Cholecystitis

Cholecystitis is inflammation of the gallbladder. Symptoms include right upper abdominal pain, nausea, vomiting, and occasionally fever. Often gallbladder attacks (biliary colic) precede acute cholecystitis. The pain lasts longer in cholecystitis than in a typical gallbladder attack. Without appropriate treatment, recurrent episodes of cholecystitis are common. Complications of acute cholecystitis include gallstone pancreatitis, common bile duct stones, or inflammation of the common bile duct.Abdominal ultrasonography showing gallstones, wall thickening and fluid around the gall bladderGallstones and biliary sludge, but the gallbladder wall is not clearly thickened, with no edema in the pericholecystic fat, thus not cholecystitis.Acute cholecystitis as seen on ultrasound. The closed arrow points to gallbladder wall thickening. Open arrow points to stones in the GBAcute cholecystitis with gallbladder wall thickening, a large gallstone, and a large gallbladderSignificant gallbladder wall thickeningSignificant gallbladder wall thickening Cholecystitis is inflammation of the gallbladder. Symptoms include right upper abdominal pain, nausea, vomiting, and occasionally fever. Often gallbladder attacks (biliary colic) precede acute cholecystitis. The pain lasts longer in cholecystitis than in a typical gallbladder attack. Without appropriate treatment, recurrent episodes of cholecystitis are common. Complications of acute cholecystitis include gallstone pancreatitis, common bile duct stones, or inflammation of the common bile duct. More than 90% of the time acute cholecystitis is from blockage of the cystic duct by a gallstone. Risk factors for gallstones include birth control pills, pregnancy, a family history of gallstones, obesity, diabetes, liver disease, or rapid weight loss. Occasionally acute cholecystitis occur as a result of vasculitis, chemotherapy, or during recovery from major trauma or burns. Cholecystitis is suspected based on symptoms and laboratory testing. Abdominal ultrasound is then typically used to confirm the diagnosis. Treatment is usually with laparoscopic gallbladder removal, within 24 hours if possible. Taking pictures of the bile ducts during the surgery is recommended. The routine use of antibiotics is controversial. They are recommended if surgery cannot occur in a timely manner or if the case is complicated. Stones in the common bile duct can be removed before surgery by endoscopic retrograde cholangiopancreatography (ERCP) or during surgery. Complications from surgery are rare. In people unable to have surgery, gallbladder drainage may be tried. About 10–15% of adults in the developed world have gallstones. Women more commonly have stones than men and they occur more commonly after age 40. Certain ethnic groups are more often affected; for example, 48% of American Indians have gallstones. Of all people with stones, 1–4% have biliary colic each year. If untreated, about 20% of people with biliary colic develop acute cholecystitis. Once the gallbladder is removed outcomes are generally good. Without treatment, chronic cholecystitis may occur. The word is from Greek, cholecyst- meaning 'gallbladder' and -itis meaning 'inflammation'. Most people with gallstones do not have symptoms. When a gallstone lodges in the cystic duct, they experience biliary colic. Biliary colic is abdominal pain in the right upper quadrant or epigastric region. It is episodic, occurs after eating greasy or fatty foods, and leads to nausea and/or vomiting. People who suffer from cholecystitis most commonly have symptoms of biliary colic before developing cholecystitis. The pain becomes more severe and constant in cholecystitis. Nausea is common and vomiting occurs in 75% of people with cholecystitis. In addition to abdominal pain, right shoulder pain can be present. On physical examination, fever is common. A gallbladder with cholecystitis is almost always tender to touch. Because of the inflammation, its size can be felt from the outside of the body in 25–50% of people with cholecystitis. Pain with deep inspiration leading to termination of the breath while pressing on the right upper quadrant of the abdomen usually causes pain (Murphy's sign). Murphy's sign is sensitive, but not specific for cholecystitis. Yellowing of the skin (jaundice) may occur but is often mild. Severe jaundice suggests another cause of symptoms such as choledocholithiasis. People who are old, have diabetes, chronic illness, or who are immunocompromised may have vague symptoms that may not include fever or localized tenderness. A number of complications may occur from cholecystitis if not detected early or properly treated. Signs of complications include high fever, shock and jaundice. Complications include the following: Cholecystitis causes the gallbladder to become distended and firm. Distension can lead to decreased blood flow to the gallbladder, causing tissue death and eventually gangrene. Once tissue has died, the gallbladder is at greatly increased risk of rupture (perforation). Rupture can also occur in cases of chronic cholecystitis. Rupture is a rare but serious complication that leads to abscess formation or peritonitis. Massive rupture of the gallbladder has a mortality rate of 30%. Untreated cholecystitis can lead to worsened inflammation and infected bile that can lead to a collection of pus surrounding the gallbladder, also known as empyema. The symptoms of empyema are similar to uncomplicated choleystitis but greater severity: high fever, severe abdominal pain, more severely elevated white blood count.