The gallbladder is a small organ that is positioned beneath the right lobe of the liver in the upper-right section of the abdomen. The gallbladder stores bile which helps in the digestion of fats. Bile is a combination of fluids usually made up of cholesterol. In the gallbladder, gallstones which are small stones made up of cholesterol may occasionally be formed. When a gallstone is trapped in an opening duct in the gallbladder, it can trigger a sudden abdominal pain known as biliary colic. When a gallstone blocks the cystic duct, it causes an inflammation of the gall bladder which is known as acute cholecystitis (“National Health Service,” n.d.). Pain from acute cholecystitis is persistent, peaks at 15 to 60 minutes and lasts a few hours. Acute cholecystitis is potentially serious but can be treated with rest, antibiotics, and intravenous fluids (“NHS,” n.d.).
Etiology
Acute cholecystitis is mainly caused by the inflammation of the gallbladder. The swelling is brought about by blockage of the cystic duct which is the tube leaving the gallbladder. According to Mayo Clinic Staff (2017), gallbladder inflammation may be a result of;
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Gallstones- The primary and most common cause of the inflammation of the gallbladder is a result of the formation of gallstones in the gallbladder. Gallstones are made from hardening cholesterol in the gallbladder. These gallstones may be big enough to obscure the cystic duct which allows bile to flow out into the small intestines. The bile build-up inside the gallbladder then causes acute cholecystitis.
Bile duct blockage- kinking of the bile duct from accidents or other body-related conditions brings the same effect of gallbladder inflammation.
Tumors- a tumor in the abdomen or near the gallbladder may obstruct bile from flowing out hence causing acute or severe cholecystitis.
Cardiovascular disease- Cardiovascular diseases damage the blood vessels that take blood to the gallbladder. The decreased blood flow may lead to less functional gallbladder causing inflammation.
Scarring or tearing of the gallbladder- a scar or tear in the gallbladder tissue may bring out inflammation.
Other infections- viral infections such as HIV/AIDS destroy the body’s immune system and can, therefore, trigger cholecystitis. An infection of the gallbladder may also cause bile to swell in the gallbladder.
Risk Factors
Acute cholecystitis may turn chronic when cholecystitis attacks repeatedly occur for a long time. The risks for developing acute cholecystitis increases with age. Other risk factors include physical inactivity, pregnancy, obesity, low fiber intake, sudden weight loss, certain ethnic groups such as the North European and Hispanics, as well as liver transplants. Gallbladder disease is also comorbid with diabetes mellitus, cerebrovascular accident, hypertension, and renal disease. Other causal factors include prolonged fasting, immunodeficiency, certain cancer types, trauma from sepsis, shock, or surgery, and critical illnesses such as vasculitis. Anorexia nervosa can cause AC when the gallstones build up in the gallbladder.
Clinical Manifestation
Majority of patients with gallstones go asymptomatic over a long period. The onset of the pathophysiological characteristics of acute cholecystitis includes sharp pain in the upper-right abdomen that does not go away. Without immediate medical intervention, the pain may persist and breathing in intensifies the pain. The pain may resonate to the right shoulder or back. The pain of acute cholecystitis is distinguishable from other conditions as it is severely felt in the right upper quadrant of the body. Patients of AC present a history of biliary pain in the upper right region of the abdomen. Pain generates from around the liver region to the right shoulder and scapula (Alan, 2017). It is also observed in patients with acute cholecystitis a high white blood cell count.
Acute cholecystitis is prevalent among the elderly specifically those with a history of diabetes. Whereas a fever and pain may be absent, the localization of the tenderness in the upper-right abdomen presents a sign. Acute cholecystitis among the elders may also progress rapidly without warning. Among children, those with sickle cell disease, prolonged TPN use, and those with hemolytic conditions have a higher risk of developing acute cholecystitis (Alan, 2017).
Epidemiology
Among the gastrointestinal disorder, AC is considered a common inpatient condition. Gallstones constitute about 80 percent of manifestation of acute cholecystitis. In 90 percent of patient cases, AC is caused by complete obstruction of the cystic duct. The blockage may be gallstone impacted or kinking of the cystic duct. Whereas 80 percent of people with gallstones go asymptomatic for long, it presents itself in 10 percent of patients with symptomatic gallstones (Vaibhav et al., 2016). Gallbladder inflammation is caused by bile inspissation from dehydration and bile stasis from severe trauma in five percent cases of AC. Acute cholecystitis is not as fatal as it registers less than 10 percent mortality rates.
Pathophysiology
Other pathophysiological manifestations of acute cholecystitis include abdominal bloating, high fever and sweating, the upper-right side of the abdomen becomes tender, less or no appetite, slight chills, nausea, and vomiting. When one has acute cholecystitis, symptoms will manifest more after a meal with high-fat content (Christian, 2018). Other signs of AC are a clay-colored stool, yellowing of the skin, and yellowing of the white of the eyes. If left untreated, acute cholecystitis can lead to serious, life-threatening complications, for instance, gallbladder rupture. It is advisable to see a doctor when symptoms of severe and uncomfortable abdominal pains are experienced.
Diagnosis
The pathophysiological manifestations of acute cholecystitis can resemble other gastrointestinal conditions. Diagnosis is conducted using a patient’s medical history and current symptomatic expressions. A doctor can carry out a simple test known as Murphy’s sign where the patient breathes in deeply as the doctor presses the stomach area beneath the ribcage (“NHS, n.d.”). Sharp pain is felt by the patient when the gallbladder contacts the doctor’s hand. If the patient’s symptoms match acute cholecystitis, then further treatment is recommended.
Hospital checks include blood tests to check for signs of inflammation in the body. An abdominal ultrasound is taken using sound waves to create a 3D image of body organs. Abdominal ultrasound is the most common diagnostic imaging used to identify gallstones. Other scans to examine the gallbladder or presence of gallstones include x-rays, CT, and MRI scans. Hepatobiliary scintigraphy is a procedure that constructs an image of the liver, intestines and surrounding organs. The images can show the presence of gallstones, or an inflamed gallbladder. Cholangiography is another procedure which uses a dye which is injected into the bile. An x-ray is then done to show whether the gallbladder is inflamed or the cyst duct is blocked or kinked. Other additional tests include a complete blood count test (CBC), or liver function test.
Treatment
Severe abdominal pain resulting from acute cholecystitis needs immediate medical attention. A doctor may recommend an initial treatment of hospitalization for monitoring or fasting to allow the gallbladder to rest. Patients with AC are often put under intravenous fluids to prevent dehydration (“NHS, n.d.”). After the initial treatment, the gallstones that cause inflammation often recede. Severe pain is treated using pain medications. Antibiotics are used to fight perceived infections from the inflammation of the gallbladder.
For AC that keeps recurring, doctors may recommend cholecystectomy, which is the surgical removal of the gallbladder. Removing the gallbladder may be necessary if the condition opens a patient to potentially serious complications. An alternative method known as percutaneous cholecystostomy may be done for those who are unable to undergo surgery (“NHS, n.d.”). The procedure involves the insertion of a needle through the abdomen into the gallbladder to remove the fluid that has accumulated. Without treatment, acute cholecystitis can lead to serious conditions such as; death of the gallbladder tissue, which can cause other infections or growths. The gallbladder can perforate or split open and open someone to develop infections or a buildup of pus (“NHS, n.d.”).
Preventing Acute Cholecystitis
Acute cholecystitis may develop as a result of many causal factors, for this reason, it may not be entirely possible to avoid. However, the best way to prevent AC from advancing is through going for regular medical check-ups. Other preventive measures require personal effort and commitment; they include engaging in regular physical exercises, losing weight at an accelerated rate increase the risk of gallstones, it is, therefore, advisable that people purpose to lose 1 to 2 pounds in a week. Being overweight increases blood cholesterol. Gallstones form in the gallbladder as a result of increased blood cholesterol (Mayo Clinic Staff, 2017). It is therefore advised that people maintain a healthy weight that reflects their basal metabolic rate. Maintaining a healthy diet keeps the fat levels in the body at an optimum level thereby reducing the risk of gallstones.
Natural remedies for high body cholesterol include more intake of fruits and avoiding food rich in high cholesterol. People or patients with high risk of AC are advised to eat food with unsaturated fats such as avocado, olive oil, peanut butter, fatty fish such as salmon and mackerel, nuts and seeds such as almonds, peanuts, and cashew nuts.
References
Alan A. (2017, November 08). Cholecystitis Clinical Presentation Medscape. Retried from https://emedicine.medscape.com/article/171886-clinical
Christian, N. (2018, January 22). What to Know About Cholecystitis? Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/172067.php
Mayo Clinic Staff (2017, November 18). Cholecystitis Retrieved 11 February 2019 https://bowvalleycollege.libguides.com/c.php?g=494959&p=5007212
National Health Service (n.d.). Acute Cholecystitis. Retrieved from https://www.nhs.uk/conditions/acute-cholecystitis/
Wadhwa, V., Jobanputra, Y., Garg, S. K., Patwardhan, S., Mehta, D., & Sanaka, M. R. (2016). Nationwide trends of hospital admissions for acute cholecystitis in the United States. Gastroenterology report , 5 (1), 36-42. https://doi.org/10.1093/gastro/gow015
