Cholecystitis

Cholecystitis refers to inflammation of the gallbladder. The condition can occur slowly over time (chronic) or suddenly (acute). Cholecystitis is usually caused by the presence of gallstones blocking the bile duct causing the gallbladder to become inflamed.

Rarely, cholecystitis occurs without the presence of gallstones. This type of acute cholecystitis is referred to as acalculous cholecystitis. It is a more serious form of cholecystitis and tends to occur after injury to the gallbladder from surgery, prolonged fasting, critical illnesses, or when a problem with the immune system occurs.

Symptoms

Symptoms vary but will often occur after eating fatty meals and may occur during the night, suddenly awakening the patient. Common complaints include:

  • Colic pain-pain that comes and goes
  • Steady pain in the upper right of the abdomen that increases rapidly and
  • lasts from 30 minutes to several hours
  • Pain in the back between the shoulder blades
  • Pain under the right shoulder
  • Abdominal tenderness
  • Nausea or vomiting
  • Indigestion, flatulence and belching
  • Chills
  • Low grade fever
  • Abdominal bloating
  • Recurring intolerance of fatty foods

Causes of Cholecystitis

The majority of cases of Cholecystitis are caused by gallstones. Other less common causes can include:

  • Trauma to the gallbladder: Injury to the gallbladder can occur from abdominal surgery or from an abdominal injury, such as in sports or an automobile accident.
  • Infection: If bile from the liver becomes infected, it can cause gallbladder inflammation.
  • Tumor: If a tumor is present and blocking the flow of bile, the bile can build up causing Cholecystitis.

Diagnosis:

Your physician will perform the following:

  • Medical History
  • Physical Examination

Tests your doctor may order to confirm a diagnosis of cholecystitis may include the following:

Ultrasound

Ultrasound is a medical imaging test that utilizes sound waves and their echoes to create 2 dimensional images. Ultrasound scanning is the most sensitive and specific test for gallstones. It can detect 95% of gallstones and can confirm gallstones as small as 2 mm.

Cholescintigraphy (HIDA scan)

The patient is injected with a small amount of harmless radioactive material that is absorbed by the gallbladder. X-ray images are then taken of the liver, bile ducts, gallbladder, and upper portion of the small intestine.

The test is used to diagnose abnormal contraction of the gallbladder or obstruction of the bile ducts.

Blood tests:

Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice.

Treatment

The most common treatment for cholecystitis is surgery called laparoscopic

cholecystectomy. This is a less invasive surgery than the traditional method of a large abdominal incision to remove the gallbladder.

With the laparascopic operation, the surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. Laparoscopic surgery leads to fewer complications, such as hospital-related infections, and has a shorter recovery time.

If tests show the gallbladder has severe inflammation, infection, or scarring from other operations, the surgeon may perform open surgery to remove the gallbladder. In some cases, open surgery is planned; however, sometimes these problems are discovered during the laparoscopy and the surgeon must make a larger incision converting to open surgery.

Recovery from open surgery usually requires 3 to 5 days in the hospital and several weeks at home. Open surgery is necessary in about 5 percent of gallbladder operations.

Benefits of Laparoscopy versus Traditional (Open) Surgery:

  • Smaller incisions
  • Minimal soft tissue trauma
  • Less pain
  • Faster healing time
  • Lower infection rate
  • Less scarring
  • Less blood loss
  • Earlier mobilization
  • Usually performed as outpatient day surgery

Post-Operative Guidelines

Common post-operative guidelines following laparoscopic cholecystectomy include the following:

  • You will probably be in the hospital for a day or two for monitoring.
  • Follow your surgeon’s instructions regarding the dressings on the incision sites.
  • Deep breathing and moving around after your surgery helps to prevent pneumonia.
  • Your surgeon may give you activity restrictions such as no heavy lifting. It is very important that you follow your surgeon’s instructions for a successful recovery.
  • You may feel soreness around the incision areas. Your surgeon may give you a prescription pain medicine or recommend NSAID’s (non-steroidal anti-inflammatory drugs) for the first few days to keep you comfortable.
  • If the abdomen was distended with gas, you may experience discomfort in the abdomen, chest, or shoulder area for a couple days while the excess gas is being absorbed.
  • Contact your doctor immediately if you have a fever, chills, increased pain, bleeding or fluid leakage from the incisions, chest pain, shortness of breath, leg pain, or dizziness.

Risks and Complications

As with any major surgery there are potential risks involved. The decision to proceed with

the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place.

Complications may include:

  • Allergic reactions to medications
  • Excessive bleeding
  • Damage to organs or blood vessels in the abdomen
  • Infection
  • Blood clot development

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