Cholecystitis

Cholecystitis

The gallbladder is a small organ situated adjacent to the liver and has a storage function for bile which is necessary for fat digestion.  When this organ becomes inflamed, the condition is termed cholecystitis. ^[1]

Epidemiology

The surgical procedure used to treat cholecystitis is the most commonly done process by general surgeons with about half a million cases performed yearly. The incidence increases with age and females are more prone to develop the condition. ^[2]

Causes

Acute cases of cholecystitis usually happen when bile becomes blocked in a passage near the gallbladder called cystic duct which eventually leads to inflammation. Most are due to gallstone. In some cases, infection, critical illness and trauma are precipitating factors. ^[1] Some factors that may increase the chance of a person to develop cholecystitis include obesity, pregnancy, hormonal therapy, diabetes mellitus, chronic parenteral nutrition, major surgery, heart attack, prolonged fasting and sickle cell disease. ^[2]

Signs and Symptoms

Most patients report pain in the upper right area of the abdomen that can radiate towards the back or the shoulders. The pain can be sharp, dull or steady. ^[3] Fever and increased heart rate are common findings. Some patients may present with yellowing of the skin and sclera called jaundice. ^[2] Other symptoms include clay-colored stool, nausea and vomiting. ^[4] The typical symptoms may not be obvious in special patients including the elderly, diabetic patients and the children. ^[2]

Diagnosis

History taking and physical exam are done to suspect cholecystitis. In the physical examination, the physician will perform examination of the abdomen. A sign called Murphy’s sign is often elicited which is inspiratory pause by the patient when the right upper quadrant of the abdomen is palpated. ^[2] Ultrasound is requested to examine the gallbladder and to check for gallstones. Blood tests may be done to check for bilirubin, amylase, lipase, blood cell count and liver enzymes. Imaging tests that may help include oral cholecystogram, CT scan and radionuclide scan. ^[3]

Treatment

Intravenous fluids and antibiotics are administered to patients with acute cholecystitis. When gallstones are present which causes significant symptoms, a surgical process called cholecystectomy is done which entails removal of the gallbladder. In some cases of chronic cholecystitis, drugs that dissolve the gallstones are prescribed to patients. Patients are also advised to take diet low in fats. ^{[1] [3]}

References:

1.      http://www.webmd.com/digestive-disorders/tc/cholecystitis-overview

2.       http://emedicine.medscape.com/article/171886-overview#a0156

3.      http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001310/

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Neural Therapy:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (there is insufficient evidence to show that Neural Therapy helps in treating Cholecystitis in any way)

Grade of Evidence: very low quality of evidence

* www.gradeworkinggroup.org

Public Discussion