Gallbladder stones / Acute cholecystitis / Gallstones

Content

Introduction

Acute cholecystitis is an "inflammation of the gallbladder (also called the gallbladder) which usually occurs when a gallstone blocks a short duct (called cystic duct), which joins the gallbladder to another channel that emerges from the liver (the so-called hepatic duct).

Gallstones are small "stones", usually made up of cholesterol, that form in the gallbladder. They are very common, usually they do not cause disturbances (symptoms) but, at times, they can cause episodes of pain (biliary colic) or inflammation of the gallbladder (cholecystitis).

Acute cholecystitis is potentially serious and usually needs to be treated in the hospital with rest, intravenous fluids, and antibiotics if needed.

The gallbladder
The gallbladder (or gallbladder) is a small, pear-shaped organ located under the liver. Its main role is to store and concentrate a liquid substance, bile, produced by the liver which is necessary to digest and absorb fats, stimulate the movement (peristalsis) of the intestine and exert an "antiseptic action against the bacterial flora. ; from the liver it passes through a series of channels, called bile ducts, until it reaches the gallbladder, where it is accumulated. Over time, the bile becomes more concentrated making fat digestion more effective. When needed, it is released into the digestive system.

The gallbladder is a useful, but not essential organ, therefore, its surgical removal does not interfere with the ability to digest food.

Symptoms

The main disorder (symptom) that characterizes acute cholecystitis is a sudden stinging pain in the upper right part of the belly (abdomen), which spreads towards the right shoulder blade or towards the back. The pain gets worse with deep breathing and, unlike other types of abdominal pain, is usually persistent and does not go away within hours.

Some people may have additional disorders (symptoms), such as:

  • high fever
  • nausea and vomit
  • sweating
  • loss of appetite
  • yellowish discoloration of the skin and eyes (jaundice)
  • swelling of the abdomen

When to see a doctor
The family doctor should be consulted if severe abdominal pain suddenly appears, especially if it lasts more than two hours or if it is accompanied by other ailments, such as jaundice and fever.

It is important that acute cholecystitis is detected (diagnosed) as early as possible because if not treated quickly there is a risk of serious complications.

Causes

Acute cholecystitis can be with stones or without stones.

Cholecystitis with stones
Cholecystitis with stones is the most common and usually the least severe form. It accounts for approximately 95% of all cases. It develops when the main opening of the gallbladder, the cystic duct, is blocked by a stone or a substance known as biliary sludge, mixture of bile (liquid produced by the liver that promotes the digestion of fats), small crystals of cholesterol and salt.

The obstruction of the cystic duct causes an accumulation of bile in the gallbladder, increasing the pressure inside the duct, which undergoes an "inflammation. In about one in five cases, the inflamed gallbladder is also infected with bacteria.

Calculus-free cholecystitis
Stoneless cholecystitis is a less common, but usually more severe, form of acute cholecystitis. It usually develops as a complication of severe disease, infection, or injury that damages the gallbladder.

Stoneless cholecystitis can be caused by accidental damage to the gallbladder during surgery, prolonged fasting, burns, or bacterial or viral infections (such as HIV).

Diagnosis

If you have severe pain in your tummy (abdomen), your family doctor does a simple test called the Murphy maneuver. It consists in pressing the hand on the patient's belly, just below the chest, asking him to breathe deeply. Since the gallbladder will move downward as the patient takes air, if it is inflamed when the doctor's hand touches it it will cause sudden pain.
If the doctor determines that it is acute cholecystitis, he will immediately send the patient to the hospital for further examination and treatment.

The tests that will be done in the hospital include:

  • blood analysis to measure the C-reactive protein (PCR) and check if there is an increase in some blood cells, neutrophils, considered indicators (markers) of inflammation
  • abdominal ultrasound to look for gallstones or other signs of gallbladder problems

Other radiological tests, such as x-rays, computed tomography (CT), or nuclear magnetic resonance (MRI), may be done if it is suspected that the stones may have damaged the tissues in contact with the gallbladder.

Therapy

Acute cholecystitis requires the patient to be hospitalized for treatment (therapies).

Initial therapy
Usually, it consists of:

  • do not eat or drink (fasting) to prevent bacteria from escaping from the gallbladder
  • administration of liquids through a needle inserted into a vein in the arm (intravenous drip) to prevent dehydration
  • medications to relieve pain

If an infection is present, antibiotics may be used and will be taken for a week. During this time, you may need to stay in the hospital.
After treatment, any gallstones that caused acute cholecystitis usually re-enter the gallbladder and the inflammation is reduced.

Surgery
In some cases, surgery to remove the gallbladder (called cholecystectomy) may be recommended after initial treatment to prevent other episodes of acute cholecystitis from occurring and thus reduce the risk of potentially serious complications.

An alternative surgical procedure to the classical intervention, although little used, is the percutaneous cholecystostomy which consists in "inserting a needle through the abdomen to release the liquid produced by the gallbladder. Generally, it is performed when the patient's general state of health does not allow surgery to be performed.

If, on the other hand, the physical conditions are good, it is preferable to proceed with the surgery which can be performed immediately, after one or two days, or after healing from the inflammation, usually expected in about two weeks.

The surgery can be performed in three ways:

  • laparoscopic cholecystectomy, a type of minimally invasive surgery which consists in the elimination of the gallbladder using special surgical instruments inserted into the abdomen through a series of small cuts (incisions)
  • laparoscopic single incision cholecystectomy, a technique that involves the removal of the gallbladder through a single incision near the navel
  • open cholecystectomy, an operation that consists in the removal of the gallbladder through an incision on the abdomen

It is possible to lead a perfectly normal life without the gallbladder: while it is useful, in fact, it is not essential as the liver will still continue to produce the bile to digest food. Some people have reported having ailments (symptoms) such as bloating and diarrhea after eating certain foods.

Prevention

It is not always possible to prevent acute cholecystitis, but the risk of developing it can be minimized through a "healthy and balanced diet and avoiding foods with a high cholesterol content that contribute to the formation of gallstones."

Overweight and obesity increase the risk of developing gallstones. It is advisable, therefore, to control your weight, prefer a healthy diet and exercise regularly. Low calorie diets with rapid weight loss should be avoided. because they could disrupt the chemistry of the bile and, in fact, increase the risk of developing gallstones.A gradual weight loss plan is more appropriate.

Complications

Without proper care, acute cholecystitis in some cases can lead to life-threatening complications which include:

  • death of the gallbladder tissue (gangrenous cholecystitis), a condition that can cause a serious infection throughout the body
  • perforation of the gallbladder with spread of "infection" inside the abdomen (peritonitis) or the formation of an accumulation of pus (abscess)

For the treatment of these complications it is necessary to resort to "emergency surgery" to remove the gallbladder. This occurs in about one in five cases.

Bibliography

NHS. Gallstones (English)

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