Acute cholecystitis

Acute cholecystitis refers to the sudden inflammation of the gallbladder.

The gallbladder is a pear-shaped organ located in the right upper quadrant of the abdomen beneath the liver. The gallbladder stores bile from the liver. Bile is a fluid essential for digestion and absorption of fats.

Acute cholecystitis causes an intense abdominal pain.

The most common cause for acute cholecystitis is gallstones in the gallbladder neck.

Acute cholecystitis can be classified according to the presence of gallstones:

• Calculous cholecystitis: It is the most common type with more than 90% of the cases. It is due to gallstones. It is usually initiated when a stone or sludge becomes impacted in the gallbladder neck or the cystic duct and closes the bile duct that carries the bile from the gallbladder to the duodenum. This results in a bile buildup that can cause inflammation of the gallbladder that is susceptible to infection or even perforation.
• Acalculous cholecystitis: Develops in the absence of gallstones. Acalculous cholecystitis is seen in critically ill patients after:
  • Major surgery
  • Severe trauma
  • Severe burns
  • Bile duct tumors
  • Sepsis

Cholecystitis typically causes a sharp pain, lasting longer than 6 hours, located in the right upper quadrant of the abdomen and often radiates to the right shoulder.

The pain, which may be intermittent, is a constant sharp pain, cramping or dull, and it is often worse after eating fatty food.

Other symptoms related to acute cholecystitis are:

• Fever
• Nausea and vomiting
• Clay colored stools
• Abdominal bloating
• Yellowing of the skin and whites of the eyes (Jaundice)

Beside the symptoms already described, pain and an arrest in inspiration upon deep palpation underneath the right costal margin (Murphy's sign) may be present.

For the diagnosis, it is useful to ask a blood test to know:

• Blood count
• Bilirubin
• Amylase
• Lipase
• Hepatic (liver) function panel: (AST, ALT, GGT, alkaline phosphatase)

In addition, imaging tests may be useful:

• Abdominal ultrasound
• Abdominal CT (Computed Tomography)

Sometimes, it is required to perform some additional tests:

• Cholescintigraphy.
• Contrast-enhanced CT scan of the gallbladder.

Acute cholecystitis requires treatment in a hospital with rest, fasting and intravenous fluids with broad-spectrum antibiotics.

Most patients respond to initial conservative medical treatment. However, up to 20% develop signs of advanced cholecystitis and need emergency surgery such as immediate laparoscopic cholecystectomy (surgery to remove the gallbladder).

In addition, analgesia is usually prescribed for the pain, preferably with NSAIDs such as ibuprofen.