Acute Cholecystitis

Cholecystitis is the inflammation of the gallbladder, often due to the outward flow of bile being obstructed by a gallstone. The onset of acute cholecystis is sudden, with at least 95 per cent of cases involving gallstones (calculous cholecystitis).  

Causes

Some risk factors for acute calculous cholecystitis have been identified, encompassing:

·         Obesity and/or rapid weight loss;

·         Usage of certain drugs;

·         Compromised immune system, due to pre-existing medical conditions;

·         Pregnancy; and

·         Old age.

Disease pathway

The cystic duct is the channel through which bile flows into and out of the gallbladder.

When this is obstructed by a gallstone, in the case of calculous cholecystitis, the accumulation of bile inside the gallbladder results in irritation and pressure. This can, in turn, result in infection, perforation and inflammation, of the organ. Meanwhile, the flows of blood and lymph within the gallbladder are compromised. This can lead to cell necrosis.

The exact mechanism of acalculous cholecystitis (not involving gallstones) is unknown, although a number of theories exist.

Symptoms and diagnosis

A cholecystitis attack begins with excruciating pain in the right upper abdomen, which can last for over twelve hours. Usually, an attack abates in two to three days; completely resolving in a week. Other symptoms known to accompany the pain include:

·         Nausea;

·         Vomiting;

·         Stiffening of the right abdominal muscles; and

·         Fever.

Cholecystitis is diagnosed based on symptoms and the results of radiographic imaging. Ultrasound imaging is used to detect gallstones, as well as the presence of fluid around the gallbladder, or the thickening of its wall; all of which are symptomatic of acute cholecystitis.

Treatment

Patients with acute cholecystitis are usually hospitalized. They are advised not to eat or drink; instead, sustenance is given via a drip (intravenously).

A tube may be inserted into the stomach to suction excess fluid accumulating in the intestine. Antibiotics and pain relievers are also administered intravenously.

The gallbladder is removed by surgery (cholecystomy). If the attack subsides without further complications, surgery can be deferred for up to several weeks.

In cases where abscesses, gangrene or necrosis are present, or the gallbladder has been perforated, immediate cholecystomy is required.

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

Neural Therapy:

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

Recommendation: No recommendation (There is insufficient evidence to support claims that neural therapy helps to treat cholecystitis. More research is needed.)

Grade of Evidence: very low quality of evidence