Cholecystitis is a term used for inflammation of the gallbladder (organ having fluids which help in digestion of fats).
Cholecystitis occurs due to obstruction of the cystic duct by the stones present in the gallbladder but this is not present in all the cases.
Anatomy of gallbladder
The gallbladder is a small pouch-like organ present below the liver. Gallbladder is small pear like organ having a duct (cystic duct) which join with the duct from liver (common hepatic duct) and both the ducts join together to form common bile duct.
The common bile duct then joins the pancreatic duct and both the duct opens into duodenum (part of large intestine), this opening of the duct in the large intestine is the only way of releasing bile in the gastric tract. When an obstruction occurs in this path of ducts then it hampers the release of bile in the intestine, therefore fluid accumulates which causes infection because of stagnation of bile. This inflammation of gallbladder is known as cholecystitis.
The major function of the gallbladder is storage of bile (needed for digestion of fats in food) produced by the liver. Bile along with gastric juices helps in breakdown (digestion) of the fat taken in food.
Infection in the gallbladder can occur due to many causes. Gallstones are not the only cause. Although 90% of cases show the history of gallstones but 10% of cases are without a history of gallstones.
Other factors for cholecystitis except gallstones are :
After severe trauma
Biliary stagnation including debilitation
Sickle cell diseases
Prolonged fasting, major surgery.
Infection in patients suffering from AIDs
Total parental nutrition(TPN)
Cardiac events are also one of the causes
Path physiology of cholecystitis
In cases where calculus (gallstones) are the cause there occurs blockage of bile duct passage which then accumulated in the gallbladder and when this bile is accumulated distention of the gallbladder takes place.
Blood vessels and lymphatic system around the gallbladder is compromised due to increase in the size of gallbladder therefore mucosal ischemia (loss of oxygen supply) occurs which leads to damage of cells and ultimately causing necrosis of gallbladder tissue.
Age/Sex prevalence of Cholecystitis
Females are more prone than males, women of multiple pregnancies, females who use birth control pills, obese people, individuals having a history of cholecystitis in grandparents.
Acute cholecystitis is of two types
• Due to gallstone – calculus cholecystitis 90% cases
• Without gallstone – calculus 10% cases
Classification depending on pathology
• Necrotising type – hemorrhage and necrosis occur in gallbladder for 3-5 days.
• Suppurative type – pus formation in gallbladder leading to the formation of an abscess in the gallbladder, attack stays for 7 to 10 days.
• Chronic type – occurring repeatedly in milder form causing atrophy of gallbladder wall.
• Oedematous type-swelling all around the gallbladder affects for 2-3 days.
• Emphysematous type- caused by gas forming bacteria anaerobes, that makes gas in walls of the gallbladder and this type is especially found in diabetic patients.
A calculus type of cholecystitis occur in following conditions
• Prolonged fasting.
• Long-term total parenteral nutrition.
• Severe trauma.
• Critical illness.
• Sickle cell anemia
• Cardiac defects cause.
• Diabetes mellitus.
• Patient with aids affected by other viruses’ cytomegalovirus.
Calculus type of cholecystitis occur in following cases
• Older age
• Obesity or rapid weight loss
• Females are more prone.
• Drugs like hormonal therapies in females.
• Pain occurs in the right side of abdomen and extends to the right shoulder.
• Pain in the right upper abdominal quadrant is very sharp and steady.
• The painful part of the abdomen is tender to touch. The patient does not allow examining.
• Vomiting may be present.
• Abdominal bloating is present.
• Most of the cases show good prognosis. Cholecystectomy is done.
• Complicated cases end in perforation of the gallbladder, sepsis, gangrenous cholecystitis.
• Perforation of gallbladder due to repeated damage to the walls of the gallbladder as by infection.
• The decay of gallbladder leads to gangrene of gallbladder.
• Enlargement of the gallbladder.
• Spread of infection within the gallbladder damaging its functions.
• Platelet count
• Complete blood count
• Ultrasound abdomen.
• X-ray abdomen.
• CT scan of the gallbladder.
• MRI of the gallbladder.
Finally, laparoscopy is the final test to identify and also the removal of the gallbladder.
• Antibiotics help to decrease the infection.
Antipyretics to decrease the fever.
• Analgesics for excessive pain.
• Fasting so as to decrease the stress on the gallbladder.
• Hospitalisation in acute emergency cases.
Finally, surgery is the solution. Cholecystectomy (removal of gallbladder) is done and the patient is advised to take fat-free diet after surgery.
• The fat-free diet is advised to the patient.
•nutritional and balanced diet is advised.
• Avoid alcohol and smoking.
• Try to reduce the stress of life by meditating.
• Obese people are advised to go for regular walk and exercise.
• Females are advised to follow family planning, avoid contraceptives pills.
• The abdomen is swollen and tender.
• Pain in the abdomen, the patient feels as if the abdomen is clutched by a hand.
• Pain is abdomen is increased by moving and applying pressure.
• Pain across abdomen is cutting type.
• Abdomen extremely sensitive to touch.
• Stitching type of pain in the region of the gallbladder.
• Pain in the gallbladder, increased by pressure, and pain is extending to stomach.
• Cholecystitis(catarrh of gallbladder) with jaundice(yellow complexion) and constipation.
• Stitching type of pain is present in kidneys which are spreading to other organs like liver, spleen, stomach, groins.
• Deep in the ileum (part of small intestine) sticking type of pain is present.
• Nausea in the morning before breakfast.
• The right side of the abdomen (liver region) is painful.
• There is the great sensitivity of left lobe of the liver.
• Stools are hard, difficult, knots like, and constipation alternates with diarrhea.
• The color of stools is bright yellow.
• The gallbladder is swollen with tenderness (painful to touch) and gallstones.
• Jaundice is present due to hyperemia of the liver.
• The patient feels the fullness of abdomen immediately after having few mouthfuls.
• Formation of gas in the abdomen is constant all the time, especially in upper region.
• The liver is very sensitive.
• On seeing abdomen there are brown spots present on the skin.
• Hepatitis is present which also lead to cholecystitis, with atrophy of liver.
• Pain in the abdomen is the shooting type especially lower abdomen and pain is transferred from right side to left side.
• Patient likes to have hot food and drink.
• Very well indicated medicine for chronic cholecystitis.
• Pain on right side of abdomen especially right hypochondrium.
• Indicated well for pain (colic) due to gallstones.
• The well-prescribed remedy for swelling and enlargement of liver and spleen along with jaundice.
• Flatulence in abdomen leads to severe pain and compels patient to bend double to get relief for some time.
• Patient dislikes milk.
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