Acute cholecystitis is very common among women but the cases seen by me were mostly male patients who had infection of the gallbladder from the infection of the small intestine. In women infection of the gallbladder were mostly related to gallstones. In either case there is severe central abdominal pain and cramps with fever and vomiting. A referral to the emergency department will usually detect the gallbladder infection from the ultrasound of the gallbladder.Treatment is usually by removal of the gallbladder after the infection has been treated with antibiotics. Prognosis is good after surgical treatment.
Cholecystitis is an acute or chronic inflammation of the gallbldder.
Cholecystitis is usually caused by the following:
1. obstruction of the cystic duct by a gallstone -80% -most common
2. bacterial infection following obstruction in 50% of cases
3. bacterial or viral infection following gastroenteritis-germs from gut going up the cystic duct into gallbladder.
4. chronic disease follows attacks of acute infection.
Cholecystitis is more common in the female, forty years of age, fat, flatulent person.
Persons who has Acute Cholecystitis has the following symptoms:
1.gradual onset of abdominal pain starting from the epigastrium, moving to the right subcostal area, may be felt in the back at the subscapular region.
2.nausea and vomiting
3.loss of appetite
4.mild fever and bodyaches
5.slight jaundice
Signs:
1.Tenderness at the right subcostal area with involuntary muscle spasm
2.Murphy Sign positive: sharp increase of tenderness at the subcostal area on palpation with thumbs pressed inwards below the ribs when the patient is asked to breathe deeply
3.Gallbladder may sometimes be felt(palpable)
In chronic Cholecystitis, there may recurrent biliary colic which may be mistaken for signs of of gastritis.
Diagnosis can usually be made by :
1.Physical examination with a positive Murphy's sign.
2.Plain X-rays can show the presence of gallstones in 10-15%
3.Oral cholecystogram is 95% accurate if the liver and intestinal functions are normal but may unreliable during the acute attack.
4.Ultrasound is highly reliable in showing up the presence of gallstones
5.Intravenous,transhepatic and endoscopic retrograde cholangiography may be more accurate in diagnosing the gallbladder function and stones
Dangers of Cholecystitis are:
gangrene
perferation
cholangitis
Acute Cholecystitis is treated by:
Admission to hospital
Gastric suction and fluid replacement
Analgesic or antispasmodic medicine usually by injection
Antibiotics for infections
Cholecystectomy -surgical removal of the gallbladder and stones now usually done through 4 holes in the abdomen.
Chronic Cholecystitis is usually treated by:
Cholecystectomy
Prognosis is usually good after surgery.
However some pain may persists after surgery.
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