Pathophysiology Cholecystitis is inflammation of the gallbladder. Cholecystitis occurs most commonly due to blockage of the cystic duct with gallstones. This blockage causes a buildup of bile in the gallbladder and increased pressure within the gallbladder, leading to right upper abdominal pain. Concentrated bile, pressure, and sometimes bacterial infection irritate and damage the gallbladder wall, causing inflammation and swelling of the gallbladder. Inflammation and swelling of the gallbladder can reduce normal blood flow to areas of the gallbladder, which can lead to cell death due to inadequate oxygen.
Early signs and symptoms Symptoms of cholecystitis can appear suddenly or develop slowly over a period of years. The main symptom is pain in the upper right side or upper middle of your belly that usually lasts at least 30 minutes. Other symptoms include severe abdominal pains that may feel sharp or dull abdominal cramping and bloating pain that spreads to your back or below your right shoulder blade fever chills nausea vomiting loose, light-colored stools jaundice, which is when your skin and the whites of your eyes turn yellow
Statistics More than 20 million Americans are estimated to have gallstones, with 500,000 cholecystectomies performed annually. Most patients with gallstones do not develop symptoms. About 1% to 2% of asymptomatic gallstones become symptomatic each year.
Diagnosis Cholecystitis can be diagnoised by conduction the following tests. Blood tests include: Amylase and lipase test, Bilirubin test, Complete blood count (CBC) and Liver function tests The CT scan uses X-rays to produce very detailed view of abdomen. The abdominal ultrasound is used to view all the internal organs in abdomen and see how blood flows through your vessels. In cholescintigraphy, or a HIDA scan, in which an injection of a small amount of radioactive material can help identify abnormal contractions or obstructions of your gallbladder and bile ducts. Endoscopic retrograde cholangiopancreatography (ERCP) involves using an endoscope, dye, and an X-ray to thoroughly examine the organs and find defects or problems. In a percutaneous transhepatic cholangiography (PTC), contrast dye is inserted into the liver with a needle. This allows doctor to see the bile ducts on X-ray.
Treatment The treatment for cholecystitis will vary depending on the specific cause of attack. The treatments include: Broad-spectrum antibiotics for fighting infection Oral dissolution therapy using medications to help dissolve gallstones Pain relievers for controlling pain during treatment Surgical removal of your gallbladder is necessary if the gallbladder is ruptured. Today, gallbladder surgery is generally done laparoscopically.
Major research Since cholecystitis can be treated easily, there are few research centers working on developing a effective way to diagnose cholecystitis, and differentiate patients of high, intermediate and low risk. Few of them are Massachusetts General Hospital and University of Maryland Medical Center (UMMC).