Acute Cholecystitis: Symptoms, Causes, & Treatment

1
Acute Cholecystitis Symptoms, Causes, Treatment

• By Dr Valeria Simone MD,
• (Southlake General Surgery, Texas, USA)

2
Overview

• Have you ever experienced a sudden, sharp pain in
  your upper abdomen that left you wondering whats
  going on? You could be dealing with acute
  cholecystitis, an inflammation of the gallbladder
  that can lead to severe complications if left
  untreated.
• In this blog post, we will delve into the
  symptoms, causes, treatment options, and
  prevention strategies for this often-overlooked
  condition.

3
Key Takeaways

• Acute cholecystitis is an inflammation of the
  gallbladder caused by obstruction of the cystic
  duct, typically due to gallstones.
• Diagnosis involves physical examination,
  laboratory tests, and imaging techniques such as
  ultrasound or HIDA scan.
• Treatment options include conservative management
  with antibiotics, pain relief, or surgical
  intervention. The prognosis is good with early
  diagnosis and intervention.

4
Understanding Acute Cholecystitis
5

• Acute cholecystitis is the inflammation of the
  gallbladder, a small organ located beneath the
  liver that stores bile, a digestive fluid
  secreted into the small intestine through bile
  ducts.
• The condition usually arises due to an
  obstruction of the biliary tract or the cystic
  duct, often caused by gallstones. Prompt
  treatment of acute cholecystitis is imperative to
  prevent severe complications like necrosis,
  gangrene, or gas buildup in the gallbladder wall,
  which can eventually result in perforation.
• Initial treatment for acute cholecystitis
  typically consists of antibiotics and pain
  relief, which can help alleviate gallbladder
  inflammation.
• The gallstones causing the condition, such as
  uncomplicated acute cholecystitis, usually return
  to the gallbladder during initial treatment.
  However, more severe cases may require additional
  intervention to prevent complications.

6
Causes and Risk Factors
7

• Gallstones, which are solidified particles
  composed of cholesterol or bilirubin, are the
  primary cause of an inflamed gallbladder, also
  known as acute cholecystitis.
• These stones can obstruct the cystic duct, a
  short tube that conveys bile from the gallbladder
  to the common bile duct, leading to inflammation
  and potential infection of the gallbladder
  tissue.
• Risk factors for acute cholecystitis include
• Increasing age
• Female sex
• Certain ethnic groups
• Obesity or rapid weight loss
• Drugs
• Pregnancy
• Additionally, gallstones can also increase your
  chances of developing this condition.
• Acalculous cholecystitis, a less common form of
  acute cholecystitis, is caused by factors
  unrelated to gallstones, such as severe illness,
  bacterial infection, or injury that can damage
  the gallbladder.
• Acute acalculous cholecystitis, a subtype of this
  condition, can be particularly severe and
  warrants prompt intervention.

8
Gallstones and Cystic Duct Obstruction

• Gallstones and cystic duct obstruction are the
  most common causes of acute cholecystitis and
  chronic cholecystitis, with consequences ranging
  from acute inflammation to potential infection of
  the gallbladder.
• When gallstones obstruct the cystic duct, the
  gallbladder becomes distended, impeding blood
  flow and lymphatic drainage, which in turn leads
  to mucosal ischemia and necrosis.
• Biliary sludge, a combination of bile,
  cholesterol, and salt in the form of small
  crystals, can also play a role in the development
  of acute cholecystitis.
• Prompt diagnosis and treatment of gallstones and
  cystic duct obstruction are critical in
  preventing complications and relieving the severe
  abdominal pain that often accompanies biliary
  colic, a condition related to this issue.

9
Acalculous Cholecystitis

• Acalculous cholecystitis is a rare and serious
  form of acute cholecystitis that can result from
  severe illness, infection, or injury damaging the
  gallbladder.
• In contrast to acute calculous cholecystitis,
  which involves gallstones, acalculous
  cholecystitis occurs without the presence of
  gallstones. In some cases, it can lead to
  complications like gangrenous cholecystitis.
• The incidence rate of acalculous cholecystitis
  has been estimated to be 0.12 of the total
  population. This is considered to be a relatively
  rare condition.
• Acalculous cholecystitis can rapidly progress to
  life-threatening complications if left untreated,
  making early diagnosis and intervention vital.
• Accurate diagnosis is critical, as the symptoms
  of this form of cholecystitis can closely
  resemble other gastrointestinal issues, making it
  challenging to identify.

10
Acute Acalculous Cholecystitis

• Acute acalculous cholecystitis (AAC) is a severe
  form of gallbladder inflammation that occurs
  without the presence of gallstones, a distinct
  characteristic that separates it from its more
  common counterpart.
• AAC often strikes when the body is under severe
  stress, such as during critical illness, severe
  trauma, or major surgery. This rare condition is
  particularly menacing due to its rapid
  progression and high mortality rate, making it a
  serious medical emergency.
• Despite its rarity, AAC shouldnt be
  underestimated as it can swiftly escalate to
  life-threatening complications such as
  gallbladder gangrene or perforation.
• Early diagnosis and prompt intervention are
  crucial in managing AAC, and its important to be
  aware of its symptoms which can include severe
  abdominal pain, fever, and jaundice.
• Remember, acute acalculous cholecystitis is a
  wolf in sheeps clothing, appearing in the
  absence of gallstones, but capable of causing
  severe damage.

11
Symptoms and Presentation
12

• The most prevalent symptom of acute cholecystitis
  is upper abdominal pain, typically localized to
  the right upper quadrant and lasting for longer
  than six hours. This pain often commences several
  hours after a meal or in the evening.
• However, be aware that cholecystitis symptoms can
  easily be confused with other conditions like
  peptic ulcer disease or pancreatitis.
• Additional symptoms associated with cholecystitis
  include
• Nausea
• Vomiting
• Shortness of breath upon inhalation (due to pain)
• Muscular rigidity on the right side of the
  abdomen
• Abdominal distension
• Chills
• Fever
• If you experience any of these symptoms, seek
  medical attention promptly for an accurate
  diagnosis and appropriate treatment.

13
Diagnosing Acute Cholecystitis

• To diagnose acute cholecystitis, healthcare
  providers employ a combination of physical
  examination, laboratory tests, and imaging
  techniques. Imaging tests, such as X-rays, CT
  scans, or MRI scans, may be conducted in a
  hospital setting.
• Abdominal ultrasound and hepatobiliary
  scintigraphy (HIDA scan) are the primary imaging
  techniques used for diagnosing cholecystitis.
  These two techniques are often favored over other
  available options.
• In addition to imaging and blood tests, a simple
  physical examination called Murphys sign may be
  performed by a healthcare provider. During this
  test, the provider
• Presses their hand on the patients abdomen, just
  below the rib cage.
• Ask the patient to breathe deeply.
• If the patient experiences sudden pain as their
  gallbladder reaches the doctors hand, it may
  indicate cholecystitis.
• A HIDA scan, which monitors the production and
  passage of bile from the liver to the small
  intestine, can also help detect blockages.

14
Treatment Options

• Treatment options for acute cholecystitis include
  conservative management with antibiotics and pain
  relief, as well as surgical intervention, such
  as laparoscopic cholecystectomy or percutaneous
  cholecystostomy.
• The choice of treatment depends on the severity
  of the condition, the patients overall health,
  and the presence of any complications.

15
Conservative Management

• Conservative management of acute cholecystitis
  involves antibiotics, pain relief, and
  monitoring. Antibiotics are employed to minimize
  the likelihood of infection and assist in
  diminishing inflammation. Pain relief is
  necessary for alleviating the discomfort
  associated with acute cholecystitis.
• Patients undergoing conservative management must
  be monitored for indications of infection,
  inflammation, and any potential complications
  that may occur.
• In some cases, conservative management may be
  sufficient to resolve acute cholecystitis without
  the need for surgery.

16
Surgical Intervention

• For many patients, surgical intervention, such as
  laparoscopic cholecystectomy, is the preferred
  treatment for acute cholecystitis. This minimally
  invasive procedure involves
• The gallbladder is removed by a series of small
  incisions in the abdomen.
• Typically, you can expect a shorter recovery
  time.
• In comparison to open surgery, less postoperative
  pain is experienced.
• In some cases, particularly for high-risk
  patients or those with complications such as
  gallbladder perforation, alternative surgical
  options may be considered.
• These include open surgery or percutaneous
  cholecystostomy, a procedure in which a small
  tube is inserted through the abdominal wall into
  the gallbladder to drain bile and other fluids,
  thereby relieving pressure and pain.

17
Complications and Prognosis

• Untreated or inadequately treated acute
  cholecystitis can lead to life-threatening
  complications, such as perforation, sepsis, and
  bile duct injury tissue death.
• Lets explore more Acute Cholecystitis
  Symptoms, Causes, Treatment - Southlake General
  Surgery

18
Appointment

• If you or a loved one are experiencing symptoms
  of acute cholecystitis, dont hesitate
  to schedule an appointment with us at Southlake
  General Surgery.
• Our team of experienced healthcare professionals
  is ready to provide comprehensive care and guide
  you through the diagnostic and treatment process.
• Our unyielding commitment to your health and
  personal well-being is our foremost
  priority. Contact us today to book your
  appointment at 1 [phone].

19
Frequently Asked Questions

• What is the main cause of acute cholecystitis?
• Acute cholecystitis is a serious illness caused
  by the blockage of the cystic duct by gallstones,
  resulting in bile accumulation and inflammation.
• Does acute cholecystitis go away?
• Although cholecystitis can sometimes go away on
  its own, it is likely that you will need surgery
  or antibiotic treatment to address the underlying
  cause. Therefore, it is not recommended to wait
  and hope that symptoms of cholecystitis will
  disappear.
• What are the three stages of cholecystitis?
• The three stages of cholecystitis are Grade 1,
  symptomatic cholelithiasis Grade 2, acute
  cholecystitis and Grade 3, gangrenous/necrotizing
  cholecystitis.

20

• What is the prognosis for acute cholecystitis?
• The prognosis for acute cholecystitis is
  generally good, but those with acalculous
  cholecystitis may have higher mortality rates of
  up to 50-60. Perforation and gangrene of the
  gallbladder are rare but can occur in delayed
  cases.
• What are the main symptoms of acute
  cholecystitis?
• The main symptoms of acute cholecystitis include
  upper abdominal pain, nausea, vomiting, shortness
  of breath upon inhalation, muscular rigidity on
  the right side of the abdomen, abdominal
  distension, chills, and fever.

21

• Medically Reviewed By Dr. Valeria Simone MD
• Board-certified General Surgeon at Southlake
  General Surgery, Texas, USA.
• Follow us on Facebook and YouTube.
• Source Acute Cholecystitis Symptoms, Causes,
  Treatment - Southlake General Surgery

22
THANK YOU!
SOUTHLAKE GENERAL SURGERY
1545 E. Southlake Blvd, Suite 270 Southlake, TX
76092
EMAIL info_at_southlakegeneralsurgery.com
VISIT US AT www.southlakegeneralsurgery.com
23
(No Transcript)