Cholecystitis & Cholangitis

General Illness Information


Common Name:

Cholecystitis and Cholangitis

Medical Term: None Specified.

Description: Infection or inflammation of the gallbladder, which collects and concentrates bile from the liver (Cholecystitis). Infection or inflammation of the ducts that drain bile from the liver to the gallbladder (cholangitis). More common in women and some ethnic groups (North American Indians). Incidence increases with age.

Causes: Unknown. Postulated to be caused by inflammation or bacterial infection, with some degree of damage by gallstones or previous infection. Cholecystitis is associated with gallstones in 90% of cases.

Prevention: Avoid risk factors when possible.

Signs & Symptoms

  • Severe cramping pain in the upper right of the abdomen. Pain may also occur in the chest (imitating a heart attack), in the upper back or the right shoulder. These symptoms frequently follow a meal rich in fats.
  • Tenderness in the upper abdomen.
  • Nausea and vomiting.
  • Slight fever. If high fever and chills occur, a bacterial infection may be present.
  • Jaundice (sometimes).
  • Pale stools (sometimes).
  • Skin itching (sometimes), from jaundice.

Risk Factors

  • Gallstones.
  • Family history of gallbladder disease.
  • Diet that is high in fat and low in fiber.
  • Chronic or acute pancreatitis.
  • Obesity.
  • Rapid weight loss.
  • Diabetes or cirrhosis.
  • Oral contraceptives.
  • Female, middle age (40-50).
  • Female with previous gallstones who takes estrogen.

Diagnosis & Treatment

Diagnostic test may include laboratory blood studies, X-rays of the gallbladder, ultrasound of the gallbladder and bile ducts, radioisotope studies of liver and pancreas

General Measures:

  • Hospital admission usually necessary. Patient with acute Cholecystitis usually needs to be hospitalized and is administered fluids and electrolytes intravenously and is not allowed to take anything by mouth. Sometimes a tube is inserted into the stomach, so that suctioning can be performed to keep the stomach empty and thus reduce stimulation of the gallbladder. Usually antibiotics are also administered as soon as acute Cholecystitis is suspected.
  • Specific treatment will depend on degree of severity, infection, size of stones, and your general health.
  • No surgical treatment methods include: Medication to dissolve the stones or extra corporeal shock wave lithotripsy that will shatter stones.
  • Surgical treatment is usually a cholecystectomy done by laparoscopic technique or by laparotomy.

Medications:

  • Intravenous fluids.
  • Analgesics, including narcotics, to relieve pain may be prescribed.
  • Antibiotics may be prescribed in acute cases.

Activity:

Rest in bed until symptoms disappear or recovery from surgery is complete. While in bed, move your legs often to reduce the likelihood of deep-vein blood clotting. Other limits on activity will be determined by treatment method.

Diet:

  • Because of nausea and vomiting, intravenous fluids are usually required during severe attacks. Clear liquids are started when nausea subsides.
  • Begin a low-fat diet as soon as you can tolerate solid foods.

Possible Complications :

  • Empyema and pus in gallbladder.
  • Gallbladder rupture and peritonitis, or abscess.
  • Hepatitis.
  • Choledocholithiasis (stones pass from gallbladder into common bile duct obstructing flow of bile).
  • Fistula formation – direct communication between gallbladder and stomach or intestines.

Prognosis

Most episodes require hospitalization and treatment. Recurrences are common. Attacks will cease with surgery to remove the gallbladder. Symptoms of some mild attacks subside spontaneously in 1 to 4 days, if no complications develop. However complications are common. Severe or recurrent Cholecystitis is a definite indication for surgery.

Other

Nothing specified.

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