Cholecystitis

Cholecystitis is the inflammation of the gallbladder, usually caused by the presence of gallstones that obstruct the cystic duct, leading to bile accumulation and inflammation. This condition can be acute or chronic.

Types of Cholecystitis

  1. Acute Cholecystitis: This is a sudden onset of inflammation and is often associated with gallstones. Symptoms can be severe and may include:

    • Intense abdominal pain, particularly in the upper right quadrant
    • Nausea and vomiting
    • Fever and chills
    • Tenderness in the abdomen
    • Jaundice (in some cases)

  2. Chronic Cholecystitis: This form develops gradually and is characterized by recurrent episodes of inflammation, often due to long-standing gallstones. Symptoms may be less severe and can include:

    • Intermittent abdominal pain
    • Indigestion, bloating, and gas
    • Fat intolerance

Causes

The primary cause of cholecystitis is the blockage of the cystic duct by gallstones. Other causes can include:

  • Bacterial Infections: Infections can occur within the gallbladder.
  • Tumors: A tumor can block the bile duct and lead to inflammation.
  • Bile Duct Obstruction: Conditions that cause bile duct obstruction, such as strictures or pancreatitis.
  • Trauma: Injury to the abdomen can lead to cholecystitis.

Diagnosis

Diagnosis typically involves:

  • Medical History and Physical Exam: Assessment of symptoms and abdominal examination.

  • Imaging Studies:

    • Ultrasound: The most common initial imaging method, which can identify gallstones and inflammation.
    • CT Scan: Provides detailed images and can help confirm diagnosis.
    • HIDA Scan: A nuclear imaging test that evaluates gallbladder function and can show how well the gallbladder is working.

  • Blood Tests: To check for signs of infection or inflammation, such as elevated white blood cell counts or liver function tests.

Treatment

Treatment options depend on the severity of the condition:

  1. Acute Cholecystitis:

    • Hospitalization: Often required for close monitoring and treatment.
    • NPO Status: Patients are usually kept “nothing by mouth” (NPO) to rest the digestive system.
    • IV Fluids and Antibiotics: To manage dehydration and treat infection.
    • Surgery: The most common treatment is cholecystectomy (surgical removal of the gallbladder), which can be performed laparoscopically or through an open procedure. Surgery is often performed once the patient is stabilized.

  2. Chronic Cholecystitis:

    • Surgery: Often recommended if symptoms are recurrent or severe. Cholecystectomy is the definitive treatment to prevent complications.

Complications

If left untreated, cholecystitis can lead to serious complications, such as:

  • Gallbladder Perforation: This can lead to peritonitis, a severe abdominal infection.
  • Abscess Formation: Pockets of infection can form around the gallbladder.
  • Cholangitis: Infection of the bile duct.
  • Pancreatitis: Inflammation of the pancreas can occur due to blockage of the bile duct.

Prognosis

The prognosis for cholecystitis is generally good with timely diagnosis and treatment. Most individuals recover well after surgery and can resume normal activities.

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