Cholecystitis is inflammation of the gallbladder. It may be acute or
The most common cause of cholecystitis are gallstones (90% of the
cases). The bile becomes concentrated in the gallbladder. This later
causes irritation and is probably the leading cause of inflammation
(chemical inflammation). This invites infection, usually from colonization
by gut organisms. 10% of the cases do not involve gallstones (achalculous
Risk factors for calculous cholecystitis
- Gallstones are more common in women.
- Increasing age
- Obesity or rapid weight loss
- Native Americans are more prone. White people have a higher
prevalence than black people. Scandinavians have a high prevalence
Acalculous cholecystitis is related to conditions associated
with biliary stasis, including debilitation, major surgery, severe
trauma, sepsis, long-term total parenteral nutrition (TPN), and
prolonged fasting. Other causes of acalculous cholecystitis include
cardiac events; sickle cell disease; Salmonella infections; diabetes
mellitus; and cytomegalovirus, cryptosporidiosis, or microsporidiosis
infections in patients with AIDS.
Cholecystitis is often accompanied by presence of gallstones. The classical
patient with cholecystitis is described as "fat, forty, female and fertile".
The main symptom is
abdominal pain in the right upper part of the abdomen (right
(from infection), nausea
and vomiting may also occur.
The main clinical sign is tenderness in the right hypochondrium.
- Abdominal ultrasonography provides high sensitivity and
specificity for detection of gallstones and cholecystitis. Findings
suggestive of acute cholecystitis include pericholecystic fluid,
gallbladder wall thickening and the presence of gallstones.
- Abdominal CT scan can also detect acute cholecystitis with
sensitivity greater than 95%. MRI scans have a similar accuracy.
- A HIDA scan is the best tool in detection and diagnosis of acute
- ERCP may be useful in patients at high risk for common duct
gallstones if signs of common bile duct obstruction are present. It
has the advantage of being therapeutic as well as diagnostic.
- Other tests include: abdominal x-ray, oral cholecystogram. A CBC
shows infection by an elevated white blood cell count. All females
of childbearing age should have pregnancy testing.
Initial treatment of acute cholecystitis is usually medical which usually
consists of antibiotics
(ampicillin, ampicillin/sulbactam, or piperacillin/tazobactam. In severe
life-threatening cases Primaxin or meropenem) and supportive therapy
killers) followed by surgical removal
of the gallbladder - cholecystectomy. Cholecystectomies can be performed
as a laparotomy or
laparoscopically although the established trend is for
laparoscopic operations which has the benefit of shorter post-operation
recovery times and smaller surgical scars.
Patients admitted for cholecystitis should receive nothing by mouth (NPO)
because of expectant surgery. However, in uncomplicated cholecystitis, a
liquid or low-fat diet may be appropriate until the time of surgery.
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