Cholecystitis, an inflammation of the gallbladder, is a complex response of human body to an insult and is considered a part of innate immunity. It can either be a response to chemical substances released in damaged tissue, or a mechanism of immune system. Its main purpose is to protect organisms, sometimes it can, however, rather cause its further damage. Inflammation is caused either by presence of aggressive substances, or by presence of micro organism. Cholecystitis is a serious disease and a cause of most acute abdomen.
Classification of Cholecystitis
Cholecystitis can be classified by either presence of gallstones, or duration of the disease.
According to the course of the disease we can distinguish acute and chronic cholecystitis. Acute cholecystitis is a condition that begins suddenly in a healthy individual. Chronic cholecystitis is a lasting process that may present no symptoms at all.
In 90% of people with cholecystitis, gallstones are also present; this condition is called cholelithiasis. The gallstones can get into the cystic duct and obstruct it, consequent accumulation of bile in the bladder is usually soon accompanied by infection caused by bacteria migrating up from duodenum. This is the etiology of infectious cholecystitis. In the residual 10% of people gallstones are not present and the mechanism of developing cholecystitis is non-infectious. Cholecystitis develops due to toxic substances in the bladder that damage the gallbladder wall.
Cholelithiasis is a main risk factor for both, acute and chronic cholecystitis. Patients with diabetes are affected more often. Non-infectious gallbladder inflammation without the presence of gallstones usually presents in compromised patients after injuries and operations.
Symptoms of Cholecystitis
Acute cholecystitis presents with constant, severe pain in the right upper quadrant of the abdomen, fever and signs of peritoneal irritation (e.g. contracted muscles of abdominal wall). The pain increases during movement and in deep inspiration. In acute cholecystitis symptoms last short, for several days the maximum. In chronic cholecystitis, on the other hand, the gallbladder is shrunken and often calcified. The course of the disease is non-specific, specific signs are lacking. Patients usually claim oppressions in the right upper quadrant of the abdomen, nausea, digestive problems and intolerance of certain food.
Complications of Cholecystitis
One of the complications of cholecystitis is perforation, in other words rupture of the gallbladder. In such a case the content of the gallbladder leaks in the abdominal cavity and inflammation of the peritoneum, or peritonitis, occurs. Inflammation may also expand to peritoneum or to the liver without perforation of the bladder. Other complication that may occur is fistula, a communication between gallbladder and other organs, e.g. stomach or duodenum.
Diagnosis of Cholecystitis
Cholecystitis is usually diagnosed by a careful history of the symptoms, physical examination and imaging tests. The physician detects presence of so called Murphy's sign – severe pain during inspiration while physician's hand is pressed against the abdominal wall in the right upper quadrant. If a gallstone obstructs the cystic duct, bile stagnates in the gallbladder and the gallbladder becomes significantly bigger, this is called hydrops of the gallbladder. In this case it is possible to palpate rough, pear-like structure in the position of the gallbladder. Sometimes the inflammation expands to the surroundings of the gallbladder and pericholecystitis occurs. The gallbladder is usually investigated by ultrasound and computer tomography, scintigraphy allows us to evaluate the content of the gallbladder and its function. Scintigraphy is performed by injection of contrast material in the biliary tract and its display by X-rays. If the gallbladder doesn't fill up in 60-90 minutes, it is probably acutely infected. Laboratory findings in cholecystitis reveal elevated inflammatory markers in blood.
Treatment of Cholecystitis
Minor acute cholecystitis of the gallbladder requires physical rest, fasting and painkillers. Later the patient is advised to be on a gallbladder protective diet. Antibiotic therapy is usually administered. In severe cases, the surgery is needed to remove the inflamed gallbladder, this is called cholecystectomia. Complication rate is higher in patient with cholecystitis without gallstones. In these patients it is recommended to carry out the surgery without unnecessary hesitation. Chronic inflammation is also cured by surgery.
Prevention of Cholecystitis
To prevent inflammation of the gallbladder, balanced health regimen is recommended. It is advisable to lower intake of fat, especially of cholesterol, and increase fibre intake. However, even strict following of these recommendations may not fully prevent the disease.