Acute Cholecystitis

(AC) is a condition which is characterized by the severe inflammation of the gall bladder. The gall bladder is the organ which stores the bile produced by the liver. It releases it to the duodenum, the first part of the small intestine to help with the digestion of the food.

gall bladder

When the bile in the gall bladder is restricted from flowing out of it because of a gall stone or tumor blocking the way, the bile gets accumulated in the gall bladder. The bile is a pale yellowish substance which has acidic properties and plays a major role in the metabolism of carbohydrates and sugar. It irritates and corrodes the gall bladder and the increased pressure causes it to get inflamed. Bacterial infection also follows.

Causes of Acute Cholecystitis

  • 90% of the times the condition is caused by cholelithiasis or the presence of gall stones in the gall bladder. Calculus or calcium deposits form into gall bladder sludge and stones, and get lodged in the neck of the gall bladder or the cystic duct. The bile is thickened and the organ gets infected with the backflow of the bacteria from the gut like E. Coli and those of the bacteroides species.
  • Micrograph of a gall bladder with cholecystitis

  • The walls of the gall bladder are inflamed. Intrinsic pressure may cause perforation in the wall of the organ and consequent destruction or necrosis of cells.

  • 10% of the cases may be caused without the presence of gall stones. Children or adults who are severely ill and who have undergone severe physical stress and trauma as in burns, injury or trauma may develop the condition without any trace of gall stones. This is known as Acute Acalculous Cholecystitis.

Symptoms of the Condition

  • Acute abdominal pain in the upper right quadrant.
  • In the beginning, the pain may be located in a completely different area especially in the right scapula (between the collar bone and the shoulder).
  • The pain may increase after eating fatty, greasy and oily foods.
  • An increase in the body temperature is seen because of the resulting infection.
  • Diarrhea, Vomiting, Nausea and granulocytosis ( increase in a type of white blood cells).
  • The gall bladder is swollen and tender.
  • Bloating and abdominal fullness.
  • Severe symptoms include very high fever and jaundice (yellowing of skin and eyes).
  • Perforation, formation of abscess and cholangitis ( infection and inflammation of the bile duct) are also some of the severe symptoms.
  • The formation of a small connection (fistula) between the the ruptured gall bladder and nearby small bowel could also occur in extreme situations. This condition is known as gallstone ileus.

Diagnosis of the condition

  • Blood Tests

    : A blood test may reveal an increase in the the liver enzyme Alkaline Phosphatase, pancreatic enzyme amylase, bilirubin levels and an increase in the WBC count. CRP (C-Reactive Protein) Is elevated in case of an accompanying infection.The higher the levels of these biochemical markers, the higher is the degree of inflammation and infection.

  • Abdominal ultrasound
  • Abdominal ultrasonography
  • Abdominal Xray
  • Oral Cholecystogram
  • Gall bladder radionuclide scan

Complications from the condition

  • Gall Bladder Perforation

    : It has the potential of turning into a life threatening condition. The perforation can be at the neck of the organ or in the peritoneal cavity ( the cavity between the membranes in the wall). This along with the infected bile can make the situation very grave.

  • Ascending Cholangitis

    : It is the swelling and infection of the bile duct.

  • Rokitansky- Aschoff sinuses

    : The development of diverticula or pockets in the gall bladder.

Treatment of Acute Cholecystitis

  • Intravenous antibiotics are administered to manage and arrest the infection. Intravenous drip also enables fluid resusciation.
  • When the inflammation and infection is severe, the only option would be surgical removal of the gall bladder (cholecystectomy). Surgery can be a traditional open surgery or done laproscopically which is a minimally invasive procedure.
  • The most important pointer here would be the immediate attention to the problem which will help to prevent further complications.

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