Acute cholecystitis

Acute cholecystitis Illnesses and conditions Stomach, liver and gastrointestinal tract Acute cholecystitis Acute cholecystitis Acute cholecystitis is swelling (inflammation) of the gallbladder. It is a potentially serious condition that usually needs to be treated in hospital. Themain symptomof acute cholecystitis is a sudden sharp pain in the upper right side of your tummy (abdomen) that spreads towards your right shoulder. The affected part of the abdomen is usually extremely tender, and breathing deeply can make the pain worse. Unlike some others types of abdominal pain , the pain associated with acute cholecystitis is usually persistent, and doesnt go away within a few hours. Some people may additional symptoms, such as: a high temperature (fever) nausea and vomiting sweating loss of appetite yellowing of the skin and the whites of the eyes (jaundice) a bulge in the abdomen When to seek medical advice Contact your GP practice if: you develop sudden and severe abdominal pain, particularly if the pain lasts longer than a few hours or you have other symptoms, such as jaundice and a fever If your GP practice is closed, phone 111. Its important for acute cholecystitis to be diagnosed as soon as possible, because there is a risk that serious complications could develop if the condition is not treated promptly. What causes acute cholecystitis? The causes of acute cholecystitis can be grouped into 2main categories: calculous cholecystitis and acalculous cholecystitis. Calculous cholecystitis Calculous cholecystitis is the most common, and usually less serious, type of acute cholecystitis. It accounts for around 95% of all cases. Calculous cholecystitis develops when the main opening to the gallbladder, called the cystic duct, gets blocked by a gallstone or by a substance known as biliary sludge. Biliary sludge is a mixture of bile (a liquid produced by the liver that helps digest fats) and small crystals of cholesterol and salt. The blockage in the cystic duct results in a build-up of bile in the gallbladder, increasing thepressure inside it and causing it tobecome inflamed. In around 1in every 5cases, the inflamed gallbladder also becomes infected by bacteria. Acalculous cholecystitis Acalculous cholecystitis is a less common, but usually more serious, type of acute cholecystitis. Itusually develops as a complication of a serious illness, infection or injury that damages the gallbladder. Acalculous cholecystitis is often associated with problems such as accidental damage to the gallbladder during major surgery, serious injuries or burns , blood poisoning (sepsis) , severe malnutrition or AIDS . Who is affected Acute cholecystitis is a relatively common complication of gallstones. Its estimated that around 10%to 15% of adults in the UK have gallstones. Thesedont usually cause any symptoms, but in a small proportion of people they can causeinfrequent episodes of pain (known as biliary colic) or acute cholecystitis. Diagnosing cholecystitis To diagnose acute cholecystitis, your GP will examine your abdomen. They will probably carry out a simple test called Murphys sign. You willbe asked to breathe in deeply with your GPs hand pressed on your tummy, just below your rib cage. Your gallbladder will move downwards as your breathe in and, if you have cholecystitis, you will experience sudden pain as your gallbladder reaches your doctors hand. If your symptoms suggest you have acute cholecystitis, your GPwill refer you to hospital immediately for further tests and treatment. Tests you may have in hospital include: blood tests to check for signs of inflammation in your body an ultrasound scan of your abdomen to check for gallstones or other signs of a problem with your gallbladder Other scans  such as an X-ray , a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan  may also be carried out to examine your gallbladder in more detail if there is any uncertainty about your diagnosis. Treating acute cholecystitis If you are diagnosed with acute cholecystitis, you will probably need to be admitted to hospital for treatment. Initial treatment Initial treatment will usually involve: fasting (not eating or drinking) to take the strain off your gallbladder receiving fluids through a drip directly into a vein (intravenously) to prevent dehydration taking medication to relieve your pain If you have a suspected infection, you will also be given antibiotics . Theseoften need to be continued for up to a week, during which time you may need to stay in hospital or you may be able to go home. With this initial treatment, any gallstones that may have caused theconditionusually fall back into the gallbladder and the inflammationoften settles down. Surgery In order to prevent acute cholecystitis recurring, and reduce your risk of developing potentially serious complications, the removal of your gallbladder will often be recommended at some pointafter the initial treatment.This type of surgeryis known as a cholecystectomy . Although uncommon, an alternative procedure called a percutaneous cholecystostomy may be carried out if you are too unwell to have surgery. This is where a needle is inserted through your abdomen to drain away the fluid that has built up in the gallbladder. If you are fit enough to have surgery, your doctors willneed to decide when the best time to remove your gallbladder may be. In some cases, you may need to have surgery immediately or in the next day or 2, while in other cases you may be advised towait for the inflammation to fully resolve over the next few weeks. Surgery can be carried out in two main ways: laparoscopic cholecystectomy a type of keyhole surgery where the gallbladder is removed using special surgical instruments inserted through a number of small cuts (incisions) in your abdomen open cholecystectomy where the gallbladder is removed through a single, larger incision in your abdomen Although some people who have had their gallbladder removed have reported symptoms of bloating and diarrhoea after eating certain foods, youcan lead a perfectly normal life without a gallbladder. The organ can be useful but its not essential, as your liver will still produce bile to digest food. Possible complications Without appropriate treatment, acute cholecystitis can sometimes lead to potentially life-threatening complications. The main complications of acute cholecystitis are: the death of the tissue of the gallbladder, called gangrenous cholecystitis, which can cause a serious infection that could spread throughout the body the gallbladder splitting open, known as a perforated gallbladder, which can spread the infection within your abdomen (peritonitis) or lead to a build-up of pus (abscess) In about 1in every 5cases of acute cholecystitis, emergency surgery to remove the gallbladder is needed to treat these complications. Preventing acute cholecystitis Its not always possible to prevent acute cholecystitis, but you can reduce your risk of developing the condition by cutting your risk of gallstones. One of the main steps you can take to help lower your chances of developing gallstones isadopting ahealthy, balanced diet and reducing the number of high-cholesterol foods you eat, as cholesterol is thought to contribute to the formation of gallstones. Being overweight, particularly being obese, also increases your risk of developing gallstones. You should therefore control your weight by eating a healthy diet and exercising regularly. However, low-calorie, rapid weight loss diets should be avoided, because there is evidence they can disrupt your bile chemistry and actually increase your risk of developing gallstones. A more gradual weight loss plan is best.