Acute Choloecystitis / gall stones: Gall stones are more common in women. The risk factors for the formation of gall stones are genetic predisposition, obesity and old age. Normal bile contains cholesterol and when the bile gets supersaturated with cholesterol, it gets precipitated in the gall bladder and this in turn leads to gall stone formation. Most of the gall stones are made up of cholesterol , though some stones may be made up of calcium salts and bile pigments. Bile pigment stones are more common in patients with hemolytic disorders. Most gall stones stay in the gall bladder and may not cause any symptoms at all. Some of the stones travel to the common bile duct and cause obstruction , there by causing serious health problems like obstructive jaundice and cholangitis.. The presence of gall stones in the gall bladder cause inflammation of the gall bladder, called cholecystitis.
Acute cholecystitis: An acute inflammation of the gall bladder is called Acute cholecystitis. The presence of gall stones in the gall bladder is the main cause of cholecystitis. Some people suffering from prolonged illness may get cholecystitis without gall stones .
Clinical features: The main symptom of acute cholecystitis is abdominal pain mainly localised in the right upper quadrant of the abdomen , associated with nausea and vomiting . There may be fever which is low grade at first and it gets higher later. The pain is more on taking deep breath and the pain radiates to the right shoulder. There will be tenderness in the right hypochondrium. After some time there will be guarding and rigidity in the right hypochondrium. Typically the pain and other symptoms should subside in a week, if it does not, it may be an indication of development of complications like abscess formation, gangrene of gall bladder or a perforation of the gall bladder. These complications are manifested by increasing pain, fever and development of paralytic ileus.
Diagnosis: Diagnosis is made by the typical location of the pain and tenderness. Ultrasound scanning confirms the presence of gall stones and gall bladder wall thickening. WBC counts show increase in leucocytosis with granulocyte predominance. Liver function tests may show some elevation of serum bilirubin , SGPT and SGOT.
Treatment: The patient is hospitalised, naso gastric suction is initiated and IV fluids are given. Antibiotics are given. If there are no other associated risk factors surgical operation - Cholecystectomy is conducted. Laparoscopic Cholecystectomy is a very good alternative for open method of cholecystectomy.
Chronic Cholecystitis: Chronic inflammation of the gall bladder occurs when an acute attack subsides and cholecystectomy is not done. The underlying gall stones cause repeated attacks of infection and inflammation of the gall bladder. The gall bladder wall thickens and the gall bladder gets contracted and becomes small. Treatment is by removal of the gall bladder.