Cholecystitis
Cholecystitis is a medical condition referring to inflammation of the gallbladder. The condition can be chronic (ongoing) or acute (sudden). Most cases of Cholecystitis are caused from gallstones. Gallstones are crystalline structures in the gallbladder or the bile ducts, usually ranging in size from a grain of sand to 3-4 centimeters. When gallstones are present, they can interfere with the normal flow of bile leading to gallbladder inflammation
Symptoms of Cholecystitis
Symptoms vary but will often occur after eating fatty meals and may occur during the night, suddenly awakening the patient. Common complaints include:
- Colic pain-pain that comes and goes
- Steady pain in the upper right of the abdomen that increases rapidly and lasts from 30 minutes to several hours
- Pain in the back between the shoulder blades
- Pain under the right shoulder
- Abdominal tenderness
- Nausea or vomiting
- Indigestion, flatulence and belching
- Chills
- Low grade fever
- Abdominal bloating
- Recurring intolerance of fatty foods
Causes of Cholecystitis
The majority of cases of Cholecystitis are caused by gallstones. Other less common causes can include:
- Trauma to the gallbladder: Injury to the gallbladder can occur from abdominal surgery or from an abdominal injury, such as in sports or an automobile accident.
- Infection: If bile from the liver becomes infected, it can cause gallbladder inflammation.
- Tumor: If a tumor is present and blocking the flow of bile, the bile can build up causing cholecystitis.
Risk Factors
A risk factor is something that increases your chance of developing a condition or disease. The following risk factors increase your chance of developing gallstones and therefore also increases your risk of cholecystitis:
Gender- Women between 20 and 60 years of age are twice as likely to develop gallstones as men.
Age- people over 60 years old
Ethnicity- Native Americans and Mexican Americans
Obesity- Obesity is a major risk factor for gallstones, especially in women.
Diet- high calorie, high fat, high cholesterol diet
Estrogen-Excess estrogen from pregnancy, hormone replacement therapy, or birth control pills
Cholesterol-lowering drugs
Diabetes- People with diabetes generally have high levels of fatty acids called triglycerides which increase the risk of gallstones.
Rapid weight loss-As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones.
Liver disease
Pancreatitis
Diagnosis
Your physician will perform the following:
Medical History
Physical Examination
Tests Dr. Shakov may order to confirm a diagnosis of cholecystitis may include the
following:
Ultrasound
Ultrasound is a medical imaging test that utilizes sound waves and their echoes to create 2 dimensional images. Ultrasound scanning is the most sensitive and specific test for gallstones. It can detect 95% of gallstones and can confirm gallstones as small as 2 mm.
Cholescintigraphy (HIDA scan)
The patient is injected with a small amount of harmless radioactive material that is absorbed by the gallbladder. X-ray images are then taken of the liver, bile ducts, gallbladder, and upper portion of the small intestine. The test is used to diagnose abnormal contraction of the gallbladder or obstruction of the bile ducts.
Blood Tests
Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice.
Treatment
The most common treatment for cholecystitis is surgery called laparoscopic cholecystectomy. This is a less invasive surgery than the traditional method of a large abdominal incision to remove the gallbladder.
With the laparascopic operation, the surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. Laparoscopic surgery leads to fewer complications, such as hospital-related infections, and has a shorter recovery time.
If tests show the gallbladder has severe inflammation, infection, or scarring from other operations, the surgeon may perform open surgery to remove the gallbladder. In some cases, open surgery is planned; however, sometimes these problems are discovered during the laparoscopy and the surgeon must make a larger incision converting to open surgery.
Recovery from open surgery usually requires 3 to 5 days in the hospital and several weeks at home. Open surgery is necessary in about 5 percent of gallbladder operations.
Benefits of Laparoscopy versus Traditional (Open) Surgery
- Smaller incisions
- Minimal soft tissue trauma
- Less pain
- Faster healing time
- Lower infection rate
- Less scarring
- Less blood loss
- Earlier mobilization
- Usually performed as outpatient day surgery
Surgery
Laparoscopic cholecystectomy is performed under sterile conditions in the operating room with the patient under general anesthesia. During laparoscopy, the patient is placed lying on their back with their body tilted so the feet are higher than the head. This position helps to move some of the abdominal organs toward the chest allowing the surgeon a clearer view.
Surgery
The surgeon makes an incision over the abdomen and inserts a harmless gas into the abdominal cavity to expand the viewing area of the abdomen giving the surgeon a clear view and room to work. The surgeon makes another incision and inserts a tube called a trocar through which the laparoscope is introduced into the abdomen. Additional small incisions may be made for a variety of surgical instruments to be used during the procedure.
With the images from the laparoscope as a guide, the surgeon can look at the gallbladder and determine the extent of the problem. A variety of surgical instruments can be inserted through the laparoscope or through other small incisions your surgeon may make to remove the gallbladder.
After treating the problem, the laparoscope and other instruments are removed and the gas released. The tiny incisions are closed and covered with small bandages.
Laparoscopy is much less traumatic to the muscles and soft tissues than the traditional method of surgically opening the abdomen with long incisions (open techniques).
Post Operative Guidelines
Common post-operative guidelines following laparoscopic cholecystectomy include the
following:
- You will probably be in the hospital for a day or two for monitoring.
- Follow your surgeon’s instructions regarding the dressings on the incision sites.
- Deep breathing and moving around after your surgery helps to prevent pneumonia.
- Your surgeon may give you activity restrictions such as no heavy lifting. It is very important that you follow your surgeon’s instructions for a successful recovery.
- You may feel soreness around the incision areas. Your surgeon may give you a prescription pain medicine or recommend NSAID’s (non-steroidal anti-inflammatory drugs) for the first few days to keep you comfortable.
- If the abdomen was distended with gas, you may experience discomfort in the abdomen, chest, or shoulder area for a couple days while the excess gas is being absorbed.
- Contact Dr. Shakov immediately if you have a fever, chills, increased pain, bleeding or fluid leakage from the incisions, chest pain, shortness of breath, leg pain, or dizziness.
Risks and Complications
As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential
disadvantages. It is important that you are informed of these risks before the surgery takes place.
Complications can be medical (general) or specific to gallbladder surgery. Medical
complications include those of the anesthetic and your general well being.
Almost any medical condition can occur so this list is not complete. Complications include:
- Excessive bleeding
- Damage to organs or blood vessels in the abdomen
- Infection
- Blood clot development