Acute Cholecystitis

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1- Introduction

2- Anatomical Overview

3- Treatment

4- purposes 

Introduction

Acute cholecystitis is a sudden inflammation of the gallbladder, a small organ located beneath the liver. This condition is often caused by gallstones blocking the cystic duct, leading to pain, swelling, and potentially serious complications. Symptoms include severe abdominal pain, nausea, vomiting, and fever.

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Anatomical Overview

Acute cholecystitis produces discomfort in the right upper quadrant or epigastrium. Inflammation of the gallbladder may cause irritation of the subdiaphragmatic parietal peritoneum, which is supplied in part by the phrenic nerve (C3, 4, and 5). This may give rise to referred pain over the shoulder, because the skin in this area is supplied by the supraclavicular nerves (C3 and 4). 

Before attempting a cholecystectomy operation, the surgeon must be aware of the many variations in the arterial supply to the gallbladder and the relationship of the vessels to the bile ducts. Unfortunately, there have been several reported cases in which the common hepatic duct or the main bile ducthave been included in the arterial ligature with disastrous consequences.

Unlike the appendix, which has a single arterial supply, the gallbladder rarely becomes gangrenous. In addition to the cystic artery, the gallbladder also receives small vessels from the visceral surface of the liver.

© image from radiopaedia.org

Treatment

Initial Management:

  1. Hospitalization: Most patients are admitted for observation and treatment.
  2. NPO (Nothing by Mouth): Patients refrain from eating or drinking to rest the gallbladder.
  3. Intravenous Fluids: IV fluids maintain hydration and correct electrolyte imbalances.
  4. Pain Management: NSAIDs or opioids manage severe pain.
  5. Antibiotics: Broad-spectrum antibiotics treat or prevent infection.

Definitive Treatment:

  1. Cholecystectomy (Gallbladder Removal):

    • Laparoscopic Cholecystectomy: Preferred method using small incisions and a laparoscope. It offers shorter recovery times.
    • Open Cholecystectomy: Required in cases with severe inflammation or complications, involving a larger incision and longer recovery.
    • Timing: Early cholecystectomy (within 24-48 hours of diagnosis) is recommended to prevent recurrence and complications.

  2. Percutaneous Cholecystostomy:

    • Procedure: A catheter drains the gallbladder, used for high-risk patients unable to undergo immediate surgery.
    • Purpose: Provides temporary relief and stabilizes the patient for future surgery.

Supportive Care:

  • Nutritional Support: A low-fat diet is recommended once the patient can eat again.
  • Monitoring and Follow-Up: Regular monitoring for complications and follow-up appointments ensure recovery.

Purposes

  • Relieve Symptoms: Alleviate the severe pain, nausea, vomiting, and other discomforts associated with the condition.

  • Reduce Inflammation: Manage and reduce inflammation of the gallbladder to prevent further complications.

  • Treat Infection: Use antibiotics to treat or prevent bacterial infection that may accompany or complicate acute cholecystitis.

  • Prevent Complications: Avoid serious complications such as gallbladder perforation, abscess formation, gangrene, and sepsis.

  • Restore Normal Function: Re-establish normal digestion and bile flow by removing the diseased gallbladder or draining its contents.

  • Improve Quality of Life: Eliminate the acute episode and prevent future occurrences to enhance the patient’s overall well-being.

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