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cholecystitis

Inflammation of gallbladder. Mechanism: 1. Blockage of cystic duct by a gallstone. 2. Buildup of bile and increased pressure in gallbladder. 3. Concentrated bile, pressure, and sometimes bacterial infection irritate and damage the epithelium, causing inflammation and swelling of gallbladder. 4. Reduced blood flow. 5. Necrosis due to inadequate oxygen. Acute cholecystitis: Inflammation of gallbladder that develops over hours, usually because a gallstone obstructs cystic duct (cholelithiasis). Symptoms include right upper quadrant pain and tenderness, sometimes accompanied by fever, chills, nausea, and vomiting. Chronic cholecystitis: Occurs after repeated episodes of acute cholecystitis, almostly due to gallstones. (e.g. Blocked with a gallstone and inflammation process takes place. The next moment, the gallstone is occasionally removed ceasing inflammation process. And it cycles.) The gallbladder is likely to get fibrotic and calcified. It may be asymptomatic, present as a more severe case of acute cholecystitis. It may lead to a number of complications such as gangrene, perforation, or fistula formation. Xanthogranulomatous cholecystitis (XGC): A form of chronic cholecystitis looking like a gallbladder cancer (clustering of foamy macrophages among other inflammatory cells, not cancerous). Cholelithiasis: The blockage of cystic duct, that can lead to cholecystitis. Acalculous cholecystitis: Cholecystitis without gallstones or cystic duct obstruction. Risk factors: Women (estrogen), oral contraceptives (progesterone), pregnancy (estrogen, progesterone). Obesity (cholesterol), sedentary. High-fat, high-cholesterol diet Rapid weight loss (secretion of extra cholesterol by liver). Fasting (overconcentrated with cholesterol by decreased gallbladder movement) Diabetes, liver disease, certain blood disorders (sickle cell anemia, leukemia) Gene (familial hypercholesterolemia) Ethnicity, age (older than 40), drugs, etc. Symptoms: 1. Mostly asymptomatic during the process of cholelithiasis. 2. Biliary colic (after blockage of cystic duct occurs): Abdominal pain in the right upper quadrant (epigastric region). It is episodic, occurring after eating greasy or fatty foods (because gallbladder contracts to squeeze bile out), and leads to nausea and/or vomiting. Fever. Tenderness. Increased size of the inflamed gallbladder (it can be felt from the outside of the body). Murphy's sign (pain in the right subcostal area on deep inspiration while palpating). Jaundice, often mild (severe jaundice may be caused by choledocholithiasis). Diagnosis: Boas' sign (Pain below the right scapula). Blood tests: - White blood count (inflammation). - C-reactive protein (inflammation). - Bilirubin (bile duct blockage). Imaging: - Sonography (ultrasound): Gallbladder wall thickening (over 3 mm), dilation of bile duct, and sonographic Murphy's sign (maximal abdominal tenderness from pressure of the ultrasound probe over the visualized gallbladder). - Cholescintigraphy (gamma scan detecting radioactive tracer) (Hepatic iminodiacetic acid (HIDA) scan): Higher sensitivity, in case ultrasound is not diagnostic. It scans the circulation of the secretion. If gallbladder is not visualized within 4 hours after the injection of the radioactive tracer, this indicates either cholecystitis or cystic duct obstruction. - CT scan: For complications (e.g. perforation, gangrene). Histopathology: In case gallbladder cancer is suspected. Treatment: Fasting: No eating or drinking to take stress off the gallbladder. Taking fluid intravenously to avoid dehydration. Antibiotics: Fight infection. Pain medications: Control pain. Endoscopic retrograde cholangiopancreatography (ERCP): Removes any stones blocking the bile ducts or cystic duct. Cholecystectomy (laparoscopic or open).