What is Cholecystitis

Cholecystitis is the inflammation of the Gallbladder. It occurs mostly as a complication of gallstones.

Statistics on Cholecystitis

Gallstones are very common – affecting 10-20% of the population. It is difficult to determine exactly what the incidence of cholecystitis is, but studies have shown that patients with gallstones have a 1% per year incidence of severe events (cholecystitis, obstructive jaundice or biliary pancreatitis).

Risk Factors for Cholecystitis

Almost all (95%) of the cases of acute cholecystitis are due to impaction of a gallstone in the gallbladder neck or cystic duct. Therefore predisposing factors for gallstones are also risk factors for cholecystitis.

Progression of Cholecystitis

If the gall bladder remains obstructed and the inflammatory process continues for longer than 2-3 days, then the inflammatory fluid passes through the wall of the gallbladder and makes it adhere to nearby structures – producing a “phlegmon”. If the inflammation remains unresolved the next development may be gall bladder gangrene and perforation which is indicated by a swinging fever. This requires an urgent operation.

Rarer complications may be a fistula formation from the gall bladder to the bowel or a small bowel obstruction.

Many patients have recovered completely from acute cholecystitis without surgical intervention. However, experience has shown that it should be treated surgically. Morbidity and mortality are related to age and coexisting medical illness.

How is Cholecystitis Diagnosed?

– Full blood count – High white cell count and ESR signifying infection/inflammation;
– Liver function tests – Can be abnormal if there is a common bile duct stone;
– Blood cultures – Required in the case of cholangitis.

Prognosis of Cholecystitis

Most cases of cholecystitis will settle down with conservative management, and a cholecystectomy can be delayed. However, in practice the gallbladder is usually removed during the same hospital admission after the patient is first stabilised to avoid further admissions to hospital, as up to 15% of cases may not settle down with conservative management, due to complications such as an empyema or perforation.

How is Cholecystitis Treated?

Acute Cholecystitis requires the patient to be and prepared for surgery – hence the patient needs to be fasted, given IV fluids, analgesia (narcotic), antibiotics. A cholecystectomy may be required at a later date if the symptoms settle spontaneously. An intraoperative cholangiogram should be performed in theatre so that it can be ensured there is not a gallstone lodged in the common bile duct.

Chronic cholecystits also requires a cholecystectomy. Patients unfit for surgery may be placed on a low fat diet to control symptoms or treated with shock wave lithotripsy. Chenodexycholic acid may also be given orally to dissolve stones which are small and radio-opaque.

Cholecystitis References

[1] Braunwald, Fauci, Kasper, Hauser, Longo, Jameson. Harrison’s Principles of Internal Medicine. 15th Edition. McGraw-Hill. 2001.
[2] Cotran, Kumar, Collins 6th edition. Robbins Pathologic Basis of Disease. WB Saunders Company. 1999.
[3] Haslet C, Chiliers ER, Boon NA, Colledge NR. Principles and Practice of Medicine. Churchill Livingstone 2002.
[4] Hurst JW (Editor-in-chief). Medicine for the practicing physician. 4th edition Appleton and Lange 1996.
[5] Kumar P, Clark M. CLINICAL MEDICINE. WB Saunders 2002.
[6] Longmore M, Wilkinson I, Torok E. OXFORD HANDBOOK OF CLINICAL MEDICINE. Oxford Universtiy Press. 2001
[7] McLatchie G and LEaper DJ (editors). Oxford Handbook of Clinical Surgery 2nd Edition. Oxford University Press 2002.
[8] MEDLINE Plus
[9] Raftery AT Churchill’s pocketbook of Surgery. Churchill Livingsone 2001.
[10] Tjandra, JJ, Clunie GJ, Thomas, RJS,; Textbook of Surgery, 2nd Ed, Blackwell Science, Asia. 2001.

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