Acute Cholecystitis

Topics: Hepatology, Common bile duct, Liver Pages: 17 (5231 words) Published: December 7, 2010
Acute Cholecystitis



Cholecystitis is inflammation of the gallbladder, usually resulting from a gallstone blocking the cystic duct.

• Gallbladder inflammation usually results from a gallstone blocking the flow of bile. • Typically, people have abdominal pain that lasts more than 6 hours, fever, and nausea. • Ultrasonography can usually detect signs of gallbladder inflammation. • The gallbladder is removed, often using a laparoscope.

Cholecystitis is the most common problem resulting from gallbladder stones. It occurs when a stone blocks the cystic duct, which carries bile from the gallbladder

In 90% of cases, acute cholecystitis is caused by gallstones in the gallbladder. Severe illness, alcohol abuse and, rarely, tumors of the gallbladder may also cause cholecystitis. Acute cholecystitis causes bile to become trapped in the gallbladder. The build up of bile causes irritation and pressure in the gallbladder. This can lead to bacterial infection and perforation of the organ. Gallstones occur more frequently in women than men. Gallstones become more common with age in both sexes. Native Americans have a higher rate of gallstones. Symptoms 

The main symptom is abdominal pain -- particularly after a fatty meal -- that is located on the upper right side of the abdomen. Occasionally, nausea and vomiting or fever may occur. Exams and Tests   

A doctor's examination of the abdomen by touch (palpation) may reveal tenderness. Tests that detect the presence of gallstones or inflammation include: • Abdominal ultrasound
• Abdominal CT scan
• Abdominal x-ray
• Oral cholecystogram
• Gallbladder radionuclide scan
A CBC shows infection by an elevated white blood cell count

Outlook (Prognosis)   
Patients who have cholecystectomy usually do very well.

Possible Complications   
• Empyema (pus in the gallbladder)
• Peritonitis (inflammation of the lining of the abdomen) • Gangrene (tissue death) of the gallbladder
• Injury to the bile ducts draining the liver (a rare complication of cholecystectomy) Cholecystitis is classified as acute or chronic.

Acute Cholecystitis: Acute cholecystitis begins suddenly, resulting in severe, steady pain in the upper abdomen. At least 95% of people with acute cholecystitis have gallstones. The inflammation almost always begins without infection, although infection may follow later. Inflammation may cause the gallbladder to fill with fluid and its walls to thicken.

Rarely, a form of acute cholecystitis without gallstones (acalculous cholecystitis) occurs. Acalculous cholecystitis is more serious than other types of cholecystitis. It tends to occur after the following:

• Major surgery
• Critical illnesses such as serious injuries, major burns, and bodywide infections (sepsis) • Intravenous feedings for a long time
• Fasting for a prolonged time
• A deficiency in the immune system
It can occur in young children, perhaps developing from a viral or another infection.

Chronic Cholecystitis: Chronic cholecystitis is gallbladder inflammation that has lasted a long time. It almost always results from gallstones. It is characterized by repeated attacks of pain (biliary colic). In chronic cholecystitis, the gallbladder is damaged by repeated attacks of acute inflammation, usually due to gallstones, and may become thick-walled, scarred, and small. The gallbladder usually contains sludge (microscopic particles of materials similar to those in gallstones), or gallstones that either block its opening into the cystic duct or reside in the cystic duct itself.

A gallbladder attack, whether in acute or chronic cholecystitis, begins as pain. The pain of cholecystitis is similar to that caused by gallstones (biliary colic) but is more severe and lasts longer—more than 6 hours and often more than 12 hours. The pain peaks after 15 to 60 minutes and remains...
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