Every part of the body is made up of cells and has the possibility of becoming inflamed. This means that if for any reason, there is a problem with any of the organs of the body, there is the possibility of that organ to become inflamed.
The gall bladder is an organ that is not left out.
Cholecystitis is a medical term that refers to the inflammation of the gallbladder. The gallbladder is a small pear-shaped organ that is found just beneath the liver. The liver is one of the largest organs of the body, and the function of the gall bladder is to store and concentrate bile.
Bile or gall is a fluid that is dark green or sometimes brownish in color. It is produced by the liver, and it is stored I’m the gall bladder.
The importance of the gall is to help in the digestion of lipids in the small intestine. Bile also helps in the detoxification process. It does this by carrying toxins that have been excreted by the liver into the small intestine.
There it is eventually passed into the large intestine, and from there to the rectum and anus where excretion is done.
Bile is passed from the liver to the gallbladder through a number of tunnels. There it is stored, and overtime, the bile becomes concentrated. The more concentrated the bile is, the more effective it is in the digestion of fats and lipids.
Generally, the gall bladder functions as a secretory organ, and it releases the bile at specific times when it is needed. Although the gall bladder is a secretory organ, it is a vestigial organ.
This means one can do without it. In other words, the gallbladder is useful but not exactly essential. If it is causing you problems, you can safely go for a removal surgery without it interfering with your ability to digest certain foods.
In most cases, cholecystitis is caused when there is a blockage of the gallbladder by small calcium deposits in the gall bladder, which will eventually become gallstones. Once there is a blockage of the gallbladder by gallstones, bile will begin to build up and, as a result, cause inflammation to occur.
Although this is what happens in most cases, this is not the only cause of cholecystitis.
Causes
The causes of cholecystitis can be broadly grouped into two:
1. Calculous cholecystitis
This is usually the most common cause of cholecystitis. It is also considered as the less serious among the two classifications. According to research, about 93-97% of all cases of cholecystitis is as a result of the deposit of calcium forming gallstones.
Calculous cholecystitis occurs when the gall bladder becomes blocked as a result of gallstones or by another substance, which is often referred to as biliary sludge.
Biliary sludge is formed when there is a mixture of bile alongside deposits of crystals from calcium and other trace elements with cholesterol. Once this sludge is created, it can cause the blockage of the gallbladder.
Once this blockage occurs, there will be a build-up of bile within the gallbladder leading to an increase in the pressure within the organ and, as such, causing swelling and inflammation to occur.
In some cases, once there is a build-up of bile, remember that the bile also helps remove toxins within the body. As such, there can be an increase in bacterial activity after the inflammation has occurred. This can lead to a more complicated issue of infection alongside inflammation.
2. Acalculous Cholecystitis
This refers to the inflammation of the bladder that is caused from other sources asides the blockage formed as a result of the deposits and biliary sludge. This type of cholecystitis is less common, and it is considered to be a more severe form of cholecystitis.
This kind of cholecystitis is often as a result of diseases or complications or other causes. The different types of causes that fall in this category include;
- Tumors: A tumor within the gall bladder especially one that is situated at the neck will prevent the drainage of bile out of the gall bladder and as a result, causing inflammation to occur.
- Bile duct blockage: When there is scarring or blockage of the bile duct, which is a passageway for the bile from the gall bladder to the small intestine, it can lead to a build up of bile in the gall bladder leading to cholecystitis.
- Infection: Certain infections such as AIDS and some viral diseases can cause the gall bladder to become inflamed, causing cholecystitis.
- Damage to the blood vessels: When there is damage to any of the blood vessels that supply the gall bladder may be due to a severe disease condition, there will be a decrease to the blood flow in the gall bladder and, as such, cause inflammation to occur leading to cholecystitis.
- Burns: When there is a certain degree of burn that affects the liver or the gall bladder, cholecystitis can occur.
- Trauma: When there is severe trauma to the abdomen, it can cause the damage of the common bile duct, which will eventually lead to the blockage of the passing of bile out of the gall bladder and, as a result, lead to inflammation of the gallbladder causing cholecystitis.
- Shock: Severe shock can cause inflammation of the gallbladder.
- Prolonged fasting and malnutrition
Symptoms of cholecystitis
One of the primary symptoms, if not the first symptom, a person suffering from cholecystitis, will experience is a sudden sharp pain in the upper right-hand side of the abdomen.
The patient may sometimes experience shoulder pain (commonly as a result of referred pain) alongside the discomfort within the abdomen.
This mostly occurs when the patient has acute cholecystitis. The pain almost always comes suddenly, and it never goes away. It may seem as though it goes away after a while, however, it comes back with full force.
Sometimes, you may experience much more pain if you breathe in deeply or laugh. If it is left untreated, then it can result in severe complications.
The patient will also experience sudden high fever as well as an increased white blood cell count after a blood test has been conducted. Alongside these symptoms, the patient may experience other signs such as:
- Abdominal bloating and sometimes, swelling
- Tenderness and severe pain on touch at the upper right hand of the abdomen.
- Little or no appetite for food
- Nausea and headaches
- Vomiting
- Sweating
- Jaundice may occur, which will result in the yellowish coloration of the skin, palms, as well as the white sclera of the eye.
The patient may also experience an increase in symptoms after eating, especially after consuming a meal that is high in fats.
Complications
If cholecystitis isn’t properly treated or treated on time, it can result in complications that may become life-threatening. Some of the complications that can arise as a result of untreated cholecystitis include:
1. Infection
Once there is a build up of bile within the gall bladder, it can result in the infection of the bile leading to other complications such as sepsis.
2. Gangrenes
Gangrene occurs when the cells or tissues of a particular organ begin to die off. This can happen in the case of cholecystitis.
When cholecystitis is left untreated for a long time, especially in older people and those who have diabetes, it can result in the death of cells that are present within the gall bladder.
Once this occurs, the gallbladder can get torn and burst to spill infected bile into the bloodstream, causing sepsis to occur.
3. Tear in the tissue of the gall bladder
Perforation or tear in the tissue of the gallbladder can be the result of untreated gall bladder inflammation. This can result in peritonitis or an abscess, which is characterized by a build-up of pus.
Treatment
Treatment is often in two stages. If the first stage doesn’t seem to help or if the inflammation has become worse, then ultimately, phase 2 will have to occur. The two phases are:
1. Initial treatment stage
At this stage, the treatment that is often prescribed includes:
Fasting (no intake of food or water) for specific hours in order to take the strain of digestion of food, especially lipids off your gall bladder.
- Intravenous fluids: Once a patient is asked to stop feeding and taking water, in order to prevent dehydration, the patient will be given intravenous fluids, which will help keep the patient filled and not dehydrated.
- Pain medications: Pain medications will be given to the patient to help relieve the pain.
- Antibiotics treatment: Antibiotics will be given if the patient is thought to have an infection.
This initial treatment often takes place in the hospital, and it is usually done within a week. If you get better within that time, and the inflammation reduces, you will be allowed to go home and complete your treatments.
Usually, after the initial treatment, the gall stone which may have caused the blockage of the gall bladder and inadvertently causing cholecystitis to occur will return, and then, the inflammation will settle.
However, if this doesn’t occur, the patient will be asked to proceed to the second stage of treatment.
2. Surgery
The second stage of treatment is surgery. This surgery entails the total removal of the gall bladder, which is often known as a cholecystectomy.
In some cases, although not very common, if the patient is unwell to undergo surgery, the patient will have to undergo percutaneous cholecystectomy.
In this procedure, instead of the total removal of the gall bladder, what occurs is that a needle will be inserted into your gall bladder through your stomach region. This will cause the fluid that has accumulated in the gall bladder to be drained away.
However, if you are fit enough to undergo surgery, the doctor will determine the best time for it to be done. In some severe cases, surgery will have to be carried out immediately; however, in other cases, the doctors will wait for the inflammation to reduce before surgery is carried out.
Surgery can be done in three ways:
1. Laparoscopic cholecystectomy
Here, the gall bladder is removed using special instruments through a hole that is made in the abdomen. In this surgery, the belly doesn’t need too many incisions, and just minimal small cuts are required.
2. Single-incision laparoscopic cholecystectomy
In this kind of surgery, a single cut or incision is done near the belly button, and from there, the gall bladder is taken out.
3. Open cholecystectomy
In this surgery, the abdomen is cut open in a single large cut, and the gall bladder is removed.
Generally, after surgery, the prognosis is good, and patients go on to live a perfectly normal life. Although some patients have been reported to have had bloating or diarrhea after surgery, however, this resolves itself, and life goes back to normal.
