Cholecystitis is the inflammation of the gall bladder. Acute Cholecystitis may be acute, chronic, or acute superimposed
on chronic. Inflammation of the gall bladder wall results in the formation of gall stones in the neck of the gall
bladder or in the cystic duct. This is associated with sudden and severe abdominal pain. In about 10% of the patients,
inflammation is observed even without the presence of gallstones and this condition is called as acute acalculous
cholecystitis. The acalculous is maybe due to chemical irritation or bacterial infection but the exact mechanism of the
acalculous is not clear.
a) Acute calculous cholecystitis: Acute inflammation of the gall bladder with gallstone is called as acute calculous
cholecystitis. the gall stones get precipitate in the neck of the gall bladder or in cystic duct. It is the primary
complication of the gall bladder and is usually recommended for emergency cholecystectomy.
b) Acute acalculous cholecystitis: Acute inflammation of the gall bladder without gall stone is called as acute
acalculous cholecystitis. This is usually results from the direct ischemia of the cystic artery which does not have
collateral circulation. It generally occurs after injuries, non- biliary surgery, severe trauma, severe burns,
multisystem organ failure and critical illness – particularly in patients with dehydration, multiple blood
transfusions, and patients receiving prolonged intravenous feedings. This serious disease can lead to gangrene
or perforation of the gall bladder.
The following are the normal major events in calculous cholecystitis,
• Development of the bacterial infection
• Irritation of gall bladder due to chemical exposure or due to obstruction
• Disruption of normal protective glycoproteins
• Direct detergent action of the bile salts on the exposed mucosal epithelium tissue
• Compromised blood flow to the mucosa
• Dysmotility and distention of gall bladder with the increased intraluminal pressure
• Hydrolysis of luminal lecithin’s to lysolecithins by the action of mucosal phospholipase
CLINICAL FEATURES
1. Progressive right upper quadrant pain frequently associated with mild fever, anorexia, tachycardia, nausea and
vomiting are usual signs. The pain may worsen upon deep breathing and often extends to the lower part of right
shoulder and back.
2. Initial slight fever tends to become higher with progress of the disease.
3. Jaundice may occur in approximately 1/4th cases.
4. Rigid abdominal muscles of the right side.
Typically, attack may subside within 02-04 days and complete relief may be seen within a week. If it doesn’t disappear,
it may lead to some serious complications mentioned below
COMPLICATIONS
• Increase in white blood cell count
• Gall bladder gangrene and/or perforation
• Pancreatitis
• Generalized peritonitis
• Emphysema
Some other typical complications like systemic vasculitis, atherosclerotic ischemic damage, etc. are seen in acalculous
cholecystitis
DIAGNOSIS
a) Physical examination of patient: Palpable gall bladder, illness with mild to moderate pain, shallow respiration,
experience of sharp pain at the upper right abdominal visage after pressing are typical signs of cholecystitis.
b) Tests:
i) Radiological examination: A plain radiograph of the chest and abdomen may be done to describe the reason for
cholecystitis (eg, gallstones, fistulation, etc.)
(ii) Ultrasound scanning: It’s carried out to describe the presence of gall stones and changes in the wall of the gall bladder.
iii) Cholescintigraphy: It’s an imaging fashion used after injection of a radioactive substance (e.g. technetium iminodiacetic
acid) excreted by the liver into the biliary ductal system indeed in presence of hyperbilirubinemia.
The absence of gall bladder in the checkup suggests the inhibition of cystic conduit. In this test images of liver, bile
duct, gall bladder and upper part of small intestine are taken
iv) Blood test Estimation of serum bilirubin and amylase situations
TREATMENT
The major goals of therapy are functional rest for the gall bladder, upper GIT and relaxation of sphincter of Oddi.
Common measures to achieve this are:
• Nothing should be given by mouth.
• Nasogastric aspiration is used to keep the stomach empty Continuous intravenous supply of fluid and
electrolytes.
• Anticholinergics (e.g. atropine 0.6 mg IM.) to reduce gastric and pancreatic secretions.
• Broad spectrum antibiotic (e.g. cephalosporins) therapy is recommended to control inflammation and the
severe infection.
• Administration of analgesics (eg, morphine, pethidine) that helps to relieve the pain.
• If the diagnosis is certain and the risk of surgery is small then the cholecystectomy i. e. removal of gall bladder
is usually preferred.
In case of tenderness across the abdomen, spread of pain, high fever, increase in gall bladder lump, etc. Then surgery
is the only option
CHRONIC CHOLECYSTITIS
It is the most common type of gall stone leading to gallbladder disease. It is found to produce repeated
attacks of biliary colic, sometimes with or without abdominal distention. Even though such effects are
produced, there are still no signs and symptoms that are conclusive to be said that it is due to chronic
cholecystitis.
Some of major effects are reduced or no functioning of the gall bladder with shrunken anatomy. The
replacement of normal muscle coat by fibrous tissue leads to incapability of gall bladder to contract and
leading to hypo functioning.
In some cases, repeated and continual attacks of mild to moderate acute cholecystitis complications. The
reason for the initiation of the inflammation is not particularly known but it is estimated that due to super
saturated of the bile with cholesterol and gall stones obstructions are the major factors.
CLINICAL FEATURES
• Nausea and vomiting
• Flatulence
• Abdominal pain after the meal followed by epigastric discomfort
• Resistance to fatty foods
• Biliary colic may occur due to the passage of gall stones into bile ducts
• A constant dull ache is observed in the right subcapsular and epigastric region.
DIAGNOSIS
a) Physical examination of patient: Palpable gall bladder, illness with mild to moderate pain, shallow
respiration, and experience of sharp pain at the upper right abdominal visage after pressing are typical signs of
cholecystitis.
b) Tests:
i) Radiological examination: A plain radiograph of the chest and abdomen may be done to describe the
reason for cholecystitis (eg, gall stones, fistulation, etc.)
(ii) Ultrasound scanning: It’s carried out to describe the presence of gall stones and changes in the wall of the
gall bladder.
iii) Cholescintigraphy: It’s an imaging fashion used after injection of a radioactive substance (e.g. technetium
iminodiacetic acid) excreted by the liver into the biliary ductal system in the presence of
hyperbilirubinemia.
The absence of a gall bladder in the checkup suggests the inhibition of the cystic conduit. In this test images of
liver, bile duct, gall bladder, and upper part of the small intestine are taken
iv) Blood test Estimation of serum bilirubin and amylase situations
MANAGEMENT
• Analgesic administration to relieve epigastric pain
• If in some cases, medical dissolution of gallstones (if possible)
• By using a catheter or lithotripsy technique for crushing of gallstones
• Stoppage of food administration by oral route and to provide a continuous supply of electrolytes and
water by IV route.
• Supporting therapy to induce and promote recovery
COMPLICATIONS
• Acute pancreatitis
• Obstructive jaundice
• Transient jaundice
• Pyogenic cholangitis