Acute Cholecystitis- Causes, Symptoms, Complications, And Treatment

Cholecystitis is a condition in which the gallbladder has inflammation. The key role of the gallbladder is to help your body digest fat. The organ can be found under the liver.

Cholecystitis are classified as follows:

Acute cholecystitis refers to moderate to mild amounts of eruption in the gallbladder. It can create a very critical condition and it is important to see your doctor as soon as possible if you detect any symptoms of acute cholecystitis.

It is called chronic cholecystitis when inflammation in the gallbladder is recurring for a prolonged period of time.

Pain is one of the most common symptoms one can experience in the initial stage of cholecystitis. It includes pain in the upper right or middle side of the abdomen and possibly to your right shoulder or back. The pain often feels like a sharp pain or dull cramps and can last up to hours.

Other symptoms of cholecystitis include:

• Whites of your eyes and yellowing of the skin
• Abdominal bloating
• Tenderness in abdomen region when touched
• Fever and chills
• Abdominal pain, typically after a meal
• Vomiting and nausea
• Clay-colored stool

Usually, gallstones are the reason for your cholecystitis. Gallstones are stone in the gallbladder or bile ducts formed by small and hard crystalline masses. Abnormal production of bile pigments, high cholesterol, and excess calcium salts are some of the components that may develop gallstones. Gallstones usually emerge as a pain sensation in the lower abdomen region due to the blockage in the bile ducts. Most gastrointestinal tract disorders are commonly rooted with gallstones.

Helminthic infection or ascariasis is another reason behind acute cholecystitis and biliary disease. Helminthic infection is known as an obstruction in the cystic duct which results in inflation, pain and even perforation or gangrene of the gallbladder.

Tumor or severe illness can also be a root cause of acute cholecystitis in the gallbladder. Even though it is a rare case, it is one of the most dangerous reasons for the development of cholecystitis.

AIDS or certain viral infections can also trigger gallbladder inflammation, which leads to cholecystitis. Like the disease, it is also a rare condition to find.

Well, when attacks of cholecystitis are repeated or prolonged, it is known as chronic cholecystitis. Chronic cholecystitis often creates a life-threatening situation for the patient. Like gallbladder rupture or tumor. In That case, the treatment for cholecystitis might involve gallbladder removal.

Surprisingly, Women have a higher probability of developing cholecystitis in comparison to men. Also, age is a crucial factor when it comes to cholecystitis. Although the relation between cholecystitis and an individual's age and gender is still not in the light, medical professionals still prefer to keep it in the list of reasons!

If left untreated cholecystitis can lead to several serious illnesses which include:

1. Infection in the gallbladder:

   In this case, the bile will build up in your gallbladder and may become infected.

2. Decay of gallbladder tissue:

   Prolonged cholecystitis can cause tissue to die in the gallbladder region (gangrene). It is one of the most common complications found, especially among adults, who wait a long time to seek treatment, and with diabetes. Prolonged inflammation in the gallbladder may lead to intense pressure on the muscles which leads to gallbladder tear or even gallbladder rupture.

3. Torn gallbladder:

   A torn gallbladder might create discomfort as A tear in may lead to gallbladder to swell, infection in bile duct, or even decay of the tissues cells in the gallbladder.

4. Gangrenous cholecystitis:

   It is a serious complication associated with acute cholecystitis. The disease is provoked by specific distension in the gallbladder causing increased pressure in the tissue cells of the wall which may lead to shortage of oxygen supply in blood. There is no specific medical research that concludes cystic artery thrombosis with Gangrenous cholecystitis, so it can happen with or without the other disorders.

5. Gallbladder perforation:

   Or gallbladder burst is a condition in which the gallbladder tissue faces pressure from the inflationation. In this case the pressure will eventually develop a gallbladder rupture. These ruptures are commonly caused by Cholecystitis.

6. Cholecystoenteric fistula:

   The disease is quite rare to find in cholecystitis patients. It occurs between the adjacent hollow viscus and gallbladder. Inflammation associated with acute cholecystitis damages the passage between bile duct and the duodenum. It is mostly common for patients of older age.

7. Gallstone ileus:

   It is defined as an intestinal obstruction due to obstruction developed by more than one gallstones in the gastrointestinal tract.

Since cholecystitis is considered to be a serious disease, the right time to seek medical attention is in the initial stage of pain, in that case, the infection might be easily treated with the help of medication only.

Furthermore, The ideal medical expert to diagnose and treat is a gastroenterologist. Gastroenterologists are those specialists who are trained in gastrointestinal (GI) tract and liver diagnosis and treatment.

A Gastroenterologist is affiliated with a degree in Gastroenterology. The focal point of the study are organs mainly located in the digestive tract or lower abdomen. Some of them are gallbladder, liver, bile ducts, and pancreas.

The manifestation of cholecystitis may mirror many other illnesses. In order to diagnose the case and reach the root cause of the uncomfortable symptoms, Your doctor will analyse your medical history through tests and verbal communication. They’ll probably examine your abdomen region for any swelling or tender areas. Apart from general examination, here are some additional tests that gastroenterologist recommend.

1. Abdominal ultrasounds:

   The mechanism of this medical device uses sound waves to create an image of your internal organs. This test is a commonly recommended imaging test to diagnose cholecystitis.

2. Hepatobiliary scintigraphy:

   The procedure creates a detailed image of the upper portion of your lower abdomen including, small intestine, gallbladder, liver,and bile ducts. This examination starts with injecting a radioactive tracer into your veins through your arm. The tracer will travel to your liver, small intestine and the gallbladder via your bloodstream. The doctor then tracks the tracer with a nuclear medicine scanner (gamma camera) to create computer images of your internal organs.

3. Cholangiography:

   It is another way to see what is happening in your body. The doctor injected a dye into your bile ducts to examine the gallbladder and bile ducts through X-ray tests.

4. CT scans:

   It is a series of computerized images that help to examine internal organs by creating detailed images.

   Your doctor may run different types of tests to diagnose acute cholecystitis. This series of examinations will determine the health rate of your complete blood count and liver functionality.

Cholecystitis pain usually feels like an unexplained abdominal pain that always needs immediate treatment. In that case, you should always see your doctor.

Your doctor may recommend you to get admission to hospital for close monitoring. You may be asked to go on a lighter diet or switch to fast. The reason behind fasting is, it allows your digestive system and gallbladder to rest.

Often medication like intravenous (IV) fluids, painkillers, and antibiotics has been prescribed to the patient to prevent dehydration and fight infection. Other medicines that might be prescriber are:

1. Indometacin:

   Is used to reverse the inflammation of the gallbladder and the contractile dysfunction seen in the first 24 hours of cholecystitis. The prokinetic action of indomethacin will also improve postprandial emptying of the gallbladder during gallbladder disease.

2. Diclofenac:

   IA single intramuscular dose may substantially decrease the rate of progression to cholecystitis in patients with symptomatic gallstones.

3. Cephalosporin and Metronidazole:

   Because there is a risk of superimposed infection, intravenous antibiotics must be started if the patient has no improvement after 12-24 hours.

   In case of chronic cholecystitis, your doctor may also recommend cholecystectomy. It is a procedure in which the doctor will remove your gallbladder through surgery. The cholecystectomy is done with laparoscopy or open surgery.

If a patient is unfit to undergo cholecystectomy, here are some non-operative ways through which cholecystectomy can be treated:

1. Percutaneous cholecystostomy:

   It is a safer alternative. This procedure is minimally invasive in the body. The doctor will place a drainage catheter into the gallbladder lumen through image guidance. This procedure uses therapeutic planning to stabilize the patient to have a more measured surgical approach on the case.

2. Solvent dissolution therapy or Extracorporeal shockwave lithotripsy:

   The procedure has been used with variable results to treat chronic cholecystitis in patients unfit for surgery, but the therapy still has no place in the management of acute cholecystitis.

   It is actually possible for the body to break down the glucose of the food without a gallbladder. The Bile juice will be redirected into your small intestine through surgical procedure.

Gallbladder surgery can be sensitive to the whole digestive system. Here are some of the things that one might experience after acute cholecystitis treatment:

1. Physical pain:

   Patients with this type of surgery are expected to experience some amount of pain. acute cholecystitis operation usually develops some amount of pain. In some cases, patients experience mild shoulder pain, it is due to the gas left in your abdomen area during the surgery.

   To ease the pain your doctor will prescribe you a set of painkillers, but as you become more active the amount of pain medication should decrease gradually for better results. Common pain medications such as Tylenol or Ibuprofen are effective for physical pain.

2. Diet:

   In the initial stage of post-surgery care, it is important to take advice from a dietician for a suitable diet. In most cases, the patient is allowed to eat bland and light edibles such as toast, rice, fruits, soups, juices, etc. After the initial recovery period, it is easy for the patient to tolerate a variety of foods without any discomfort and complications. It is mandatory to take a few days off from your normal appetite even before the surgery.

3. Wound Care:

   Acute cholecystitis surgery often left four small-sized wounds on the lower side of the abdomen. These wounds are mostly closed by regular or dissolvable stitches. It is beneficial for the patient to keep the stitches dry. The patient must examine the wounds every day for any signs of redness or bleeding. Although, bruising around the wounds is normal and will go eventually.

4. Bowel Habits:

   Most of the time after surgery, patients might experience mild discomfort in their bowel movements. Constipation is the most common one. It is due to decreased activity, and narcotic pain medications that make your stool hard and difficult to pass. It is advisable to increase fiber content and fluid intake in your diet.

   If necessary one can take a mild laxative for comfort. On the other hand, In some cases, patients develop Infrequent diarrhea after a cholecystectomy that can be easily treated with mild medication.

5. Exercise and Activity:

   After a certain time, the patients are allowed to indulge in light to moderate activities after operation. Yet it is advisable to avoid lifting heavier objects than 8 to 10 pounds for at least 2 weeks. One can begin lifting heavier objects if the abdomen will not show any sign of pain and discomfort while doing so.

   Moderate exercise like walking will help improve circulation. Other than that daily routine activities like driving, going to work or intercourse can be resumed after two weeks if the patient shows effective recovery.

Other than pain and discomfort, there can be some things that one might face in a critical condition. They are:

1. Infection:

   It depends on one’s immunity system and it can occur with any operation. In a medical setup, a professional will take Every step to ensure reaction-free recovery.

2. Wound infection:

   In case one fails to keep the wound clean and dry, the infections can develop on the surface of the wound. In that case, one must seek medical attention to seek the treatment immediately.

   Although it is rare, A long-term complication like Hernia may arise after months or years of operation. Mostly common in males, a hernia can bump out of the tissues through a weak spot like your incision. An operation is mandatory to cure the hernia.