Calculous cholecystitis as well as acalculous cholecystitis is described as inflammation of the gallbladder. This common intra-abdominal infection can generate severe complications due to its natural history and requires operative treatment. What are the causes of this disease? In this article, we’ll talk about what cholecystitis is, discuss the risks of this problem and take a look at the most effective treatment options.
This article was last reviewed by Svetlana Baloban, Healsens, on January 4, 2021. This article was last modified on 7 February 2021.
What is Cholecystitis? Etiology
As stated above, the problem comes from the cystic duct blockage, which causes inflammation. Normally, bile is made in the liver, travels down the bile duct, and is stored in the gallbladder. After eating certain foods, especially spicy or greasy foods, the gallbladder is stimulated to release the bile from the gallbladder through the cystic duct, down the bile duct into the duodenum. This process aids in food digestion.
The gallbladder not only stores the bile, but it can concentrate it as well. Concentrated bile is susceptible to precipitation forming stones when homeostasis is disrupted. It can occur due to bile stasis, supersaturation of cholesterol and lipids from the liver, disruption in the concentration process, and cholesterol crystal nucleation.
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When cystic duct blockage is caused by a stone, it is called acute calculous cholecystitis. So, about 95% of people with acute cholecystitis have gallstones1. It is worth knowing that temporary obstruction by gallstones can cause pain, the process is called biliary colic. The diagnosis of biliary colic is upgraded to acute calculous cholecystitis if the pain does not resolve in six hours. If no stone is identified, it is called acuteacalculous cholecystitis23.
Regardless of the cause of the blockage, the gallbladder wall edema will eventually cause wall ischemia and become gangrenous. The gangrenous gallbladder can become infected by gas-forming organisms, causing acute emphysematous cholecystitis. The main thing to know is that all of these conditions can quickly become life-threatening. Moreover, the gap has the highest mortality rate.
In addition to an acute condition, cholecystitis can also be chronic.
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Risks of Gallbladder Disease
The risk of gallbladder disease increases in women, obese patients, pregnant women, and patients in their 40s. Drastic weight loss or acute illnesses may also increase the risk. The formation of gallstones and this condition can run in families. What is more, genetic factors are estimated to account for only approximately 25% of the overall risk of gallstones4.
Other conditions that cause the breakdown of blood cells, for example, sickle cell disease, also increase the incidence of gallstones.
Acute Cholecystitis Treatment
Cases of acute untreated cholecystitis could lead to perforation of the gallbladder, sepsis, and death. Cholecystitis is a condition best treated with surgery. However, it can be treated conservatively if necessary.
Surgery to remove the gallbladder or cholecystectomy is the best treatment! 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. In situations in which the patient is acutely ill and considered a poor surgical candidate, he or she may be treated with temporizing percutaneous drainage of the gallbladder. Milder cases of chronic cholecystitis in patients considered poor surgical candidates might be managed with low-fat and low-spice diets. The results of this treatment vary. Medical treatment of gallstones with ursodiol is also reported to have occasional success.567
In addition, the doctor may prescribe antimicrobial agents. They are meant for high-risk patients, especially those having gallbladder necrosis. The use of broad-spectrum antibiotics and sometimes antifungal agents is associated with better prognosis8.
Timing Of Surgical Removal of the Gallbladder
A 2010 meta-analysis compared early laparoscopic cholecystectomy (ELC – 1 wk of onset of symptoms) and delayed laparoscopic cholecystectomy (DLC – at least 6 wk after symptoms free). The researchers concluded that similar results were obtained in both cases with respect to bile duct injury. However, hospital stay was shorter for the early laparoscopic cholecystectomy group. The results also showed that the group where surgery was not delayed had lower mortality; bile duct complications and improvement in many other parameters were analyzed9.
FURTHER READING
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- Gallbladder Dysfunction: Cholecystitis, Choledocholithiasis, Cholangitis, and Biliary Dyskinesia
- Clinical aspects of bile culture in patients undergoing laparoscopic cholecystectomy
- Gallbladder Dysfunction: Cholecystitis, Choledocholithiasis, Cholangitis, and Biliary Dyskinesia
- Preventing a Mass Disease: The Case of Gallstones Disease: Role and Competence for Family Physicians
- Timing of Cholecystectomy in Acute Cholecystitis
- Comparison of Emergency Cholecystectomy with Delayed Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage in Patients with Moderate Acute Cholecystitis
- Acute calculous cholecystitis: Review of current best practices
- Acute calculous cholecystitis: Review of current best practices
- Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis
