Generality
Acute cholecystitis is inflammation of the gall bladder, which develops over a short period of time, usually due to gallstones.
Acute cholecystitis produces a stabbing abdominal pain, which lasts several hours; furthermore, it can cause: nausea, vomiting, fever, weight loss, jaundice, abdominal swelling, sweating and pale stools.
In general, a physical examination, anamnesis, blood tests and abdominal ultrasound are sufficient to make the diagnosis of acute cholecystitis; it can happen, however, that the doctor wants to deepen the research with more specific exams, such as the magnetic resonance in the abdomen, the abdominal CT, the hepatobiliary scintigraphy and / or the cholangiography.
Acute cholecystitis requires hospitalization, because through this the patient can hope for optimal healing.
Short review of what is the gallbladder or gall bladder
Belonging to the digestive system, the gall bladder (or gallbladder ) is a small hollow organ, located between the chest and abdomen, on the right half of the human body, which has the important task of storing and releasing in the small intestine, at the time of need, bile, which is the yellow-greenish liquid secreted by the liver, on which the digestion of fats depends.
Clearly, in order to fulfill the aforementioned functions, the gall bladder is in connection both with the liver (from which the bile comes) and with the small intestine (which is the seat of discharge of the bile); to sanction this connection are the so-called bile ducts (or bile ducts ).
What is Acute Cholecystitis?
Acute cholecystitis is the medical expression that describes the inflammation of the gall bladder with abrupt and sudden onset.
Causes
Acute cholecystitis recognizes several causes.
In most cases (95% of the circumstances), it is due to the presence of gallstones (or gallstones ); more rarely, it is the consequence of a cancer of the gallbladder or biliary tract, a traumatic injury affecting the bile ducts or the gall bladder itself, a serious state of malnutrition, a serious infection (eg: AIDS) or a vascular disease, such as which the gall bladder does not receive the right blood supply.
To generally define the first situation (in which the cause is gallstones), doctors use the expression calculous acute cholecystitis, while, to describe the second situation in general (in which the cause is a condition different from gallstones), they use the expression acalculosa acecchiata (or non-calculata).
How Biliary Calculi Cause Acute Calculative Cholecystitis
Gallstones (or gall bladder stones or gallstones) are small solid aggregates that form inside the gall bladder, after an abnormal precipitation process of some bile constituents.
Gallstones become the cause of acute cholecystitis, at the moment they obstruct the cystic duct (that is, the channel for leaking bile from the gallbladder) and involve the stagnation of bile inside the gall bladder.
Did you know that ...
- There are 2 types of gallstones: cholesterol gallstones, which characterize more than 80% of clinical cases, and pigmented gallstones, which distinguish the remaining percentage of clinical cases.
In cholesterol gallstones, the aggregates that are the result of the abnormal precipitation process are - as is easily understood - based on cholesterol; in pigmented gallstones, however, unusual aggregations contain bilirubin, the pigment that gives color to bile and derives from the degradation of hemoglobin;
- Gallstones are very common; according to the statistics, in fact, one person is affected every 10.
Risk Factors of Acute Cholecystitis
Suffering from gallstones is the main risk factor for acute cholecystitis.
The onset of gallstones recognizes several favorable conditions, including:
- Advanced age;
- Overweight and obesity;
- Consumption of fatty or high cholesterol foods;
- Hypercholesterolemia;
- A low-fiber diet;
- Diabetes mellitus;
- A quick weight loss;
- Taking drugs that contain estrogen (eg, contraceptive pill);
- The presence of some liver disease;
- A sedentary lifestyle.
Symptoms and Complications
The most characteristic symptom of acute cholecystitis is a sharp, piercing pain, located in the upper part of the right abdomen ; this intense painful sensation usually lasts for several hours, tends to get worse with deep breaths and, in many patients, ends up affecting the right shoulder and / or back.
Did you know that ...
Abdominal pain produced by acute cholecystitis tends to become temporary after meals.
Other Symptoms of Acute Cholecystitis
Sometimes, to the aforementioned pain, acute cholecystitis can add other symptoms, including:
- Temperature;
- Nausea and vomit;
- Loss of appetite;
- Sweating or chills;
- Jaundice;
- Abdominal swelling;
- Sense of soreness in the abdomen;
- Light feces (or clay color).
Complications
In the absence of appropriate and timely care, acute cholecystitis can lead to various complications, including:
- Gallbladder infection . It is correlated above all to episodes of acute calculous cholecystitis, in particular to the stagnation of bile produced by these circumstances;
- Necrosis of part of the gallbladder. It means that the biliary tissue has died out;
- Laceration of the gallbladder. It can be the consequence of a gall bladder trauma.
When should I go to the doctor?
Any abdominal pain that appears suddenly and that seems to last over time deserves to be communicated to a doctor as soon as possible.
Early diagnosis of acute cholecystitis is essential to avoid complications and achieve recovery.
Diagnosis
In general, to make the diagnosis of acute cholecystitis, it is sufficient:
- Physical examination and medical history . They include the in-depth study of symptoms (also with maneuvers) and the search for possible favoring factors.
A very useful medical maneuver, for the purpose of diagnosing acute cholecystitis, is the Murphy test; the latter requires the doctor to ask the patient to breathe deeply, while pressing the right side of the abdomen, just below the rib cage (the presence of acute cholecystitis leads to pain, when, during inhalation, the gallbladder re-enters the pressure zone established by the doctor's hand);
- Blood tests, in particular the dosage of PCR (Protein C Reactive). They serve to identify in the blood any molecules associated with inflammation;
- Abdominal ultrasound . It allows you to view the abdominal organs, including the gall bladder, and understand their state of health.
However, it may happen that the doctor wants to investigate further with more specific examinations, such as:
- An MRI or abdominal CT scan . They provide additional images of the gallbladder;
- Hepatobiliary scintigraphy . It is a nuclear medicine procedure that, through the use of a radiopharmaceutical, allows to analyze not only the state of health, but also the functionality of the biliary tract and of the organs affected by the circulation of the bile (ie liver, gall bladder and small intestine) ;
- Cholangiography . It is X-ray imaging test, which allows you to view the bile ducts and the gall bladder. There are several variants of cholangiography, including diagnostic cholangiopancreatography and percutaneous transhepatic cholangiography.
Therapy
The treatment of acute cholecystitis always involves hospitalization, because only in this way can the patient receive all the appropriate care for the circumstance.
The most classic hospital treatment for those suffering from acute cholecystitis includes:
- Fasting from food and, sometimes, from fluids, so as to leave the gall bladder at rest, during the most acute phase of inflammation;
- Intravenous fluid administration . It is used to prevent any fluid fasting from causing dehydration in the patient;
- The administration of painkillers . These drugs help reduce pain until the inflammation is over;
- Administration of antibiotics . Antibiotic therapy is useful in preventing gallbladder infections or treating them;
- The removal of gallstones, provided they are the cause of acute cholecystitis. The most used technique for removing gallstones is therapeutic cholangiopancreatography;
- Surgical removal of the gallbladder, if the functions of the latter are irretrievably compromised or if acute cholecystitis is a recurring phenomenon. Also known as cholecystectomy, the gallbladder removal surgery also involves joining the liver to the small intestine, so that it is still possible to release the bile during the digestion of fats.
Currently, there are 2 approaches to performing a cholecystectomy: by laparoscopy and by laparotomy.
Did you know that ...
With the removal of gallstones, calculative acute cholecystitis resolves within 2-3 days.
Is it possible to lead a normal life without the gall bladder?
This is one of the issues that most affect people who, due to acute cholecystitis, have had or need to have their gallbladder removed.
The answer is: yes, it is possible to lead a normal life even without a gall bladder, as the removal of the latter does not in any way affect the production of bile by the liver.
Prognosis
For a favorable prognosis in case of acute cholecystitis, early diagnosis and timely treatment of the condition are essential.
Prevention
Losing weight (in the case of obesity or being overweight) and keeping it normal, and adopting a healthy diet are the 3 main behaviors that all doctors recommend when they talk about the prevention of acute cholecystitis.
