ACUTE CHOLECYSTITIS

Cholecystitis is an inflammation of the gallbladder wall and nearby

abdominal lining. Cholecystitis is usually caused by a gallstone in the
cystic duct, the duct that connects the gallbladder to the hepatic duct.
The presence of gallstones in the gallbladder is called cholelithiasis.
Cholelithiasis is the pathologic state of stones or calculi within the
gallbladder lumen.

Gallstones are crystalline structures formed by concretion (hardening)

or accretion (adherence of particles, accumulation) of normal or abnormal
bile constituents. According to various theories, there are four possible
explanations for stone formation. First, bile may undergo a change in
composition. Second, gallbladder stasis may lead to bile stasis. Third,
infection may predispose a person to stone formation. Fourth, genetics and
demography can affect stone formation.

Risk factors associated with development of gallstones include heredity,

Obesity, rapid weight loss, through diet or surgery, age over 60, female
gender-gallbladder disease is more common in women than in men.
Women with high estrogen levels, as a result of pregnancy, hormone
replacement therapy, or the use of birth control pills, are at particularly high
risk for gallstone formation, Diet-Very low calorie diets, prolonged fasting,
and low-fiber/high- cholesterol/high-starch diets all may contribute to
gallstone formation.

Sometimes, persons with gallbladder disease have few or no symptoms.

Others, however, will eventually develop one or more of the following
symptoms; (1) Frequent bouts of indigestion, especially after eating
fatty or greasy foods, or certain vegetables such as cabbage,
radishes, or pickles, (2) Nausea and bloating (3) Attacks of sharp
pains in the upper right part of the abdomen. This pain occurs when a
gallstone causes a blockage that prevents the gallbladder from emptying
(usually by obstructing the cystic duct). (4) Jaundice (yellowing of the skin)
may occur if a gallstone becomes stuck in the common bile duct, which
leads into the intestine blocking the flow of bile from both the gallbladder
and the liver. This is a serious complication and usually requires immediate
treatment.

The only treatment that cures gallbladder disease is surgical removal of

the gallbladder, called cholecystectomy. Generally, when stones are
present and causing symptoms, or when the gallbladder is infected and
inflamed, removal of the organ is usually necessary. When the gallbladder
is removed, the surgeon may examine the bile ducts, sometimes with X
rays, and remove any stones that may be lodged there. The ducts are not
removed so that the liver can continue to secrete bile into the intestine.
Most patients experience no further symptoms after cholecystectomy.
However, mild residual symptoms can occur, which can usually be
controlled with a special diet and medication.

The medical cholecystitis definition states that 'cholecystitis is an

inflammation of the gallbladder that usually develops over hours'. This is
because a gallstone obstructs the cystic duct that connects the gall bladder
to the hepatic duct. There are two types of cholecystitis, namely, the acute
cholecystitis and the chronic cholecystitis. The acute cholecystitis is a very
rare condition and occurs in critically ill people. This is usually due to other
complications like a severe illness, diabetes or HIV infection. The chronic
cholecystitis happens when the gallbladder is swollen for a long time.

Cholecystitis Pathophysiology
Cholecystitis is an inflammation of the gallbladder wherein the walls of the
organ become thick and hard. The gallbladder contains bile and gallstones
that block the opening of the cystic duct. Thus, due to cholecystitis the
ability of the gallbladder to concentrate and store bile reduces. This causes
the gallbladder wall to get inflamed and the inflammation spreads to the
outer covering as well. This irritates the surrounding organs like the
diaphragm and the bowel.

Cholecystitis Symptoms
The cholecystitis signs and symptoms are similar to those seen in a
gallstones signs and symptoms. One may experience the cholecystitis
symptoms after eating a large, fatty meal. The cholecystitis signs and
symptoms during an attack include a severe, steady pain in the upper right
abdomen. The pain worsens with deep breathing and may extend to the
lower right shoulder blade. The pain becomes agonizingly unbearable and
the patient may suffer from nausea and vomiting. The acute cholecystitis
signs and symptoms include pain in the upper right quadrant of abdomen,
jaundice, fever, nausea and vomiting.

The cholecystitis pain lasts for about 12 hours or more and the muscles on
the right side of the abdomen become rigid. In few patients, cholecystitis
symptoms may include fever. Patients with chronic cholecystitis may suffer
from mild cholecystitis signs and symptoms as compared to those with
acute cholecystitis. The chronic cholecystitis signs and symptoms are
vague, not very severe abdominal pain. Chronic indigestion and belching
are also seen as chronic cholecystitis symptoms.

The cholecystitis signs and symptoms subside after two to three days.
These cholecystitis symptoms disappear totally after about a week. If the
cholecystitis symptoms do not fade away even after a week, you should
seek medical help. This pain may be due to development of an abscess, a
perforation or even gangrene. The signs and symptoms due to these
causes will include fever, chills, high blood cell count and lack of sounds
from the intestine.

Cholecystitis symptoms in pregnancy are seen due to the fetus pushing the
stomach and intestines backwards and sideways. This displacement leads
to intestinal peristalsis, stomach emptying and trap bile in the gallbladder.
This leads to development of cholecystitis symptoms in pregnancy. This
makes cholecystitis the second most common non-obstructive surgical
condition in pregnancy, after appendicitis.

Cholecystitis Treatment
Once a patient is diagnosed with cholecystitis, he is admitted to the
hospital. The person is not alowed to eat or drink at all and is kept on
intravenous (IV) liquids. If there is any infection due to cholecystitis,
medications will be given to help fight the infection. Due to frequent
occurrences of cholecystitis, the doctor may advice surgical removal of the
gallbladder, that is, cholecystectomy.

In case of gangrene or perforation of the gallbladder, the patient may be

taken into surgery immediately. If there is an infection, a temporary tube
may be placed through the skin into the gallbladder. This will help drain out
the infection. If no complications are seen, then the cholecystectomy may
be scheduled after a few days or weeks. After the gallbladder is removed,
the bile is allowed to flow from the liver into the small intestine, as there is
no gallbladder to store it. Gallbladder is not necessary for survival and
removal may not affect the ability to digest food. But, it may lead to
diarrhea.

Acute Cholecystitis Diet

Acute cholecystitis diet is an important part of the cholecystitis treatment.
You need to avoid fatty foods and high fat meals, as it helps reduce the
cholecystitis signs and symptoms. Spicy foods like hot peppers, wasabi,
Mexican and Japanese foods may irritate the gastrointestinal tract and
worsen the cholecystitis symptoms. Also, caffeine and soda will increase
the chances of developing cholecystitis symptoms. You should avoid
alcohol, as it increases the risk of gallstones and cholecystitis. The
cholecystitis signs and symptoms due to alcohol consumption, increases
the risk of developing pancreatitis symptoms. Loss of excessive weight in a
short period of time will lead to development of cholecystitis. Therefore,
maintain a healthy weight and do not lose more than one to two pounds per
week.

Prepared by:

Macabuhay, Melody

Mansalay,Adrian Enrico

Orillaza, Patricia joy

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