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Gallbladder disease: Cholecystitis

Gallbladder disease is the term used for several types of conditions that can affect the gallbladder which is the small pear-shaped sac located underneath the liver [1]. Gall bladder disease includes inflammation, infection, stones, or blockage of the gall bladder [2]. The main gall bladder disease is cholecystitis and gallstones [2].


Cholecystitis is inflammation of the gallbladder that occurs due to occlusion of the cystic duct or impaired emptying of the gall bladder [3]. Often this impairment is due to stones or biliary sludge that has become impacted at the neck of the gall bladder [3]. It can be chronic or acute.


The etiology of cholecystitis by definition is cystic duct blockage which causes inflammation [3]. Normally, bile is made in the liver and travels down the bile duct and is stored in the gall bladder [3]. After eating certain foods, especially spicy or greasy foods, the gall bladder is stimulated to empty the bile of the gallbladder, through the cystic duct, down the bile duct into the duodenum [3]. This process aids in food digestion.

The gallbladder does not only stores bile, but it also concentrates it [3]. The concentrated bile is susceptible to precipitation forming stones when homeostasis is disrupted, that can occur due to bile stasis, supersaturation from the liver of cholesterol and lipids, disruption in the concentration process, and cholesterol crystal nucleation [3].


When cystic duct blockage is caused by a stone, it is called acute calculous cholecystitis [3]. It is important to know, one can have pain due to temporary obstruction by gallstones, and that is called biliary colic [3]. The diagnosis of biliary colic is upgraded to acute calculous cholecystitis if the pain does not resolve in six hours [3]. If no stone is identified, it called acute acalculous cholecystitis [3].


Hence, gallbladder inflammation can also be caused by [3, 4]:

Ø Gallstones. Most often, cholecystitis is the result of hard particles that develop in your gallbladder (gallstones). Gallstones can block the tube (cystic duct) through which bile flows when it leaves the gallbladder. Bile builds up, causing inflammation.

Ø Tumor. A tumor may prevent bile from draining out of your gallbladder properly, causing bile buildup that can lead to cholecystitis.

Ø Bile duct blockage. Kinking or scarring of the bile ducts can cause blockages that lead to cholecystitis.

Ø Infection. AIDS and certain viral infections can trigger gallbladder inflammation. Blood vessel problems. A very severe illness can damage blood vessels and decrease blood flow to the gallbladder, leading to cholecystitis.


Regardless of the cause of the blockage, during the early phases of cholecystitis, the gallbladder will usually reveal extensive venous congestion and edema [3]. With time, fibrosis and the presence of chronic inflammatory cells may appear. More advanced cases may present with perforation or gangrene [3]. The gangrenous gallbladder can become infected by gas-forming organisms, causing acute emphysematous cholecystitis; all of these conditions can quickly become life–threatening, and rupture has a high rate of mortality [2,3].


Gallbladder disease occurs in men and women, with certain populations being more prone to it [3]. The risk of gallbladder disease increases in women, obese patients, pregnant women, and patients in their 40s [3]. Drastic weight loss or acute illness may also increase the risk.


Chronic cholecystitis symptoms include [3, 4];

Ø Right upper quadrant abdominal pain with bloating

Ø Food intolerance (spicy and greasy foods)

Ø Increased gas

Ø Nausea

Ø Vomiting

Ø Pain in the midback or shoulder

Ø Fever


Cases of acute cholecystitis have similar symptoms only more severe [3]. Often symptoms are mistaken for cardiac issues. The finding of right upper abdominal pain with deep palpation, Murphy sign, is usually classic for this disease [3]. Often, there is a specific dietary event leading to the acute attack.


Treatment and management of cholecystitis includes [3,5];

1. Laparoscopic cholecystectomy: The most appropriate management of cholecystitis. There are low morbidity and mortality rates with quick recovery. This can also be done with an open technique in cases where the patient is not a good laparoscopic candidate

2. Temporizing percutaneous drainage of gall bladder: It can be done in situations in where the patient is acutely ill and considered a poor surgical candidate.

3. Low-spice and low-fat diets: For milder cases of chronic cholecystitis that are poor surgical candidates. The results of this treatment varies.

4. Medical treatment of gallstones with ursodiol: This has been reported to have occasional success.


You can reduce your risk of cholecystitis by taking the following steps to prevent gallstones [3]:

Ø Lose weight slowly. Rapid weight loss can increase the risk of gallstones. If you need to lose weight, aim to lose 1 or 2 pounds (0.5 to about 1 kilogram) a week.

Ø Maintain a healthy weight. Being overweight makes you more likely to develop gallstones. To achieve a healthy weight, reduce calories and increase your physical activity. Maintain a healthy weight by continuing to eat well and exercise.

Ø Choose a healthy diet. Diets high in fat and low in fiber may increase the risk of gallstones. To lower your risk, choose a diet high in fruits, vegetables and whole grains.



Reference:

1. Gallbladder Disease: Overview, Types, and Diagnosis. Available at https://www.healthline.com/health/gallbladder-disease


2. Gallbladder Disease | Johns Hopkins Medicine. Available at https://www.google.com/amp/s/www.hopkinsmedicine.org/health/conditions-and-diseases/gallbladder-disease%3famp=true


3. Acute Cholecystitis Article. Available at https://www.statpearls.com/ArticleLibrary/viewarticle/19448


4. Cholecystitis - Symptoms and causes - Mayo Clinic. Available at https://www.mayoclinic.org/diseases-conditions/cholecystitis/symptoms-causes/syc-20364867


5. Acute cholecystitis available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124163/

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