Cholecystitis What we need to know

Cholecystitis is an inflammatory disease of the gallbladder. Gallbladder is a hollow, pear-shaped organ located in the upper abdominal region (right hypochondrium) and is a reservoir of bile juice produced by the liver. Gallbladder contraction ensures the passage of bile into the duodenum in response to fatty food intake. Infection of the gallbladder and bile ducts, or obstruction by stones, obstructs the flow of bile and causes inflammation, swelling, and pain in the bladder area.

Forms of cholecystitis:

• acute
• chronic
• Calculous (caused by stone disease)
• Acalculous (inflammatory process not related to stone disease)

Gallstone disease may be the cause of both acute and chronic cholecystitis. Calculous cholecystitis is a fairly common disease. Gallstone disease affects almost 15% of the world's population.

Symptoms

Symptoms of acute cholecystitis:

• Pain in the right iliac region (right, upper part of the abdomen), with irradiation in the direction of the back and right ring. The pain may be sharp, dull or spasmodic in nature. Worse with deep breathing. Sometimes it gives an imitation of heart attack pain.
• Nausea and vomiting There are accompanying symptoms of a gallbladder attack. It may be less pronounced in the elderly.
• fever – A temperature higher than 38 degrees may develop in one third of cases of acute cholecystitis. The temperature reaction is proportional to the inflammatory process.

Additional symptoms:

• Abdominal distension and tenderness to touch
• Rigidity of the muscles of the right lobe of the abdomen
• General weakness, especially in the elderly

Symptoms of chronic cholecystitis are less intense and characterized by periodicity. The condition is aggravated by biliary colic - acute abdominal pain and vomiting, which is associated with eating fatty food.

reasons

The most common cause of cholecystitis is gallstone disease. Stones block the bile duct and obstruct the flow of bile. Gallbladder stones are usually formed from bile sediment, located mainly at the bottom of the bladder, however, when the gallbladder contracts, they often move towards the duct, causing blockage and obstruction of the duct. This causes acute cholecystitis. A moving stone causes periodic obstruction of the duct, obstructs the flow of bile, contributes to the development of infection and the formation of chronic cholecystitis.

In addition to choking with stones, there are other causes of obstructive cholecystitis:

• biliary strictures (scarring), which is the result of chronic inflammation, gradually narrows the lumen of the duct and obstructs the flow of bile.
• Biliary dyskinesia - Decrease in the ability of the gallbladder to contract, which is the result of damage to its muscular layer and causes bile congestion in the bladder.
• Biliary stasis – It develops as a result of chronic liver diseases or long-term parenteral nutrition, when food does not enter the digestive tract, which reflexively ensures the contraction of the gallbladder and the flow of bile.
• Tumors – A tumor process of the gallbladder or bile ducts may obstruct the flow of bile and cause cholecystitis.

These conditions are usually prolonged and cause chronic inflammation, although the rapid progression of the chronic process may exacerbate the condition.

In addition to the above, rare causes of cholecystitis are:

ischemia – Impaired blood supply can cause acute or chronic cholecystitis. This is usually associated with acute trauma, blood loss, or diseases with blood vessel occlusion (strangulation) and/or inflammation (vasculitis).

infection – Bacterial infections of the gallbladder and bile ducts often develop without obstruction by stones, in conditions of a weakened immune system.

Risk factors

Gallstone disease increases the likelihood of developing cholecystitis, but there are other risk factors:

• Female gender
• Pregnancy
• Obesity
• diabetes
• High level of cholesterol in the blood
• Rapid weight loss
• Age (the risk of cholecystitis increases at the age of 40 and above)

The inflammatory process of the gallbladder can cause much more harm to a person than simply obstructing the flow of bile juice in the digestive tract. A severe inflammatory process sometimes causes tissue necrosis (death), gangrenous cholecystitis, tissue wall integrity violation, and biliary peritonitis develop, which is a life-threatening condition.

Also, during the course of chronic cholecystitis, cysts form in the bladder, which makes it difficult to contract and empty the bladder and complicates the condition.

Complications

• Injuries of the liver, pancreas and biliary tract
• Disturbance of digestive and absorption processes in the small intestine
• Gallbladder fibrosis - developed as a result of chronic inflammation
• As a result of edema, blood circulation and necrosis of the gallbladder wall, which creates the risk of developing gangrenous cholecystitis.
• Gallbladder perforation and biliary peritonitis
• Complication of peritonitis with septicemia and sepsis - spread of the infectious process in the bloodstream and other organs.

Diagnosis

Diagnosis of the disease begins with the collection of anamnestic data and an objective examination of the patient. On palpation, there is pain in the right armpit, in the position of deep inhalation (Murphy's sign), it can indicate in favor of cholecystitis.

• General blood test
• Liver function tests
• Abdominal ultrasound
• Endoscopic ultrasound
• Abdominal computed tomography

Treatment

Treatment of cholecystitis depends on the form of the disease, the course and the underlying cause. In all cases, treatment should be started immediately, due to the high risk of complications.

"Synevo" offers laboratory tests for diagnosing cholecystitis and monitoring the functional state of the liver:

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