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Cholecystitis
| Cholecystitis | |
|---|---|
 | |
| Acute cholecystitis as seen on CT. Note the fat stranding around the enlarged gallbladder. | |
| Specialty | General surgery, gastroenterology |
| Symptoms | Intense right upper abdominal pain, nausea, vomiting, fever[1] |
| Duration | Short term or long term[2] |
| Causes | Gallstones, severe illness[1][3] |
| Risk factors | Birth control pills, pregnancy, family history, obesity, diabetes, liver disease, rapid weight loss[4] |
| Diagnostic method | Abdominal ultrasound[5] |
| Differential diagnosis | Hepatitis, peptic ulcer disease, pancreatitis, pneumonia, angina[6] |
| Treatment | Gallbladder removal surgery, gallbladder drainage[7][5] |
| Prognosis | Generally good with treatment[4] |
Cholecystitis is inflammation of the gallbladder.[8] Symptoms include right upper abdominal pain, pain in the right shoulder, nausea, vomiting, and occasionally fever.[1] Often gallbladder attacks (biliary colic) precede acute cholecystitis.[1] The pain lasts longer in cholecystitis than in a typical gallbladder attack.[1] Without appropriate treatment, recurrent episodes of cholecystitis are common.[1] Complications of acute cholecystitis include gallstone pancreatitis, common bile duct stones, or inflammation of the common bile duct.[1][8]
More than 90% of the time acute cholecystitis is caused from blockage of the cystic duct by a gallstone.[1] Risk factors for gallstones include birth control pills, pregnancy, a family history of gallstones, obesity, diabetes, liver disease, or rapid weight loss.[4] Occasionally, acute cholecystitis occurs as a result of vasculitis or chemotherapy, or during recovery from major trauma or burns.[9] Cholecystitis is suspected based on symptoms and laboratory testing.[5] Abdominal ultrasound is then typically used to confirm the diagnosis.[5]
Treatment is usually with laparoscopic gallbladder removal, within 24 hours if possible.[7][10] Taking pictures of the bile ducts during the surgery is recommended.[7] The routine use of antibiotics is controversial.[5][11] They are recommended if surgery cannot occur in a timely manner or if the case is complicated.[5] Stones in the common bile duct can be removed before surgery by endoscopic retrograde cholangiopancreatography (ERCP) or during surgery.[7] Complications from surgery are rare.[4] In people unable to have surgery, gallbladder drainage may be tried.[5]
About 10–15% of adults in the developed world have gallstones.[5] Women more commonly have stones than men and they occur more commonly after age 40.[4] Certain ethnic groups are more often affected; for example, 48% of American Indians have gallstones.[4] Of all people with stones, 1–4% have biliary colic each year.[5] If untreated, about 20% of people with biliary colic develop acute cholecystitis.[5] Once the gallbladder is removed outcomes are generally good.[4] Without treatment, chronic cholecystitis may occur.[2] The word is from Greek, cholecyst- meaning "gallbladder" and -itis meaning "inflammation".[12]
- ^ a b c d e f g h Strasberg, SM (26 June 2008). "Clinical practice. Acute calculous cholecystitis". The New England Journal of Medicine. 358 (26): 2804–11. doi:10.1056/nejmcp0800929. PMID 18579815.
- ^ a b Feldman, Mark (2010). Sleisenger & Fordtran's Gastrointestinal and liver disease pathophysiology, diagnosis, management (9 ed.). [S.l.]: MD Consult. p. 1065. ISBN 9781437727678. Archived from the original on 2017-09-08.
- ^ Levy, Angela D.; Mortele, Koenraad J.; Yeh, Benjamin M. (2015). Gastrointestinal Imaging. Oxford University Press. p. 456. ISBN 9780199392148. Archived from the original on 2017-09-08.
- ^ a b c d e f g "Gallstones". NIDDK. November 2013. Archived from the original on 28 July 2016. Retrieved 27 July 2016.
- ^ a b c d e f g h i j Ansaloni, L (2016). "2016 WSES guidelines on acute calculous cholecystitis". World Journal of Emergency Surgery. 11: 25. doi:10.1186/s13017-016-0082-5. PMC 4908702. PMID 27307785.
- ^ Ferri, Fred F. (2010). Ferri's differential diagnosis : a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders (2nd ed.). Philadelphia, PA: Elsevier/Mosby. p. Chapter C. ISBN 978-0323076999.
- ^ a b c d Patel, PP; Daly, SC; Velasco, JM (18 October 2015). "Training vs practice: A tale of opposition in acute cholecystitis". World Journal of Hepatology. 7 (23): 2470–3. doi:10.4254/wjh.v7.i23.2470. PMC 4606202. PMID 26483868.
- ^ a b Internal Clinical Guidelines Team (October 2014). Gallstone Disease: Diagnosis and Management of Cholelithiasis, Cholecystitis and Choledocholithiasis. Clinical Guideline 188 (Report). p. 101. PMID 25473723.
- ^ "Section VIII". Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management (10 ed.). Elsevier Health Sciences. 2015. p. 1154. ISBN 9781455749898. Archived from the original on 2017-09-08.
- ^ Schuld, J; Glanemann, M (June 2015). "Acute Cholecystitis". Viszeralmedizin. 31 (3): 163–5. doi:10.1159/000431275. PMC 4569253. PMID 26468309.
- ^ van Dijk, AH; de Reuver, PR; Tasma, TN; van Dieren, S; Hugh, TJ; Boermeester, MA (June 2016). "Systematic review of antibiotic treatment for acute calculous cholecystitis". The British Journal of Surgery. 103 (7): 797–811. doi:10.1002/bjs.10146. PMID 27027851. S2CID 205507793.
- ^ Collins, Edwards (2013). A Short Course in Medical Terminology. Lippincott Williams & Wilkins. p. 246. ISBN 9781469835785. Archived from the original on 2017-09-08.
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