A Simple Guide to Cholecystitis

A Simple Guide to Cholecystitis
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What is Cholecystitis?
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Cholecystitis is an acute or chronic inflammation of the gallbldder.

What are the causes of Cholecystitis?
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Cholecystitis is usually caused by the following:

1. obstruction of the cystic duct by a gallstone -most common cause 80-90% of cases

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.

What are the symptoms and signs of Cholecystitis?
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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 gastritis.

How do you diagnose Cholecystitis?
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Diagnosis can usually be made by :
1.Physical examination -a positive Murphy's sign suggest Cholecystitis.

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

What is the complications of Cholecystitis?
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1.gangrene of the gallbladder due to obstruction of blood supply

2.perforation of the gallbladder due to obstruction of the cystic duct

3.cholangitis - infection of the bile duct which can lead to hepatitis and intestinal infection

What is the treatment of Cholecystitis?
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Acute Cholecystitis:
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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:
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Cholecystectomy

What is the prognosis of Cholecystitis?
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Prognosis is usually good after surgery.

However some pain may persists after surgery due to scar tissue.