Causes of infected gallbladder: Cholecystitis – Symptoms and causes

25.10.197402.10.2021 by alexxlab

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Cholecystitis: Gallbladder Inflammation, Symptoms, Treatment

Overview

Anatomy of the gallbladder, featuring gallstones stuck in the cystic duct.

What is cholecystitis?

Cholecystitis is an inflammation of the gallbladder. Your gallbladder is a small pear-shaped organ tucked away under your liver in the upper right section of your abdomen. The gallbladder’s job is to store bile – a fat-digesting fluid made by the liver – and to release it after you eat a meal. Cholecystitis usually develops when the bile gets trapped in your gallbladder, and becomes infected with bacteria. Bile gets trapped when gallstones block the flow of bile out of your gallbladder.

What are gallstones and how do they block the flow of bile?

Gallstones are hardened deposits of the digestive fluids that form in your gallbladder, and can range in size from a tiny grain of sand (called sludge) to a golf ball. They are made up of either cholesterol or pigment stones. Gallstones made of cholesterol are yellow-greenish in color, and are more common. Pigment stones are mostly made of bilirubin, a substance that is created when the liver breaks down red blood cells.

Gallstones themselves are not necessarily a problem. It’s possible to have gallstones sitting in your gallbladder, never bothering you and, in that case, they don’t need to be treated. However, gallstones that leave the gallbladder can get stuck in your ducts (tubes). They block the flow of bile out of your gallbladder, which causes a buildup of bile. These events cause the walls of your gallbladder to become inflamed and swell, and that can lead to bacterial infection of the bile. Your life can even be in danger unless you seek prompt medical and surgical help.

How does the gallbladder work?

The gallbladder connects to your liver by a duct system (tubes) that look like a tree trunk with branches. There are many ducts, or “branches” inside your liver. These tree branches connect to two main tree limbs in your liver, called the right and left hepatic ducts. These two ducts merge (like the trunk of a tree) to form your common hepatic duct. One main “tree limb” coming off the common hepatic duct is called the cystic duct. It connects directly into your gallbladder. The common hepatic duct, the “tree trunk,” continues but its name changes to the common bile duct. Your common bile duct empties into the duodenum section of the small intestine.

Bile, a fat-dissolving liquid substance that is made continuously by your liver, travels through the duct system and enters your digestive system at the duodenum. When you are not eating, a valve structure at the common bile duct and duodenum connection, called the major duodenal papilla, is usually closed. This allows the bile to reflux back through the cystic duct into your gallbladder to be stored. During mealtime, your gallbladder contracts, and the valve opens, pushing the stored bile out of your gallbladder, through the cystic duct and down the common bile duct into your intestine. Bile mixes with the partially digested food, further helping the breakdown of the fat in your diet.

Gallstones, or even sludge, in the gallbladder can obstruct this normal flow of bile, leading to cholecystitis.

How common is cholecystitis?

Approximately 120,000 Americans are treated for acute cholecystitis every year. Women make up 60% of this number.

Who is at risk to get cholecystitis?

You are at greater risk of developing cholecystitis if you:

Have a family history of gallstones.
Are a woman age 50 or older.
Are a man or woman age 60 or older.
Eat a diet high in fat and cholesterol.
Are overweight or obese.
Have diabetes.
Are of Native American, Scandinavian or Hispanic descent.
Are currently pregnant or have had several pregnancies.
Are a woman who takes estrogen replacement therapy or birth control pills.
Have lost weight rapidly.

Symptoms and Causes

What causes cholecystitis?

Cholecystitis is commonly caused by gallstones that have blocked your cystic duct, which prevents bile from exiting your gallbladder. Your gallbladder becomes swollen and may become infected with bacteria. Less common causes include blocked bile ducts due to scarring, reduced blood flow to your gallbladder, tumors that block the flow of bile from your gallbladder, or viral infections that inflame your gallbladder.

Structure of the digestive anatomy showcasing the liver, stomach, pancreas and gallbladder.

What are the symptoms of cholecystitis?

Symptoms can be acute or chronic.

Acute cholecystitis comes on suddenly and causes severe, ongoing pain. More than 95% of people with acute cholecystitis have gallstones. Pain begins in your mid to upper right abdomen and may spread to your right shoulder blade or back. Pain is strongest 15 to 20 minutes after eating and it continues. Pain that remains severe is considered a medical emergency.

Chronic cholecystitis means you’ve had repeated attacks of inflammation and pain. Pain tends to be less severe and doesn’t last as long as acute cholecystitis. The repeated attacks are usually caused by gallstones blocking the cystic duct intermittently.

Other signs and symptoms of cholecystitis may include:

Tenderness in your abdomen when it’s touched.
Nausea and bloating.
Vomiting.
Fever above 100.4 F (38 C). Fever may not be present in older adults and usually doesn’t occur in people with chronic cholecystitis.
Chills.
Abdominal pain that gets worse when taking a deep breath.
Abdominal pain and cramping after eating – especially fatty foods.
Jaundice (a yellowing of skin and eyes).

Diagnosis and Tests

How is cholecystitis diagnosed?

Your healthcare professional will ask about your symptoms. They may order blood work to check your white blood cell count and how well your liver is working. A higher than normal white blood cell count is a sign of an infection, inflammation, or an abscess.

Imaging tests that could be ordered include:

Abdominal ultrasound: This test uses sound waves to examine the gallbladder and the bile ducts. It helps identify signs of inflammation in your gallbladder, the presence of gallstones, and thickening or swelling of the gallbladder wall.
Hepatobiliary nuclear imaging (HIDA scan): This is an imaging test that involves an injected radioactive substance. A gamma camera sees the radiation as it moves through the different tracts of the digestive system. If that substance doesn’t enter your gallbladder, then the healthcare provider knows the organ is blocked, indicating cholecystitis. This test can also detect the function of the gallbladder and its ability to eject the bile once stimulated. This is called the ejection fraction of the gallbladder, which is considered normal when it is above 30-35%.
Magnetic Resonance Cholangiopancreatography (MRCP): This type of MRI shows details of your liver, gallbladder, bile ducts, structures and ducts of the pancreas as well. It can show gallstones, inflammation or blockage of the bile ducts and gallbladder and if there is any inflammation of the pancreas.
Abdominal Computed Tomography (CT Scan): This X-ray test shows details of your liver, gallbladder and bile ducts. It shows inflammation of the gallbladder.

Management and Treatment

How can cholecystitis be treated?

Treatment of cholecystitis usually takes place in the hospital. Treatments may include:

Fasting, to rest the gallbladder.
IV fluids to prevent dehydration.
Pain medication.
Antibiotics to treat infection.
Removing the gallbladder. This surgery, called a cholescystectomy, is usually performed by making tiny cuts (incisions) through the abdomen to insert a laparoscope (tiny camera) to see inside the abdomen and surgical instruments to remove the gallbladder. The gallbladder is usually removed within 24 to 48 hours of admission if you have a confirmed case of acute cholecystitis.
Draining the gallbladder to treat and prevent the spread of infection. This procedure, called percutaneous cholecystostomy, is usually reserved for those who are too ill to undergo surgery.
Removing gallstones in the area blocking the common bile duct. This procedure, done by an endoscopist, called endoscopic retrograde cholangiopancreatography (ERCP), is reserved for patients with a suspected or confirmed blocked common bile duct, and can clear the duct of stones and sludge.

What is it like to recover from gallbladder surgery?

Recovery from gallbladder surgery, when done laparoscopically, is usually uneventful. As with any surgery there can be minimal pain at the incision sites. Most patients are discharged from the hospital shortly after the surgery, and do not require additional testing or interventions. If the surgery is done through a larger wound (open surgery) then the recovery can be slower and require more days in the hospital.

Can I live without my gallbladder?

Yes, you can live a normal life without a gallbladder. Since the gallbladder’s main role is the storage of the bile, and bile is made continuously by the liver, you don’t need your gallbladder for normal digestion. Bile can still flow directly from your liver, through the common bile duct and into the small intestine.

What complications can occur if cholecystitis is not treated?

Complications can range from ongoing infection to possible death.

Severely Infected gallbladder: A blocked gallbladder that is extremely uncomfortable and painful. Without treatment, it could lead to an overwhelming infection, or even gangrene of the gallbladder.
Cholangitis: An acute infection of the main bile ducts and liver that can be extremely life-threating if not promptly treated.
Inflamed pancreas (Pancreatitis): Your common bile duct and the pancreatic duct share the same “valve” into the duodenum. If a gallstone blocks that valve, the potent pancreatic enzyme juice excreted by the pancreases gets backed up causing pancreatitis, which can also be severe and life threatening.

What if I have cholecystitis during pregnancy?

During early and later pregnancy cholecystitis can be treated by antibiotics. Surgery is usually a safe option during the second trimester, but can also be performed safely at any time if antibiotics fail to treat the infection

Prevention

How can cholecystitis be prevented?

You can reduce your risk of developing cholecystitis by:

Eating a healthy diet: Choose to eat a healthy diet – one high in fruits, vegetables whole grains and healthy fats – such as the Mediterranean diet. Stay away from foods high in fat and cholesterol.
Exercising: Exercise reduces cholesterol, and the lower the cholesterol level the lower the chance of getting gallstones.
Losing weight slowly: If you are making efforts to lose weight, don’t lose more than one to two pounds a week. Rapid weight loss increases your risk for developing gallstones.

Outlook / Prognosis

What is the outlook for patients with cholecystitis?

There is a higher rate of the symptoms recurring if cholecystitis is treated only with medications. There is a higher risk of death, as well, for patients who do not address the worsening conditions.

Surgery to remove the gallbladder (cholecystectomy) is usually the definitive treatment. The benefits of the surgery outweighs the risks in most cases, since the surgical treatment carries very low risk of complications in most cases. Your surgeon will assess your risks for the surgery and discuss all of your treatment options before the operation.

Living With

What’s the difference between cholecystitis and cholelithiasis?

Cholelithiasis is the formation of gallstones. Cholecystitis is the inflammation of the gallbladder.

How do I take care of myself if I have a diagnosis of cholecystitis?

Educate yourself about the symptoms of cholecystitis so that you and your healthcare provider can identify it and treat it as early as possible.

When should I see my healthcare provider?

Abdominal pain of any sort should always be an alarm. If you have sudden pain or bouts of pain in your upper right area of your abdomen or right shoulder or back, contact your healthcare provider.

When should I go to emergency room?

Don’t hesitate to go to the emergency room if you have severe abdominal pain that does not spontaneously resolve or that continues to worsen.

What questions should I ask my doctor?

Is my pain cholecystitis, for sure, or could it be caused by something else?
Should my cholecystitis be treated with medication or with surgery, or both?
What do you think caused these symptoms?
How quickly am I likely to recover from surgery?
Keeping my other medical conditions in mind, are there any risks in getting surgery?
Could I have any non-surgical treatments?
How quickly should I have surgery?
What specialist should I follow up with?
What foods should I eat/avoid?

A note from Cleveland Clinic

If you have pain in the upper right quadrant of your abdomen, seek immediate answers from a healthcare provider. Gallbladder inflammation, whether it’s chronic or acute, requires swift and vigilant care!

Cholecystitis: Gallbladder Inflammation, Symptoms, Treatment

Overview

Anatomy of the gallbladder, featuring gallstones stuck in the cystic duct.

What is cholecystitis?

What are gallstones and how do they block the flow of bile?

How does the gallbladder work?

Gallstones, or even sludge, in the gallbladder can obstruct this normal flow of bile, leading to cholecystitis.

How common is cholecystitis?

Approximately 120,000 Americans are treated for acute cholecystitis every year. Women make up 60% of this number.

Who is at risk to get cholecystitis?

You are at greater risk of developing cholecystitis if you:

Have a family history of gallstones.
Are a woman age 50 or older.
Are a man or woman age 60 or older.
Eat a diet high in fat and cholesterol.
Are overweight or obese.
Have diabetes.
Are of Native American, Scandinavian or Hispanic descent.
Are currently pregnant or have had several pregnancies.
Are a woman who takes estrogen replacement therapy or birth control pills.
Have lost weight rapidly.

Symptoms and Causes

What causes cholecystitis?

Structure of the digestive anatomy showcasing the liver, stomach, pancreas and gallbladder.

What are the symptoms of cholecystitis?

Symptoms can be acute or chronic.

Other signs and symptoms of cholecystitis may include:

Tenderness in your abdomen when it’s touched.
Nausea and bloating.
Vomiting.
Fever above 100.4 F (38 C). Fever may not be present in older adults and usually doesn’t occur in people with chronic cholecystitis.
Chills.
Abdominal pain that gets worse when taking a deep breath.
Abdominal pain and cramping after eating – especially fatty foods.
Jaundice (a yellowing of skin and eyes).

Diagnosis and Tests

How is cholecystitis diagnosed?

Imaging tests that could be ordered include:

Abdominal ultrasound: This test uses sound waves to examine the gallbladder and the bile ducts. It helps identify signs of inflammation in your gallbladder, the presence of gallstones, and thickening or swelling of the gallbladder wall.
Hepatobiliary nuclear imaging (HIDA scan): This is an imaging test that involves an injected radioactive substance. A gamma camera sees the radiation as it moves through the different tracts of the digestive system. If that substance doesn’t enter your gallbladder, then the healthcare provider knows the organ is blocked, indicating cholecystitis. This test can also detect the function of the gallbladder and its ability to eject the bile once stimulated. This is called the ejection fraction of the gallbladder, which is considered normal when it is above 30-35%.
Magnetic Resonance Cholangiopancreatography (MRCP): This type of MRI shows details of your liver, gallbladder, bile ducts, structures and ducts of the pancreas as well. It can show gallstones, inflammation or blockage of the bile ducts and gallbladder and if there is any inflammation of the pancreas.
Abdominal Computed Tomography (CT Scan): This X-ray test shows details of your liver, gallbladder and bile ducts. It shows inflammation of the gallbladder.

Management and Treatment

How can cholecystitis be treated?

Treatment of cholecystitis usually takes place in the hospital. Treatments may include:

Fasting, to rest the gallbladder.
IV fluids to prevent dehydration.
Pain medication.
Antibiotics to treat infection.
Removing the gallbladder. This surgery, called a cholescystectomy, is usually performed by making tiny cuts (incisions) through the abdomen to insert a laparoscope (tiny camera) to see inside the abdomen and surgical instruments to remove the gallbladder. The gallbladder is usually removed within 24 to 48 hours of admission if you have a confirmed case of acute cholecystitis.
Draining the gallbladder to treat and prevent the spread of infection. This procedure, called percutaneous cholecystostomy, is usually reserved for those who are too ill to undergo surgery.
Removing gallstones in the area blocking the common bile duct. This procedure, done by an endoscopist, called endoscopic retrograde cholangiopancreatography (ERCP), is reserved for patients with a suspected or confirmed blocked common bile duct, and can clear the duct of stones and sludge.

What is it like to recover from gallbladder surgery?

Can I live without my gallbladder?

What complications can occur if cholecystitis is not treated?

Complications can range from ongoing infection to possible death.

Severely Infected gallbladder: A blocked gallbladder that is extremely uncomfortable and painful. Without treatment, it could lead to an overwhelming infection, or even gangrene of the gallbladder.
Cholangitis: An acute infection of the main bile ducts and liver that can be extremely life-threating if not promptly treated.
Inflamed pancreas (Pancreatitis): Your common bile duct and the pancreatic duct share the same “valve” into the duodenum. If a gallstone blocks that valve, the potent pancreatic enzyme juice excreted by the pancreases gets backed up causing pancreatitis, which can also be severe and life threatening.

What if I have cholecystitis during pregnancy?

Prevention

How can cholecystitis be prevented?

You can reduce your risk of developing cholecystitis by:

Eating a healthy diet: Choose to eat a healthy diet – one high in fruits, vegetables whole grains and healthy fats – such as the Mediterranean diet. Stay away from foods high in fat and cholesterol.
Exercising: Exercise reduces cholesterol, and the lower the cholesterol level the lower the chance of getting gallstones.
Losing weight slowly: If you are making efforts to lose weight, don’t lose more than one to two pounds a week. Rapid weight loss increases your risk for developing gallstones.

Outlook / Prognosis

What is the outlook for patients with cholecystitis?

There is a higher rate of the symptoms recurring if cholecystitis is treated only with medications. There is a higher risk of death, as well, for patients who do not address the worsening conditions.

Living With

What’s the difference between cholecystitis and cholelithiasis?

Cholelithiasis is the formation of gallstones. Cholecystitis is the inflammation of the gallbladder.

How do I take care of myself if I have a diagnosis of cholecystitis?

Educate yourself about the symptoms of cholecystitis so that you and your healthcare provider can identify it and treat it as early as possible.

When should I see my healthcare provider?

Abdominal pain of any sort should always be an alarm. If you have sudden pain or bouts of pain in your upper right area of your abdomen or right shoulder or back, contact your healthcare provider.

When should I go to emergency room?

Don’t hesitate to go to the emergency room if you have severe abdominal pain that does not spontaneously resolve or that continues to worsen.

What questions should I ask my doctor?

Is my pain cholecystitis, for sure, or could it be caused by something else?
Should my cholecystitis be treated with medication or with surgery, or both?
What do you think caused these symptoms?
How quickly am I likely to recover from surgery?
Keeping my other medical conditions in mind, are there any risks in getting surgery?
Could I have any non-surgical treatments?
How quickly should I have surgery?
What specialist should I follow up with?
What foods should I eat/avoid?

A note from Cleveland Clinic

Cholecystitis: Gallbladder Inflammation, Symptoms, Treatment

Overview

Anatomy of the gallbladder, featuring gallstones stuck in the cystic duct.

What is cholecystitis?

What are gallstones and how do they block the flow of bile?

How does the gallbladder work?

Gallstones, or even sludge, in the gallbladder can obstruct this normal flow of bile, leading to cholecystitis.

How common is cholecystitis?

Approximately 120,000 Americans are treated for acute cholecystitis every year. Women make up 60% of this number.

Who is at risk to get cholecystitis?

You are at greater risk of developing cholecystitis if you:

Have a family history of gallstones.
Are a woman age 50 or older.
Are a man or woman age 60 or older.
Eat a diet high in fat and cholesterol.
Are overweight or obese.
Have diabetes.
Are of Native American, Scandinavian or Hispanic descent.
Are currently pregnant or have had several pregnancies.
Are a woman who takes estrogen replacement therapy or birth control pills.
Have lost weight rapidly.

Symptoms and Causes

What causes cholecystitis?

Structure of the digestive anatomy showcasing the liver, stomach, pancreas and gallbladder.

What are the symptoms of cholecystitis?

Symptoms can be acute or chronic.

Other signs and symptoms of cholecystitis may include:

Tenderness in your abdomen when it’s touched.
Nausea and bloating.
Vomiting.
Fever above 100.4 F (38 C). Fever may not be present in older adults and usually doesn’t occur in people with chronic cholecystitis.
Chills.
Abdominal pain that gets worse when taking a deep breath.
Abdominal pain and cramping after eating – especially fatty foods.
Jaundice (a yellowing of skin and eyes).

Diagnosis and Tests

How is cholecystitis diagnosed?

Imaging tests that could be ordered include:

Abdominal ultrasound: This test uses sound waves to examine the gallbladder and the bile ducts. It helps identify signs of inflammation in your gallbladder, the presence of gallstones, and thickening or swelling of the gallbladder wall.
Hepatobiliary nuclear imaging (HIDA scan): This is an imaging test that involves an injected radioactive substance. A gamma camera sees the radiation as it moves through the different tracts of the digestive system. If that substance doesn’t enter your gallbladder, then the healthcare provider knows the organ is blocked, indicating cholecystitis. This test can also detect the function of the gallbladder and its ability to eject the bile once stimulated. This is called the ejection fraction of the gallbladder, which is considered normal when it is above 30-35%.
Magnetic Resonance Cholangiopancreatography (MRCP): This type of MRI shows details of your liver, gallbladder, bile ducts, structures and ducts of the pancreas as well. It can show gallstones, inflammation or blockage of the bile ducts and gallbladder and if there is any inflammation of the pancreas.
Abdominal Computed Tomography (CT Scan): This X-ray test shows details of your liver, gallbladder and bile ducts. It shows inflammation of the gallbladder.

Management and Treatment

How can cholecystitis be treated?

Treatment of cholecystitis usually takes place in the hospital. Treatments may include:

Fasting, to rest the gallbladder.
IV fluids to prevent dehydration.
Pain medication.
Antibiotics to treat infection.
Removing the gallbladder. This surgery, called a cholescystectomy, is usually performed by making tiny cuts (incisions) through the abdomen to insert a laparoscope (tiny camera) to see inside the abdomen and surgical instruments to remove the gallbladder. The gallbladder is usually removed within 24 to 48 hours of admission if you have a confirmed case of acute cholecystitis.
Draining the gallbladder to treat and prevent the spread of infection. This procedure, called percutaneous cholecystostomy, is usually reserved for those who are too ill to undergo surgery.
Removing gallstones in the area blocking the common bile duct. This procedure, done by an endoscopist, called endoscopic retrograde cholangiopancreatography (ERCP), is reserved for patients with a suspected or confirmed blocked common bile duct, and can clear the duct of stones and sludge.

What is it like to recover from gallbladder surgery?

Can I live without my gallbladder?

What complications can occur if cholecystitis is not treated?

Complications can range from ongoing infection to possible death.

Severely Infected gallbladder: A blocked gallbladder that is extremely uncomfortable and painful. Without treatment, it could lead to an overwhelming infection, or even gangrene of the gallbladder.
Cholangitis: An acute infection of the main bile ducts and liver that can be extremely life-threating if not promptly treated.
Inflamed pancreas (Pancreatitis): Your common bile duct and the pancreatic duct share the same “valve” into the duodenum. If a gallstone blocks that valve, the potent pancreatic enzyme juice excreted by the pancreases gets backed up causing pancreatitis, which can also be severe and life threatening.

What if I have cholecystitis during pregnancy?

Prevention

How can cholecystitis be prevented?

You can reduce your risk of developing cholecystitis by:

Eating a healthy diet: Choose to eat a healthy diet – one high in fruits, vegetables whole grains and healthy fats – such as the Mediterranean diet. Stay away from foods high in fat and cholesterol.
Exercising: Exercise reduces cholesterol, and the lower the cholesterol level the lower the chance of getting gallstones.
Losing weight slowly: If you are making efforts to lose weight, don’t lose more than one to two pounds a week. Rapid weight loss increases your risk for developing gallstones.

Outlook / Prognosis

What is the outlook for patients with cholecystitis?

There is a higher rate of the symptoms recurring if cholecystitis is treated only with medications. There is a higher risk of death, as well, for patients who do not address the worsening conditions.

Living With

What’s the difference between cholecystitis and cholelithiasis?

Cholelithiasis is the formation of gallstones. Cholecystitis is the inflammation of the gallbladder.

How do I take care of myself if I have a diagnosis of cholecystitis?

Educate yourself about the symptoms of cholecystitis so that you and your healthcare provider can identify it and treat it as early as possible.

When should I see my healthcare provider?

Abdominal pain of any sort should always be an alarm. If you have sudden pain or bouts of pain in your upper right area of your abdomen or right shoulder or back, contact your healthcare provider.

When should I go to emergency room?

Don’t hesitate to go to the emergency room if you have severe abdominal pain that does not spontaneously resolve or that continues to worsen.

What questions should I ask my doctor?

Is my pain cholecystitis, for sure, or could it be caused by something else?
Should my cholecystitis be treated with medication or with surgery, or both?
What do you think caused these symptoms?
How quickly am I likely to recover from surgery?
Keeping my other medical conditions in mind, are there any risks in getting surgery?
Could I have any non-surgical treatments?
How quickly should I have surgery?
What specialist should I follow up with?
What foods should I eat/avoid?

A note from Cleveland Clinic

Acute cholecystitis – Illnesses & conditions

Acute cholecystitis is swelling (inflammation) of the gallbladder. It is a potentially serious condition that usually needs to be treated in hospital.

The main symptom of 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 doesn’t 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

You should see your GP as soon as possible if you develop sudden and severe abdominal pain, particularly if the pain lasts longer than a few hours or is accompanied by other symptoms, such as jaundice and a fever.

If it’s not possible to contact your GP immediately, phone your local out-of-hours service or call the NHS 24 111 service for advice.

It’s 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 (see below).

What causes acute cholecystitis?

The causes of acute cholecystitis can be grouped into 2 main 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 the pressure inside it and causing it to become inflamed. In around 1 in every 5 cases, the inflamed gallbladder also becomes infected by bacteria.

Acalculous cholecystitis

Acalculous cholecystitis is a less common, but usually more serious, type of acute cholecystitis. It usually 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.

It is estimated that around 10-15% of adults in the UK have gallstones. These don’t usually cause any symptoms, but in a small proportion of people they can cause infrequent 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 Murphy’s sign. You will be asked to breathe in deeply with your GP’s 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 doctor’s hand.

If your symptoms suggest you have acute cholecystitis, your GP will 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. These often 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 the condition usually fall back into the gallbladder and the inflammation often 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 point after the initial treatment. This type of surgery is 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 will need 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 to wait 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, you can lead a perfectly normal life without a gallbladder.

The organ can be useful but it’s 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 1 in every 5 cases of acute cholecystitis, emergency surgery to remove the gallbladder is needed to treat these complications.

Preventing acute cholecystitis

It’s 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 is adopting a healthy, 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.

Cholecystitis (gallbladder inflammation) | healthdirect

What is cholecystitis?

Cholecystitis is an inflammation of the gallbladder, often caused by gallstones. It can be very painful and usually needs prompt medical treatment.

The gallbladder is a small organ underneath the liver on the right side of the upper abdomen. It stores a thick dark green fluid called bile which the liver produces to help with digestion.

What are the symptoms of cholecystitis?

Symptoms of cholecystitis include:

an intense pain in the middle or right side of the upper abdomen, or between the shoulders
indigestion, especially after fatty food
nausea and/or vomiting
fever

Symptoms often appear after someone has eaten a large, fatty meal.

If you are in pain, don’t ignore it because cholecystitis is a serious condition can lead to complications. An infection in your abdomen can be very serious. See your doctor if the pain lasts for more than 3 hours. If the pain is very bad, go straight to your nearest hospital emergency department.

CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.

What causes cholecystitis?

Cholecystitis most frequently occurs when gallstones (stones that form within the bile coming down from the liver) block the tube leading out of the gallbladder. This results in a build-up of bile, which causes inflammation.

Cholecystitis can also be caused by other problems with the bile duct, such as a tumour, problems with blood supply to the gallbladder, and infections.

The condition might settle down on its own, but cholecystitis tends to come back. Most people eventually need surgery to remove the gallbladder. Sometimes, cholecystitis can lead to liver inflammation, a serious infection, a torn gallbladder, or the death of some of the tissue in the gallbladder.

Anatomy of the upper abdominal area, showing the liver and gallbladder.

How is cholecystitis diagnosed?

If a doctor suspects you have cholecystitis, they will examine you and ask you about your medical history. They will usually order an ultrasound of your abdomen. They may also do a blood test to look for signs of liver inflammation or infection.

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How is cholecystitis treated?

Cholecystitis can sometimes settle down if you eat a low-fat diet. You may also be given medicine to dissolve gallstones.

If you go to hospital, you will be fed and hydrated through an intravenous drip and you may have antibiotics to fight infection. You will probably also need medicine for pain relief.

Most people have their gallbladder removed 2 to 3 days after they are admitted to hospital. In this operation, the gallbladder is removed using laparoscopy. This is a type of keyhole surgery performed in the belly area. You don’t need your gallbladder, and after the operation, bile will flow straight from your liver to your small intestine.

Resources and support

If you need to know more about gallstones, or to get advice on what to do next, call healthdirect on 1800 022 222 to speak with a registered nurse, 24 hours, 7 days a week (known as NURSE-ON-CALL in Victoria).

The Signs of an Impending Gallbladder Rupture

If you’re experiencing pain in your upper-right abdomen, it’s important to remain calm and consult a medical professional. This pain could be caused by any number of factors, but there’s a chance it’s being caused by gallbladder inflammation. If left untreated, gallbladder inflammation can lead to a gallbladder rupture, a serious and potentially life-threatening medical condition.

Below, we discuss the signs of an impending gallbladder rupture. If you’re experiencing the symptoms described throughout this article, it’s important to seek immediate medical attention. A gallbladder rupture can be effectively treated with surgery, but it’s best to consult one of the top gallbladder surgeons in Tampa before emergency surgery is needed.

The Signs to Watch Out For

Gallbladder ruptures are rarely caused by a traumatic abdominal injury. More often, they are caused by gallstones, bacterial infections, ascariasis, or biliary sludge. Because gallbladder ruptures are caused by gallbladder inflammation (cholecystitis), you should be watching for the following symptoms:

Upper right abdominal pain
Abdominal tenderness
Nausea and vomiting
Fever and possible chills
Yellowing of the skin (jaundice)

If you’re experiencing the above symptoms, you may be suffering from acute or chronic cholecystitis. Acute cholecystitis is sudden inflammation and, if left untreated, can lead to chronic cholecystitis and an increased risk of a gallbladder rupture.

Related: 9 Types of Gallbladder Diseases and Complications

If your gallbladder has ruptured, you’re likely experiencing sudden excruciating pain. If you believe your gallbladder has ruptured, seek immediate medical attention for gallbladder surgery in Tampa.

The Dangers of A Ruptured Gallbladder

The chief danger of a gallbladder rupture is an infection, which can lead to sepsis. Sepsis is a life-threatening condition where your body creates a dysregulated response to infection. Essentially, your body is hurting itself while trying to attack the infection. Sepsis can lead to tissue damage, organ failure, and death, which is why it’s so important to seek medical treatment if you are experiencing the signs of cholecystitis.

Related: Could My Gallbladder Be Causing Abdominal Pain?

Consult a Medical Professional for Diagnosis and Treatment

If you are experiencing the signs of an impending gallbladder rupture, your best course of action is to consult a medical professional. The outlook for your condition will be far more promising if your gallbladder can be removed before it ruptures. As one of the top gallbladder surgeons in Tampa, Dr. Clark can diagnose your condition and determine if surgery is right for you.

Although your abdominal pain may be the result of something benign, it’s important to consult a medical professional in order to avoid the above complications. Until you consult a surgeon like Dr. Clark, you’ll have no way of knowing if you need gallbladder surgery in Tampa.

To learn more about gallbladder surgery in Tampa, or to schedule a consultation with Whalen Clark, M.D., please request an appointment today.

Disclaimer:The contents of this website are for general educational purposes only. All content and media on the Whalen Clark, M.D. website does not constitute professional medical advice nor is the information intended to replace the services of Whalen Clark, M.D. or other qualified medical professionals. If you believe you are having a medical emergency, call 911 immediately.

The content, views, and opinions communicated on this website do not represent the views of Whalen Clark, M.D. Reliance on any information provided by this website is solely at your own risk. Although this website contains links to other medical websites, this is strictly for informational purposes. Whalen Clark, M.D. is not responsible nor do they approve of the content featured on any third party linked websites referenced on this website.

Cholecystitis – an overview | ScienceDirect Topics

Cholecystitis

Cholecystitis is a disease that results from inflammation of the gallbladder, typically secondary to gallstone obstruction of the cystic duct. Cholecystitis may be acute or chronic. Most cholecystitis in children is chronic and is associated with gallstones. The presentation of “acute” cholecystitis in children most likely represents a significant episode of an ongoing process of gallbladder distension and mucosal damage that culminated in cholecystitis.

The pathophysiology of cholecystitis parallels that of gallstone formation, with gallbladder stasis as the initiating event. The stasis is usually secondary to obstruction of the cystic duct by a gallstone or to local edema secondary to a stone. Other causes include external compression of the cystic duct by swollen lymph nodes, torsion of the gallbladder, congenital ductal abnormalities, and trauma. The basis for the inflammation is unclear, although mechanical distension, ischemia, bacteria, and lysolecithins have been implicated.

The typical presenting symptom is right upper quadrant abdominal pain, occasionally radiating to the back and associated with vomiting. When distended and inflamed, the gallbladder lies on the anterior abdominal wall between the 9th and 10th costal cartilages, causing localized tenderness on palpation and giving rise to the diagnostic Murphy sign. Jaundice and fever are seen in 25% to 30% of children and are more common in young infants. The onset of symptoms is usually over a period of 1 week, but lesser symptoms of biliary colic may occur over several years. The differential diagnosis should include hepatitis, hepatic abscess, tumor, gonococcal perihepatitis (Fitz-Hugh–Curtis syndrome), pancreatitis, appendicitis, peptic ulcer disease, pneumonia, pyelonephritis, and kidney stones.

Laboratory evaluation should include a complete blood count with differential, total, and conjugated bilirubin, alkaline phosphatase, GGT, serum aminotransferases, amylase, and lipase levels; and urinalysis. Leukocytosis is frequently found. Elevated aminotransferase levels and mild hyperbilirubinemia are seen in 20% of patients in the absence of obstruction. Elevated amylase levels are common even without pancreatitis. Marked elevation of the bilirubin, alkaline phosphatase, or GGT levels may indicate choledocholithiasis (stones in the bile duct). The characteristic ultrasound finding is a discrete echo density indicating a stone, usually occupying a dependent position in the gallbladder, which changes or moves when the patient is moved and is associated with acoustic shadowing (Fig. 79.3). Gallbladder dilation, a thickened gallbladder wall, the presence of sludge, and biliary tree anomalies may also be seen (Figs. 79.4 and 79.5A and B). However, the sensitivity and the positive predictive value of ultrasound in pediatric cholecystitis are low.¹⁷⁹ Cholescintigraphy can be helpful to evaluate gallbladder function, revealing normal hepatic uptake, but nonvisualization of the gallbladder occurs at 1 hour.¹⁸⁰ False-positive results may occur with prolonged fasting, TPN, and hepatocellular disease. Oral cholecystography is used less frequently, owing to several inherent drawbacks, such as failure to concentrate the dye (particularly if hyperbilirubinemia exists), a 6% to 8% false-negative rate, hypersensitivity to the dye, and radiation exposure.

Hospitalization with institution of intravenous fluids, cessation of oral feeding, gastric decompression, and analgesics is appropriate. Antibiotics are not needed in simple cases but are indicated for persistent fever, clinical worsening, or concern for obstruction. Cefoxitin or piperacillin/tazobactam is often used to cover enteric organisms and provide good biliary excretion.

Cholecystectomy is the procedure of choice in calculous cholecystitis and is most often performed laparoscopically. In the current era, cholecystectomy is being performed at increasing frequency for indications of biliary dyskinesia and nonhemolytic stones, rather than for hemolytic disease.⁵³^,⁵⁴ In children with sickle cell disease, a combination of packed red blood cell transfusion, exchange transfusion, and adequate hydration with dextrose-containing intravenous fluids is typical. Children with certain medical disorders, such as congenital heart disease, appear to have an increased risk of death after urgent cholecystectomy, and elective cholecystectomy may be advisable.¹⁸¹ Cholecystostomy with stone removal can be done in those patients for whom a functioning gallbladder is important, such as in patients with Crohn disease. Table 79.3 lists the possible treatment options in children. Adverse events associated with cholecystectomy include postoperative fever or infection, retained stone, and need for ERCP. Bile duct injury or leaks occur infrequently.⁵⁴^,¹⁸¹^,¹⁸²

Most cases of cholecystitis resolve over several days. Complications occur in up to 30% of cases and include gallbladder perforation, abscess, and empyema formation. When fever persists or exceeds 102°F and pain or tenderness worsens, perforation is more likely. Such perforations typically occur in the fundus of the gallbladder. A local perforation may wall off as an abscess, extend into the peritoneum as peritonitis, or lead to a cholecystenteric fistula. Surgical evaluation with appropriate antibiotic support is essential.

Chronic obstruction of the cystic duct may lead to the interesting finding of the “milk of calcium” gallbladder or “limy bile” syndrome. In this situation, complete obstruction of the cystic duct leads to a hydropic gallbladder. Bile pigments are deconjugated to colorless compounds, and excess calcium is secreted, opacifying the bile to a white appearance both visually and radiographically. Calcium accumulating in the wall of the gallbladder secondary to chronic cystic duct obstruction may produce the “porcelain gallbladder.” This condition appears secondary to chronic cholecystitis and in adults leads to carcinoma in up to 50% of cases.¹⁸³ Courvoisier gallbladder is a markedly enlarged gallbladder secondary to chronic, often malignant obstruction of the common bile duct.¹⁸⁴ This condition is unusual in adults and has not been reported in children.

90,000 Causes of cholecystitis – Clinic Health 365, Yekaterinburg

The gallbladder is a small, pear-shaped organ located directly under the liver on the right side of the abdomen.

A fluid accumulates in the gallbladder – bile, which is secreted into the lumen of the duodenum after eating to participate in the digestion process, especially after eating foods high in fat.

From the gallbladder, bile enters the intestines through a small cystic duct, connecting with the common hepatic duct, they form a common bile duct – the common bile duct.

Cholecystitis is an inflammation of the gallbladder. Cholecystitis can develop rapidly (acute cholecystitis) or gradually over time (chronic cholecystitis).

The cause of cholecystitis can be:

Gallstones . The overwhelming number of cases of cholecystitis is associated with blockage of the cystic duct by gallstones, resulting in stagnation of bile, leading to inflammation of the gallbladder.

Damage . Damage to the gallbladder, especially as a result of previous surgery or trauma to the abdominal cavity, can cause cholecystitis

Infection . Bile infection can lead to inflammation of the gallbladder.

Tumor . The tumor, squeezing the bile duct, can prevent the correct outflow of bile from the gallbladder, causing its stagnation and the occurrence of cholecystitis.

Risk factors for the development of cholecystitis

The following factors can increase the risk of cholecystitis:

Gallstones. Most cases of cholecystitis are due to the presence of gallstones. With gallstone disease, there is a high risk of developing the disease.

Prolonged labor. Prolonged labor can damage the gallbladder, increasing the chances of developing cholecystitis early after birth.

Traumatic injuries. Serious abdominal trauma can increase the risk of cholecystitis.

Diabetes. Uncompensated diabetes can damage the gallbladder and increase the risk of cholecystitis.

Related articles:

Abdominal pain

Pain in the lower abdomen

Appendicitis

Ultrasound of the abdominal cavity

Videoesophagogastroduodenoscopy (FGS)

MR – cholangiography (see.MRI of the abdominal cavity)

Gallbladder

Stomach ulcer

Gastritis

Pancreatitis

Pancreas

Irritable bowel syndrome (IBS)

Gastroesophageal reflux disease (GERD)

Ulcerative colitis

Crohn’s disease.

Gastroenteritis

Cholecystitis: signs, symptoms, treatment – MedCom

Causes of the disease

Cholecystitis can be triggered by factors of infectious and non-infectious origin.Cases of cholecystitis have become widespread during the penetration and multiplication of colonies in the gallbladder of pathogenic microorganisms – here E. coli, streptococci, staphylococci, enterococci are active. The infection can enter the organ through the blood or lymph from other foci of chronic inflammation. In this case, the treatment of cholecystitis is carried out using antibiotics.

The reasons for the development of cholecystitis that are not associated with infection include:

Penetration of pancreatic enzymes into the gallbladder.
Hormonal disorders.
Formation of stones in the bile ducts.
Congenital pathologies.
Obesity.
Diabetes mellitus.
Helminthic invasions.
Hypertension, which contributes to the deterioration of the blood supply to the organ.
Stretching the walls of the bladder.

Non-observance of a healthy lifestyle can become the main provoking factor. Violations in the diet or the predominance of spicy, fatty, spicy foods in the diet leads to a change in the qualitative composition of bile and an increase in the likelihood of symptoms of cholecystitis.A provoking factor can be pregnancy, during which the enlarging uterus compresses the gallbladder, as well as organ injuries.

Symptoms of cholecystitis

Signs of cholecystitis in most cases begin to appear already at the earliest stages. The first symptoms of cholecystitis may appear after a sharp change in the usual diet, drinking a lot of alcohol or severe stress. Initially, a person begins to worry about pain in the upper abdomen, which spreads to the area under the right rib.The severity of pain can be different, with a sharp change from paroxysmal sensations to pulling and gradually increasing. With cholecystitis, a very sharp pain resembles biliary colic.

A bitter or metallic taste appears in the oral cavity, excessive dryness, nausea, flatulence, unpleasant belching. The skin and sclera gradually acquire a yellowish tint, and with the development of the pathological process, the body temperature rises. The acute period with cholecystitis can last from 5-10 days to a month.In the absence of stones and localized purulent foci, cholecystitis can be treated rather quickly.

If symptoms are ignored, the disease flows into a chronic process. It is characterized by periods of exacerbation and remission, during which the symptoms do not bother the person. The frequency of acute manifestations of the disease will depend on adherence to diet and treatment recommendations.

Diagnostic Methods

After the first signs of the disease appear, you should seek help from a gastroenterologist.A preliminary diagnosis is made by the attending physician based on the patient’s complaints, taking into account the nature of the described pain, the frequency of their manifestation and other symptoms.

It is possible to reliably confirm the diagnosis and determine the methods of treatment after a complete diagnosis:

Investigation of a blood test in a laboratory. With cholecystitis, especially in the acute period, ESR levels will be increased, and neutrophilic leukocytosis will also be detected.
ultrasound. The examination allows you to visually assess the changes in the organ.The doctor establishes the shape of the organ, the thickness of the walls and its dimensions, assesses the contractile function and the number of dense formations, if any. At advanced stages with cholecystitis, you can notice organ deformation and thickening of the walls.
Probing, during which three portions of bile are taken. With the help of further microscopic examination, the bile consistency and color are assessed. At this stage, the pathogen that is the cause of the infectious process is also determined.This will determine how to treat cholecystitis and which drugs will be more effective.
X-ray contrast method – allows you to assess the degree of impairment of the motor function of an organ.

In doubtful cases, the patient may be assigned additional diagnostic examinations.

Treatment of pathology

The treatment of cholecystitis is based on an integrated approach based on adherence to a specially selected diet, taking medications, flushing the ducts and physiotherapeutic measures.Diet therapy is indicated for cholecystitis at all stages of the disease and consists in fractional nutrition, as well as the use of products baked, boiled or stewed. During treatment, it is necessary to observe the intervals between meals, avoiding large gaps in time.

For the treatment of pain attacks with cholecystitis, the doctor prescribes antispasmodics and pain relievers. If, according to the results of the diagnosis, it was possible to identify the presence of infectious agents-pathogens, then an antibacterial drug will be selected based on their type.After the relief of the acute condition with cholecystitis, the patient is prescribed drugs to stimulate the process of bile formation and its outflow from the organ.

Physiotherapy can be prescribed to restore the tone of the gallbladder: UHF, electrophoresis. Forced release of the gallbladder with cholecystitis is performed by flushing, for which the probe and probeless method is used. With the ineffectiveness of conservative treatment methods that do not allow to eliminate acute symptoms, the patient is asked about the need for surgical intervention.

A favorable prognosis after the treatment of cholecystitis awaits those patients who responsibly followed the recommendations of the attending physician and supported the diet.

Regional State Budgetary Healthcare Institution “Graivoron Central District Hospital”

Wednesday,
6
June
2018

Cholelithiasis

Cholelithiasis – a disease of the gallbladder and bile ducts with the formation of stones.Although, the correct name of the medical term is as “gallstone disease” – ICD-10 code: K80. The disease is complicated by defective liver function, hepatic colic, cholecystitis (inflammation of the gallbladder) and may be obstructive jaundice with the need for a surgical operation to remove the gallbladder.

Today we will consider the causes, symptoms, signs, exacerbation, what to do with an attack of pain, when an operation is needed. Let’s especially talk about the nutrition of patients (diet), the menu, what foods can and cannot be eaten during treatment without surgery and after it.

What is it?

Cholelithiasis is a pathological process in which stones (calculi) form in the gallbladder and ducts. Due to the formation of stones in the gallbladder, the patient develops cholecystitis.

How gallstones are formed

The gallbladder is a reservoir for bile produced by the liver. The movement of bile along the biliary tract is provided due to the coordinated activity of the liver, gallbladder, common bile duct, pancreas, duodenum.This ensures the timely flow of bile into the intestines during digestion and its accumulation in the gallbladder on an empty stomach.

The formation of stones in it occurs due to changes in the composition and stagnation of bile (dyscholia), inflammatory processes, motor-tonic disorders of bile secretion (dyskinesia).

There are cholesterol (up to 80-90% of all gallstones), pigmented and mixed stones.

The formation of cholesterol stones is facilitated by the oversaturation of bile with cholesterol, its precipitation, the formation of cholesterol crystals.With impaired motility of the gallbladder, crystals are not excreted into the intestine, but remain and begin to grow.
Pigmented (bilirubin) stones appear as a result of increased breakdown of red blood cells in hemolytic anemia.
Mixed stones are a combination of both shapes. Contains calcium, bilirubin, cholesterol.

Occur mainly in inflammatory diseases of the gallbladder and biliary tract.

Risk factors

There are several reasons for the occurrence of gallstone disease:

excessive secretion of cholesterol in bile

Decreased secretion of phospholipids and bile acids into bile

stagnation of bile

biliary tract infection

· hemolytic diseases.

Most gallstones are mixed. They include cholesterol, bilirubin, bile acids, proteins, glycoproteins, various salts, trace elements. Cholesterol stones contain mainly cholesterol, have a round or oval shape, layered structure, a diameter of 4-5 to 12-15 mm, localized in the gallbladder.

Cholesterol-pigment-calcareous stones – multiple, have edges, the shape is different. They vary considerably in number – tens, hundreds and even thousands.
Pigmented stones – small, multiple, hard, fragile, completely homogeneous, black with a metallic shade, located both in the gallbladder and in the bile ducts.
Calcium stones are composed of various calcium salts, bizarre shape, have spike-like processes, light or dark brown in color.

Epidemiology

According to numerous publications during the XX century, especially in the second half of it, there was a rapid increase in the prevalence of cholesterol, mainly in industrialized countries, including Russia.

So, according to a number of authors, the incidence of cholelithiasis in the former USSR increased almost twice every 10 years, and stones in the bile ducts were detected at autopsies in every tenth deceased, regardless of the cause of death. At the end of the 20th century, more than 5 million were registered in the Federal Republic of Germany, and in the United States more than 15 million patients with cholelithiasis, and about 10% of the adult population suffered from this disease. According to medical statistics, cholelithiasis occurs in women much more often than in men (ratio from 3: 1 to 8: 1), and with age, the number of patients increases significantly and after 70 years it reaches 30% or more in the population.

Increasing surgical activity for cholelithiasis during the second half of the 20th century led to the fact that in many countries the frequency of operations on the biliary tract surpassed the number of other abdominal operations (including appendectomy). So, in the USA in the 70s, more than 250 thousand cholecystectomies were performed annually, in the 80s – more than 400 thousand, and in the 90s – up to 500 thousand

Classification

Based on the characteristics of the disease adopted today, its following classification is distinguished in accordance with the stages that are relevant for it:

Stone formation – a stage that is also defined as latent stone carriage.In this case, there are no symptoms of gallstone disease, however, the use of instrumental diagnostic methods allows us to determine the presence of stones in the gallbladder;
Physicochemical (initial) stage – or, as it is also called, the pre-stone stage. It is characterized by changes in the composition of bile. There are no special clinical manifestations at this stage, the detection of the disease at the initial stage is possible, for which a biochemical analysis of bile is used for the peculiarities of its composition;
Clinical manifestations – a stage, the symptoms of which indicate the development of an acute or chronic form of calculous cholecystitis.

In some cases, the fourth stage is also distinguished, which consists in the development of complications accompanying the disease.

Symptoms of gallstone disease

In principle, gallstone disease can proceed for a very long time without any symptoms or manifestations. This is due to the fact that the stones in the early stages are small, do not clog the bile duct and do not injure the walls. The patient may for a long time be completely unaware of the presence of this problem.In these cases, they usually talk about stonework. When the actual gallstone disease makes itself felt, it can manifest itself in different ways.

Among the first symptoms of the disease should be noted the heaviness in the abdomen after eating, stool disturbances (especially after eating fatty foods), nausea and moderate jaundice. These symptoms may appear even before severe pain in the right hypochondrium – the main symptom of cholelithiasis. They are explained by unexpressed violations of the outflow of bile, which is why the digestion process is worse.

The following symptoms and signs are most common for gallstone disease:

Temperature rise. A rise in temperature usually indicates acute cholecystitis, which often accompanies gallstone disease. An intense inflammatory process in the right hypochondrium leads to the release of active substances into the blood that contribute to a rise in temperature. Prolonged pain after colic with the addition of fever almost always speaks of acute cholecystitis or other complications of the disease.A periodic rise in temperature (wave-like) with a rise above 38 degrees may indicate cholangitis. However, in general, fever is not an obligatory symptom in cholelithiasis. The temperature may remain normal even after severe lingering colic.
Pain in the right hypochondrium. The most typical manifestation of gallstone disease is the so-called biliary (biliary, hepatic) colic. This is an attack of acute pain, which in most cases is localized at the intersection of the right costal arch and the right edge of the rectus abdominis muscle.The duration of an attack can vary from 10 to 15 minutes to several hours. At this time, the pain can be very strong, give to the right shoulder, back or other areas of the abdomen. If the attack lasts more than 5-6 hours, then you should think about possible complications. The frequency of seizures varies. It often takes about a year between the first and second seizures. However, in general, they become more frequent over time.
Fat intolerance. In the human body, bile is responsible for the emulsification (dissolution) of fats in the intestine, which is necessary for their normal breakdown, absorption and assimilation.In gallstones, stones in the neck or bile duct often block the path of bile to the intestines. As a result, fatty foods do not break down normally and cause intestinal disturbances. These disorders can manifest themselves as diarrhea (diarrhea), flatulence in the intestines (flatulence), and mild abdominal pain. All these symptoms are non-specific and can occur in various diseases of the gastrointestinal tract (gastrointestinal tract). Intolerance to fatty foods can also occur at the stage of stone bearing, when other symptoms of the disease are still absent.At the same time, even a large stone located at the bottom of the gallbladder may not block the outflow of bile, and fatty foods will be digested normally.
Jaundice. Jaundice occurs due to stagnation of bile. The pigment bilirubin is responsible for its appearance, which is normally excreted with bile into the intestine, and from there it is excreted from the body with feces. Bilirubin is a natural metabolic product. If it ceases to be secreted with bile, then it accumulates in the blood.So it spreads throughout the body and accumulates in the tissues, giving them a characteristic yellowish tint. Most often, in patients, the sclera of the eyes turn yellow first, and only then the skin. In light people, this symptom is noticeable better, and in dark-skinned people, unexpressed jaundice can be missed even by an experienced doctor. Often, simultaneously with the onset of jaundice, the urine also darkens in patients (dark yellow, but not brown). This is because the pigment begins to be excreted from the body through the kidneys. Jaundice is not an obligatory symptom in calculous cholecystitis.Also, it does not appear only with this disease. Bilirubin can also accumulate in the blood during hepatitis, liver cirrhosis, some hematological diseases or poisoning.

In general, the symptoms of gallstone disease can be quite varied. There are various stool disorders, atypical pains, nausea, periodic bouts of vomiting. Most doctors are aware of this variety of symptoms, and just in case they prescribe an ultrasound of the gallbladder to exclude gallstone disease.

Attack of gallstone disease

An attack of gallstone disease usually means biliary colic, which is the most acute and typical manifestation of the disease. Stone carriage does not cause any symptoms or disorders, and patients usually do not attach importance to unexpressed digestive disorders. Thus, the disease is latent (hidden).

Biliary colic usually appears suddenly. It is caused by a spasm of smooth muscles located in the walls of the gallbladder.Sometimes the mucous membrane is also damaged. This most often occurs when a stone is displaced and gets stuck in the neck of the bladder. Here it blocks the outflow of bile, and bile from the liver does not accumulate in the bladder, but flows directly into the intestines.

Thus, an attack of gallstone disease is usually manifested by characteristic pains in the right hypochondrium. In parallel, the patient may experience nausea and vomiting. Often, an attack occurs after sudden movements or exertion, or after eating a large amount of fatty foods.Once during an exacerbation, stool discoloration may be observed. This is due to the fact that pigmented (colored) bile from the gallbladder does not enter the intestines. Bile from the liver flows down only in small quantities and does not give an intense color. This symptom is called acholia. In general, the most typical manifestation of an attack of gallstone disease is characteristic pain, which will be described below.

Diagnostics

Identification of symptoms characteristic of hepatic colic requires specialist advice.Under the physical examination, he carried out, means the identification of symptoms characteristic of the presence of stones in the gallbladder (Murphy, Ortner, Zakharyin). In addition, a certain tension and soreness of the skin in the area of the muscles of the abdominal wall within the projection of the gallbladder is revealed. The presence of xanthomas on the skin (yellow spots on the skin formed against the background of lipid metabolism disturbances in the body) is also noted, yellowness of the skin and sclera is noted.

The results of a general blood test determine the presence of signs indicating nonspecific inflammation at the stage of clinical exacerbation, which in particular consist in a moderate increase in ESR and in leukocytosis.A biochemical blood test determines hypercholesterolemia, as well as hyperbilirubinemia and increased activity characteristic of alkaline phosphatase.

Cholecystography, used as a method for diagnosing gallstone disease, determines the enlargement of the gallbladder, as well as the presence of calcareous inclusions in the walls. In addition, in this case, the stones with lime inside are clearly visible.

The most informative method, which is also the most common in the study of the area of interest to us and for the disease in particular, is an ultrasound of the abdominal cavity.When examining the abdominal cavity, in this case, accuracy is ensured regarding the detection of certain echo-tight formations in the form of stones in combination with pathological deformations that the bladder walls undergo during the disease, as well as with changes that are relevant in its motility. Signs indicating cholecystitis are also clearly visible on ultrasound.

Imaging of the gallbladder and ducts can also be performed using MRI and CT techniques for this purpose in the specified areas.Scintigraphy, as well as endoscopic retrograde cholangiopancreatography, can be used as an informative method indicating disturbances in the processes of bile circulation.

Diet for cholelithiasis

It is necessary to limit or exclude from the diet fatty, high-calorie, cholesterol-rich dishes, especially with a hereditary predisposition to cholelithiasis. Food should be frequent (4-6 times a day), in small portions, which helps to reduce the stagnation of bile in the gallbladder.The food should contain a sufficient amount of dietary fiber, due to vegetables and fruits. You can add food bran (15 g 2-3 times a day). This reduces the lithogenicity (tendency to stone formation) of bile.

The therapeutic diet for cholelithiasis lasts from 1 to 2 years. Compliance with a diet is the best prevention of exacerbations of gallstone pathology, and if you do not adhere to it, then severe complications may develop.

The consequences of non-compliance include: the occurrence of atherosclerosis, the appearance of constipation, dangerous with stones in the bladder, an increase in the load on the gastrointestinal tract and an increase in the density of bile.A therapeutic diet will help to cope with excess weight, improve the intestinal microflora and protect the immune system. As a result, a person’s mood improves, sleep is normalized.

In severe cases, non-compliance with the diet leads to ulcers, gastritis, colitis. If you want to recover from pathology without surgery, then diet is the primary requirement.

Operation

Patients should undergo elective surgery before or immediately after the first biliary colic. This is due to the high risk of complications.

After surgical treatment, it is necessary to observe an individual dietary regimen (frequent, fractional meals with restriction or exclusion of individually intolerable foods, fatty, fried foods), adherence to work and rest, physical education. Eliminate alcohol consumption. It is possible to have a spa treatment after the operation, provided that the remission is stable.

Complications

The appearance of stones is fraught not only with dysfunction of organs, but also with the occurrence of inflammatory changes in the gallbladder and organs located nearby.So, due to stones, the walls of the bladder can be injured, which, in turn, provokes the onset of inflammation. Provided that the stones pass through the cystic duct with bile from the gallbladder, the outflow of bile may be difficult. In the most severe cases, stones can block the entry and exit of the gallbladder, becoming stuck in it. With such phenomena, bile stagnation occurs, and this is a prerequisite for the development of inflammation. The inflammatory process can develop over several hours and over several days.

Under such conditions, the patient may develop an acute inflammatory process of the gallbladder. Moreover, both the degree of damage and the rate of development of inflammation can be different. So, both minor edema of the wall and its destruction and, as a result, rupture of the gallbladder are possible. Such complications of gallstone disease are life-threatening. If the inflammation spreads to the abdominal organs and to the peritoneum, then the patient develops peritonitis. As a result, the complication of these phenomena can be infectious-toxic shock and multiple organ failure.In this case, there is a violation of the work of blood vessels, kidneys, heart, brain. With severe inflammation and high toxicity of microbes multiplying in the affected wall of the gallbladder, an infectious-toxic shock can appear immediately.

In this case, even resuscitation measures do not guarantee that the patient will be able to get out of this state and avoid death.

Prevention

For the prevention of the disease, it is useful to carry out the following measures:

· do not practice prolonged therapeutic fasting;

· for the prevention of gallstone disease, it is useful to drink enough liquid, at least 1.5L per day;

· in order not to provoke the movement of stones, avoid work associated with a prolonged stay in an inclined position;

· follow a diet, normalize body weight;

· increase physical activity, give the body more movement;

· eat more often, every 3-4 hours, to cause regular emptying of the bladder from accumulated bile;

· Women should limit the intake of estrogen, this hormone promotes the formation of stones or their increase.

For the prevention and treatment of cholelithiasis, it is useful to include in the daily diet a small amount (1-2 tsp.) Of vegetable oil, preferably olive oil. Sunflower is digested only by 80%, while olive oil is completely digestible. In addition, it is more suitable for frying because it produces fewer phenolic compounds.

The intake of vegetable fat stimulates the activity of the bile bladder, as a result of which it is able to empty itself at least once a day, preventing congestion and the formation of stones.

To normalize metabolism and prevent gallstone disease, magnesium should be included in the diet. The trace element stimulates intestinal motility and bile production, removes cholesterol. In addition, an adequate supply of zinc is required for the production of bile enzymes.

In case of cholelithiasis, it is better to stop drinking coffee. The drink stimulates the bladder to contract, which can cause a blockage in the duct and subsequent seizure.

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Eating improperly, you deprive yourself of immunity and a harmonious physique, in return for health problems, premature aging and a high risk of early death.

Cholecystitis symptoms and treatment in adults

Cholecystitis is the general name for a group of diseases that lead to the development of inflammatory processes in the gallbladder.The main sign of pathological changes in the tissues of the organ is systematic pain in the right hypochondrium. Cholecystitis occurs in men and women of all age groups. Risk factors are alcohol abuse, an unbalanced diet, and stressful situations. Children and adults with signs of cholecystitis will need advice from a gastroenterologist, nutritionist and therapist.

The reasons for the development of pathology

The foci of inflammation in the gallbladder are formed under the influence of pathogenic microflora or stagnation of bile.In the first case, viruses or bacteria enter the organ through sources of chronic infection (oral cavity, nasopharynx) or directly from the intestine. The causative agents of the disease are staphylococci, streptococci or hepatitis C and B viruses.

The reasons for the stagnation of bile remain:

gallstone disease;
violation of the patency of the biliary tract;
congenital malformations or malformations;
chronic pathologies of the gastrointestinal tract.

The risk of developing cholecystitis increases against the background of a hereditary predisposition of a person to inflammation of the gallbladder. In a similar way, the systematic use of alcohol and tobacco smoking affects the organ. Hormonal changes in a woman’s body during pregnancy or menopause remain a significant risk factor for disrupting the normal functioning of the gallbladder.

Types of inflammatory processes in the gallbladder

Gastroenterologists use several reasons to classify cholecystitis.Among them:

presence or absence of calculi (stones) in the lumen of the gallbladder;
severity of destructive changes in the tissues of the organ;
the severity of the patient’s symptoms of cholecystitis.

In the first case, doctors distinguish calculous (with the deposition of stones) and non-calculous cholecystitis. Concrements are detected in 90% of patients who are faced with an inflammatory process in the gallbladder. Non-calculous cholecystitis, characterized by the absence of stones, is characterized by rare exacerbations and a favorable prognosis when choosing conservative treatment methods.

The severity of symptoms and destructive changes allows doctors to identify acute and chronic types of the disease. In the first case, the patient is faced with a sharp manifestation of symptoms, acute pain syndrome, intoxication of the body. The chronic form of cholecystitis can be almost asymptomatic. Pain is rare and of low intensity.

According to the severity of the clinical picture of the disease, mild, moderate and severe forms of cholecystitis are distinguished.The main difference between the two is the duration and frequency of pain in patients.

Symptoms of pathology

Chronic cholecystitis is characterized by an undulating course. Attacks of pain of varying intensity occur in the right hypochondrium.The pain syndrome is of an irradiating nature – the shoulder, scapula or collarbone become secondary foci. An increase in discomfort occurs after a meal by the patient or against the background of moderate physical exertion.

Other symptoms of cholecystitis include:

general weakness;
increase in body temperature;
systematic bouts of nausea;
Regular vomiting with impurities of bile.

Against the background of intoxication of the body, tachycardia, shortness of breath, hypotension are manifested.The presence of stones in the lumen of the gallbladder leads to yellowness of the skin of patients and intense itching.

Do you have symptoms of cholecystitis?

Only a doctor can accurately diagnose the disease.
Do not delay the consultation – call by phone

+7 (495) 775-73-60

Diagnostic measures

The main difficulty for the gastroenterologist is determining the type and nature of the patient’s cholecystitis.The patient needs to visit a gastroenterologist. During the history and physical examination, the doctor will make a preliminary diagnosis. The strategy for the treatment of cholecystitis is developed after the gastroenterologist receives the results of the following studies:

As an additional test, the doctor may refer you to a computed tomography scan of the abdomen.

Cholecystitis treatment

Onconservative treatment of acute and chronic cholecystitis, not complicated by stones, is based on the patient’s diet and medication.Diet with cholecystitis involves switching to boiled or stewed dishes. The break between meals should not exceed 4 hours.

Medication therapy includes pain relievers and antispasmodics. If pathogenic microflora is found in the patient’s biomaterials, the doctor may insist on the use of antibiotics.

Physiotherapy is designed to restore the tone of the gallbladder. Patients receive referrals for electrophoresis, inductometry and UHF.

Surgical intervention is performed against the background of advanced cholecystitis.Removal of the gallbladder is performed during abdominal or laparoscopic surgery. In the first case, the surgeon is able to assess the condition of the adjacent organs and tissues. In the second, doctors use endoscopes that minimize the time needed to fully restore the patient’s working capacity.

Statistics

Cholecystitis is the most common abdominal pathology.It accounts for up to 12% of clinically reported cases. Concrements are found in 60-95% of people suffering from inflammation of the gallbladder.

Cholecystitis develops more often in women: signs of the disease are found in girls 4-6 times more often than in men. Up to 75% of those with a chronic or acute type of disease belong to the 45-60 age group.

Questions and Answers

Answers to frequently asked questions:

Vinogradov

Dmitry Alekseevich

Work experience 5 years

Do you have any questions? Leave a word and sign up for a consultation

Is cholecystitis dangerous for the life of patients?

Dmitry A. Vinogradov

Gastroenterologist

The greatest danger to human life is not the disease itself, but its possible complications.So, intoxication of the body can lead to multiple organ failure. In the absence of medical care, the patient may not survive the onset of an exacerbation

Are there effective remedies for disease prevention?

Dmitry A. Vinogradov

Gastroenterologist

Patients at risk should follow the recommendations of the gastroenterologist regarding the daily diet.Refusal from alcoholic beverages and tobacco products will positively affect the time intervals between attacks of chronic cholecystitis.

Is surgery on the background of cholecystitis dangerous?

Dmitry A. Vinogradov

Gastroenterologist

Patients who experience gallbladder removal retain their original quality of life.A timely operation eliminates the likelihood of complications that can threaten the life of a child or an adult.

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Diagnostics

LISOD uses methods that meet international medical standards to diagnose gallbladder cancer.

Laboratory research is carried out in a clinical laboratory equipped with modern equipment.A special spectral system is used for diagnostics, which allows obtaining results with high accuracy. Elevated bilirubin levels indicate liver or gallbladder disease, including gallbladder cancer. Alkaline phosphatase and aspartate aminotransferase levels also help detect gallbladder disease.
Ultrasound allows not only to detect the tumor, but also its spread to the walls of the gallbladder and the liver. This method is especially effective when used during endoscopy or laparoscopy.This technique makes it possible to examine the gallbladder at close range.
Computed tomography (CT) is used for both primary diagnosis and tumor staging. In addition, the condition of the pancreas and liver is being clarified. This allows LISOD specialists to properly plan surgical treatment.
Cholangiography (contrast examination of the bile ducts) also helps in the diagnosis of gallbladder tumors.
Laparoscopy. A laparoscope is inserted through a small incision in the anterior abdominal wall into the abdominal cavity to examine internal organs, including the gallbladder. During this study, a biopsy is done (taking a suspicious area of tissue for microscopic examination) and the stage (extent) of the tumor is specified.
At LISOD, when carrying out such operations, modern endoscopic and laparoscopic equipment is used, which is operated by leading specialists – endoscopic surgeons who are proficient in these techniques (both diagnostics and performing surgical interventions in full).The laparoscopic method allows you to make an accurate and correct diagnosis, determine the volume and stage of the process, and choose the tactics of treatment.

Conducting a comprehensive examination enables LISOD specialists to confirm or deny a diagnosis of gallbladder cancer.

Treatment

Consultants of the LISOD Information Service will provide you with full information on the diagnosis and treatment of this type of cancer:

0-800-500-110 (toll-free for calls to
from landline phones in Ukraine)
or +38 044 520 94 00 – daily
from 08:00 to 20:00.

The surgical method is the main one in the treatment of gallbladder cancer.

For cancer of the gallbladder, cholecystectomy is performed – surgical removal of the gallbladder and surrounding tissues. Removal of regional (adjacent) lymph nodes is also possible. For surgical interventions on the gallbladder in LISOD, the laparoscopic method is used. Laparoscopy of the gallbladder is that through small incisions (0.5 – 1.5 cm) with a special optical device, a laparoscope (a telescopic tube containing a lens system and attached to a video camera), penetrate into the abdominal cavity. Thus, on the monitor screen, the surgeon sees the operating field and has the ability to excise the neoplasm with very thin special instruments. Then the excised tissue is placed in special container bags and removed. Laparoscopy of the gallbladder is a low-traumatic method, it is more easily tolerated by patients, and there are fewer side reactions.

In case of inoperable cases, chemotherapy treatment is carried out, and sometimes, according to indications, radiotherapy is prescribed.

Symptoms

Common signs of gallbladder cancer are pain , liver enlargement , palpable tumor formation in the abdomen .Sometimes there is gastric dyspepsia , soreness in the gallbladder . The pain is localized in the right hypochondrium and epigastric region, radiates to the right shoulder. Similar pains are found in stone and tubeless cholecystitis. In most cases, gallbladder cancer is combined with gallstone disease and cholecystitis.

Due to blockage of the common bile duct, jaundice appears, which, unlike the blockage of the duct with a stone, develops without previous hepatic colic and fever.Anemia is rare, there is no noticeable weight loss.

Risk factors

Several risk factors are now known to increase the likelihood of gallbladder cancer. However, the presence of one or even several of these factors does not necessarily mean the development of cancer.

Stones of the gallbladder and its inflammation. 75-90% of patients with gallbladder tumors had stones or signs of chronic inflammation of this organ.People with large gallbladder stones were more likely to develop a tumor than people with several small stones. Keep in mind, however, that most people with gallbladder stones will never develop cancer.
“Porcelain” gallbladder. In patients with severe inflammation of the gallbladder, the walls of the gallbladder may be coated with calcium deposits, which significantly increases the risk of cancer. Therefore, we recommend removing such a gallbladder.
Typhoid fever.People infected with the bacterium salmonella, which causes typhoid fever, have a 6-fold increased risk of developing gallbladder cancer. However, typhoid fever is a rare disease.
Common bile duct cysts contain bile, may grow in size and contain areas of precancerous changes, which increases the risk of developing gallbladder cancer.
Smoking cigarettes also increases the risk of gallbladder cancer.
Occupational hazards.Rubber and metal workers are at increased risk of developing gallbladder cancer from exposure to certain chemicals, such as nitrosamines.
Malformations of the pancreatobiliary zone at the confluence of the ducts of the liver, gallbladder and pancreas increase the risk of developing gallbladder cancer.
Age. Most gallbladder cancer patients are over 70 years old.
Polyps of the gallbladder 1 cm in size and more often turn into a malignant tumor.Therefore, we recommend removing the gallbladder in this category of people.
Obesity is also a risk factor for gallbladder cancer.
Diet. High carbohydrate and low fiber levels increase the likelihood of gallbladder tumors.
Helicobacter pylori. The presence of such an infection increases the risk of developing both stomach and duodenal ulcers, as well as stones and gallbladder cancer.

Prevention

In most cases, it is impossible to prevent the development of gallbladder cancer.However, some risk factors can be avoided.

Maintaining a normal weight is one of the ways to reduce the risk of both cancer in this localization and other tumors (colon, prostate, uterus, kidney, breast).
Adequate fruit and vegetable intake and limiting animal fat intake may reduce the risk of gallbladder cancer.
Daily physical activity is another way to reduce the risk of gallbladder cancer.
Quitting smoking also reduces the risk of gallbladder cancer.
Treatment of gallbladder stones reduces the likelihood of chronic inflammation and the risk of cancer.

Questions and Answers

The section publishes questions from patients and the answers of our specialists. Each person’s question concerns a specific problem related to their illness.The patients are answered by Israeli clinical oncologists and the chief physician of LISOD, MD, professor Alla Vinnitskaya.

Experts’ answers are based on knowledge of the principles of evidence-based medicine and professional experience. The answers correspond exclusively to the information provided, are for informational purposes only and do not constitute a medical recommendation.

The main purpose of section is to provide information to the patient and family so that they can make a decision about the type of treatment with the treating physician.The proposed treatment tactics may differ from the principles stated in the answers of our specialists. Feel free to ask your doctor about the reasons for the differences. You need to make sure you are getting the right treatment.

Hello.My mother is 50 years old. In 2004, the diagnosis of pulmonary sarcoidosis and diabetes mellitus was confirmed. Recently, her condition has worsened greatly. For one month, doctors could not make a diagnosis, except for “diabetes mellitus” (they performed five ultrasound scans, three tomography scans, and many other tests). On the basis of the last tomography with contrast, the diagnosis was made – gallbladder cancer of the fourth stage with metastases to the liver and retroperitoneal lymph nodes. Alpha-fetoprotein – 0.5 U / ml; CA-19-9 – 4 units / ml. Can you please tell me if a blood test confirms the diagnosis of Stage Four Gallbladder Cancer? Is there any hope that the diagnosis was wrong?

This blood test does not confirm or exclude cancer.A biopsy is required to make a definitive diagnosis.

Hello! My husband (37 years old) was diagnosed with moderately differentiated adenocarcinoma of hepatic choledochus (Klatskin’s tumor, grade IV).Conclusion of the last CT scan (30.03.2012):. Secondary infiltration of liver segments. Signs of biliary hypertension. Portal hypertension. Hepatosplenomegaly. Phenomena of pelvic ascites. Secondary abdominal lymphadenopathy. Postoperative changes. She was prescribed chemotherapy with Xeloda and Gemzar drugs. Doctors give no hope of recovery. Can you please tell me if there is any chance of recovery?

Unfortunately, the disease is incurable at this stage.The chemotherapy was prescribed correctly.

Good afternoon.My father is 72 years old. On September 14, 2010, he was operated on (nothing was done). Diagnosis – cancer of the common bile duct, grade 4 (the tumor blocked the bile duct). Metastases in the small pelvis. A concomitant disease is a stomach ulcer. No pain. At discharge, bilirubin is 290. How can I help my father, perhaps there are foods, herbs, medications that will reduce the swelling. It hurts to understand that you are losing a very dear person.
Thank you in advance for your attention and help.
Svetlana

Unfortunately, if the diagnosis is correct, this tumor does not respond well to treatment.If the patient’s condition allows, then you can try chemotherapy with Xeloda or Gemcitabine. In the first place, it is necessary to ensure the outflow of bile; this can be done either surgically, endoscopically, or by percutaneous drainage of the biliary tract (if possible).

Cholelithiasis

Gallstone disease is the formation of stones (calculi) in the gallbladder, bile ducts.Gallstones lead to the development of cholecystitis. With an uncomplicated course of the disease, conservative methods of therapy are used. If, with the help of RCPG with EPST, it is not possible to extract the calculus from the bile duct (common bile duct), then surgical treatment is indicated.

Epidemiology

According to numerous publications, during the 20th century, especially in the second half of it, there was a rapid increase in the prevalence of gallstone disease, mainly in industrialized countries, including Russia.So, according to a number of authors, the incidence of cholelithiasis in the former USSR increased almost twice every 10 years, and stones in the biliary tract were detected at autopsies in every tenth deceased, regardless of the cause of death. At the end of the 20th century, more than 5 million were registered in the Federal Republic of Germany, and in the United States more than 15 million patients with cholelithiasis, and about 10% of the adult population suffered from this disease. According to medical statistics, cholelithiasis occurs in women much more often than in men (ratio from 3: 1 to 8: 1), and with age, the number of patients increases significantly and after 70 years it reaches 30% or more in the population.The increasing surgical activity for cholelithiasis, observed during the second half of the 20th century, led to the fact that in many countries the frequency of operations on the biliary tract surpassed the number of other abdominal operations (including appendectomy). So, in the USA in the 70s, more than 250 thousand cholecystectomies were performed annually, in the 80s – more than 400 thousand, and in the 90s – up to 500 thousand.

Etiology

The etiology of gallstone disease cannot be considered sufficiently studied. Only exogenous and endogenous factors are known that increase the likelihood of its occurrence.Endogenous factors include, first of all, gender and age. According to the majority of both domestic and foreign statistics, women, as already mentioned, suffer from cholelithiasis 3-5 times more often than men, and according to some authors, even 8-15 times. At the same time, stones are especially often formed in women who have multiparous.

Gallstones have been described in children even in the first months of life, however, gallstones are extremely rare in childhood. With age, the prevalence of cholelithiasis increases and becomes maximum after 70 years, when the frequency of detection of gall stones at autopsies in persons who died from various causes reaches 30 percent or even more.

The constitutional factor also seems to play a significant role. So, gallstone disease, undoubtedly, is more common in persons of a pycnic physique, prone to obesity. Overweight is observed in approximately 2/3 of patients. Some congenital anomalies that impede the outflow of bile, for example, stenoses and cysts of hepaticocholedochus, parapapillary diverticula of the duodenum, contribute to the development of gallstone disease, and from acquired diseases – chronic hepatitis with an outcome in liver cirrhosis.Diseases characterized by increased breakdown of erythrocytes, for example, hemolytic anemia, are of some importance in the formation of mainly pigment stones, although small pigmented stones formed in most patients are usually not accompanied by clinical manifestations typical for cholelithiasis.

Of the exogenous factors, the main role is apparently played by the dietary habits associated with the geographic, national and economic characteristics of the life of the population.The increase in the prevalence of cholesterol during the 20th century, mainly in economically developed countries, is explained by most authors by an increase in the consumption of food rich in fat and animal proteins. At the same time, in economically prosperous Japan, due to national dietary habits, cholelithiasis occurs several times less frequently than in developed countries of Europe, the USA or Russia. It is extremely rare for gallstones to occur in poor tropical countries, India, Southeast Asia, where the population feeds mainly on plant foods and often suffers from malnutrition.

Pathogenesis

The initial process of gallstone formation is the formation of putty bile (biliary sludge). In 80-85% of cases, the biliary sludge disappears, but most often it returns again. The reason for the appearance of biliary sludge are: pregnancy, taking hormonal drugs, a sharp decrease in body weight, etc. But in some situations it is necessary to take medications, which is decided individually in each case. Gallstones are formed from the basic elements of bile.Normal bile secreted by hepatocytes, in an amount of 500-1000 ml per day, is a complex colloidal solution with a specific gravity of 1.01 g / cm³, containing up to 97% water. The dry residue of bile consists primarily of bile acid salts, which ensure the stability of the colloidal state of bile, play a regulatory role in the secretion of its other elements, in particular cholesterol, and are almost completely absorbed in the intestine during enterohepatic circulation.

Distinguish between cholesterol, pigment, calcareous and mixed stones.Single-component calculi are relatively rare. The overwhelming majority of stones have a mixed composition with a predominance of cholesterol. They contain over 90% cholesterol, 2-3% calcium salts and 3-5% pigments, and bilirubin is usually found in the form of a small core in the center of the calculus. Stones with a predominance of pigments often contain a significant admixture of calcareous salts, and they are called pigment-calcareous. The structure of stones can be crystalline, fibrous, layered or amorphous.Often, one patient in the biliary tract contains stones of various chemical composition and structure. The size of the stones varies greatly. Sometimes they are fine sand with particles less than a millimeter, in other cases one stone can occupy the entire cavity of an enlarged gallbladder and weigh up to 60-80 g. The shape of bile stones is also diverse. They are spherical, ovoid, multifaceted (faceted), barrel-shaped, subulate, etc.

To a certain extent, two types of stone formation in the bile ducts are conventionally distinguished:

primary
secondary

The formation of calculi in unchanged biliary tract is the beginning of a pathological process, which for a long time or throughout life may not cause significant functional disorders and clinical manifestations.Sometimes it causes violations of the patency of various parts of the biliary system and the addition of a chronic, prone to exacerbation of the infectious process, and, consequently, the clinic of gallstone disease and its complications.

Secondary stone formation occurs as a result of the fact that already during gallstones there are disturbances in the outflow of bile (cholestasis, biliary hypertension) due to obturation of the “narrow” places of the biliary system with primary stones (neck of the gallbladder, terminal section of choledochus), as well as secondary cicatricial stenosis , as a rule, localized in the same places, which contributes to the development of an ascending infection from the lumen of the gastrointestinal tract.If in the formation of primary stones the main role is played by violations of the composition and colloidal structure of bile, then secondary stones are the result of cholestasis and the associated infection of the bile system. Primary stones form almost exclusively in the gallbladder, where bile under normal conditions stagnates for a long time and is brought to a high concentration. Secondary calculi, in addition to the bladder, can also form in the bile ducts, including intrahepatic ones.

Primary cholesterol stones

The most studied is the process of formation of primary cholesterol stones, which in pure form or with small admixtures of bile pigments and calcium salts are most common, accounting for more than 75-80% of all calculi.Cholesterol synthesized by hepatocytes is insoluble in water and body fluids, therefore it enters the bile composition “packed” into colloidal particles – micelles, consisting of bile acid salts and partly lecithin, the molecules of which are oriented in such a way that their hydrophilic groups are turned outward, which provides the stability of the colloidal gel (solution), and the hydrophobic ones inside – to insoluble hydrophobic cholesterol molecules. In the composition of a micelle, there are 6 molecules of bile salts and 2 molecules of lecithin per 1 molecule of cholesterol, which increase the capacity of the micelle.If for one reason or another, for example, as a result of a violation of the synthesis of bile acids, observed with an excess of estrogens associated with pregnancy or the use of estrogenic contraceptives, bile acids are unable to ensure the formation of stable micelles, bile becomes lithogenic and cholesterol precipitates, which determines the appearance and growth of stones of the appropriate composition. With a normal content of bile salts, the instability of micelles and the lithogenicity of bile can be determined by both excessive synthesis and the release of cholesterol into bile, apparently observed in obesity: there is a relative deficiency of bile salts.

The formation of pigment calculi has been studied to a much lesser extent. Primary pigment stones are caused by disorders of pigment metabolism in various forms of hemolytic anemias. Often pigment stones are formed a second time in the presence of an infectious process in the biliary tract, including those associated with cholelithiasis. The causative agents of inflammation, primarily E. coli, synthesize the enzyme P-glucuronidase, which converts soluble conjugated bilirubin into unconjugated, precipitated.Primary pure calcareous stones are extremely rare and can form in hypercalcemia associated with hyperparathyroidism.

Secondary cholesterol stones

Secondary calcification of predominantly pigmented and, to a lesser extent, cholesterol stones usually occurs in infected bile ducts, and the source of calcium salts is mainly the secretion of the mucous glands of the outlet section of the gallbladder and inflammatory exudate.

Stones in the gallbladder, the specific gravity of which, as a rule, is less than one, are in a suspended (floating) state and cannot exert gravitational pressure on the walls of the bladder.Stones with a diameter of less than 2-3 mm are able to pass along the cystic duct into the common bile duct and then, together with the bile, into the duodenum. Larger stones can, under bile pressure, push through the cystic duct and the narrow terminal part of the common bile duct with difficulty, injuring the mucous membrane, which can lead to scarring and stenosis of these already narrow places of the biliary system. The obstruction of the outflow of any secretion, in particular of bile, in accordance with the general law of surgical pathology, always contributes to the emergence and progression of an ascending infection from the lumen of the gastrointestinal tract, which usually primarily develops in the gallbladder (cholecystitis).

Violation of the outflow of bile contributes to an increase in pressure in the biliary system and the development of secondary (biliary) pancreatitis.

Symptoms

In its pure form, the disease practically does not give symptoms, the first signs appear after 5-10 years. The only manifestation of the gallstone proper can be called jaundice, as well as an attack of biliary colic caused by the movement of a stone along the biliary tract. Sudden pain, an attack of colic occurs when the pressure in the gallbladder (more than 3000 Pa) or the bile duct (over 2700 Pa) increases due to an obstacle to the emptying of bile in the form of a stone.

All other symptoms are associated with concomitant diseases.