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Acute cholecystitis

The acute cholecystitis is acute inflammation of the wall of the gallbladder.

To understand its causes and consequences, the anatomical characteristics of the bile ducts will basically be described. These constitute a collecting system through which bile flows from the place of its synthesis, in the liver cells, to the place of its elimination in the duodenum. The gallbladder is only a passage and storage place for bile. The hepatic ducts unite in a similar way as the branches of a tree do, to give rise to thicker ducts, until they form the right and left hepatic ducts. In turn, both join to form the common hepatic duct, to which the cystic duct is added, which constitutes the mouth of the gallbladder. The sum of the hepatic duct and the cystic duct gives rise to the common bile duct, which crosses the pancreas, eventually leading to the duodenum.

Bile is a substance composed, above all by lipids, such as cholesterol and bile acids, and its function is to regulate the metabolism of cholesterol, promote the digestion of fats through the action of bile acids and eliminate substances metabolized by the liver.

Causes of acute cholecystitis

90% of cases of acute cholecystitis are due to the existence of stones in the bile ducts.

In the remaining 10% it can be caused by infection of the gallbladder by salmonella, cytomegalovirus, or in patients with AIDS due to a deficit of blood supply to the area, especially in diabetic patients, or by obstruction of the cystic duct for other reasons, such as example, tumors of the same.

As already mentioned, in most cases acute cholecystitis is caused by the existence of stones. These stones can be formed by alterations in the metabolism of bilirubin or by alteration in the motility of the gallbladder.Alterations in bilirubin metabolism may be due to an increase in cholesterol in its composition, bacterial infections or a decrease in the concentration of bile salts, as occurs in the case of prolonged fasting. This would explain the formation of stones in patients who follow nutrition by vein.

Alterations in the motility of the gallbladder can appear primarily or during pregnancy, because the increase in circulating progesterone inhibits the contraction of the smooth muscle that is part of the gallbladder, thus making it difficult to empty.

Whatever the production mechanism, the consequence will be the formation of a stone, which causes obstruction of the cystic duct, making it difficult to empty the gallbladder. The accumulation of bile acids and other products damage the wall of the gallbladder, favoring infection by bacteria. If this infection progresses, it can lead to gallbladder abscesses.

Only 10% of the time the gallbladder becomes inflamed in the absence of a stone. In these cases, the infection could be secondary to bile retention, for example due to prolonged fasting or pregnancy.

Symptoms of acute cholecystitis

On many occasions the first manifestation of cholecystitis is the appearance of biliary colic. This is characterized by the appearance of pain in the right side of the abdomen, nausea and vomiting, generally bitter.

Later the pain may become moderate and be accompanied by an increase in temperature (no greater than 38º C).

During the exploration we will find pain in the right side of the abdomen when pressing, being maximum when palpated in deep inspiration (Murphy’s sign).

About a third of patients have a palpable gallbladder, appearing as a painful mass.

In some cases, jaundice is seen as a result of bilirubin retention.

In more than half of the cases, cholecystitis resolves spontaneously, without reaching frank infection of the gallbladder, but in other cases it can evolve to produce sepsis .

How is it diagnosed?

Diagnosis is oriented initially on the clinic and physical examination, and confirmation is achieved through laboratory tests, abdominal radiography, ultrasound, and hepatobiliary scintigraphy.

The abdominal X-ray can show us the existence of stones, although most of the stones are not revealed by this method.

The ultrasound will show thickening of the gallbladder wall, distention of the gallbladder and the existence of stones or biliary sludge .

Hepatobiliary scintigraphy uses radioactive markers that bind to cholesterol. The absence of observation of the gallbladder is diagnostic of cholecystitis in 95% of cases.

Treatment of acute cholecystitis

The treatment will consist, at first, in ending the inflammation of the gallbladder and, later, with the formation of stones.

For the first, the patient will be hospitalized and will be fed by vein, aspiration of the stomach contents, and analgesics or spasmolytics to reduce pain. Antibiotics should not be used initially, but if the attack lasts more than 4 days or abscesses are suspected, ampicillin or cephalosporins will be administered and, in the most severe cases, metronidazole with aminoglycosides.

To definitively avoid the formation of new stones, a cholecystectomy will be performed, which consists of the removal of the gallbladder. This can be done urgently, if complications such as abscesses appear, or if it is not urgent, scheduling surgery.

How can I avoid it?

To avoid the formation of gallstones and the subsequent appearance of cholecystitis, it is advisable to eat a diet low in fat.

It is also advisable to avoid, as far as possible, long fasts.

Finally, to avoid the appearance of recurrences, the only definitive solution is surgical treatment.

A doctor should be consulted at the first symptoms of biliary colic: nausea, vomiting of bitter content, pain in the upper right region of the abdomen, since early treatment of this can prevent the evolution to cholecystitis, although in most cases the cases this evolution is inevitable.

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Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of ​​Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.

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