Cholecycstitis is a painful inflammation of the gallbladder, the small, pear-shaped sac under the liver that stores bile. It is commonly due to impaction (sticking) of a gallstone within the neck of the gall bladder, leading to inspissation of bile, bile stasis , and infection by gut organisms. After a meal, bile is squeezed out of the gallbladder by strong muscular contractions, and passes through a duct into the duodenum. Some patients have no symptoms. Patients with mild and infrequent symptoms may consider oral medication to dissolve gallstones. In chronic cholecystitis, the gallbladder is damaged by repeated attacks of acute inflammation, usually from gallstones, and may become thick-walled, scarred, and small. The gallbladder generally contains sludge or gallstones that often obstruct its outlet or the cystic duct
Causes of Cholecystitis
Cholecystitis results from cholelithiasis in greater than 95% of cases (presence of choleliths, or gallstones, in the gallbladder), with choleliths most commonly blocking the cystic duct directly. This leads to to inspissation of bile, bile stasis, and secondary infection by gut organisms, predominantly E coli and Bacteroides species.
The Gallbladder's wall becomes inflamed. Extreme cases may result in necrosis and rupture. Inflammation often spreads to its outer covering, thus irritating surrounding structures such as the diaphragm and bowel.
Symptoms of Cholecystitis
The most common symptom of cholecystitis is pain in your upper right abdomen that can sometimes move around to your back or right shoulder blade. Other symptoms include:
* Nausea or vomiting.
* Tenderness in the right abdomen.
How is it diagnosed?
Cholecystitis can be difficult for a doctor to diagnose because its symptoms resemble those of other illnesses. If a doctor suspects cholecystitis after a physical exam of the patient, the doctor may perform an abdominal ultrasound to create an image of the internal organs and measure the thickness of the gallbladder wall (a maker of inflammation and scarring). Other imaging tests may also be performed to see the liver, bile ducts, gallbladder and upper part of the small intestine. In addition, a blood test will reveal an increase in the white blood count, as well as an increase in bilirubuin.
Treatment of Cholecystitis
You will normally be admitted to hospital. Usually you will not be allowed to eat or drink (to rest the gallbladder), and you will be given fluids and painkillers directly into a vein through a 'drip'. With this initial treatment the gallstone that caused the blockage often falls back into the gallbladder, and the inflammation and symptoms often settle down. In rare cases of chronic cholecystitis, you may also receive medicine that dissolves gallstones over a period of time.
To help prevent cholecystitis, the patient should maintain an ideal weight and follow a diet high in fiber, vegetables and fruit.
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