CHRONIC CHOLECYSTITIS

Clarinda clare linusDiploma in Medical Science

Intake January 2011Lecturer : DR. Angelo

The gallbladder is a hollow system that sits just beneath the liver.

In adults, the gallbladder measures approximately 8 centimetres (3.1 in) in

length and 4 centimetres (1.6 in) in diameter when fully distended.

It is divided into three sections: fundus, body and neck.

The Gallbladder

The neck tapers and connects to the biliary tree via the cystic duct, which then joins the common hepatic duct to become the common bile duct.

At the neck of the gallbladder is a mucosal fold called Hartmann's pouch, where gallstones commonly get stuck.

Cholecystitis is the inflammation of the gallbladder, usually resulting from a gallbladder stone blocking the cystic duct.

It lasts for a long time and characterized by repeated attacks of pain (biliary colic).

It may become thick walled, scarred and small. The gallbladder usually contains sludge (a microscopic particles or materials similar to gallstones)

It block its opening into the cystic duct or reside in cystic duct itself.

What is Cholecystitis

Notice thickness of galldladder wall, abundant polyhedric stones and small papillary tumor in the cystic duct.

morphology

Enlarged mucosal folds of the gallbladder can be seen, and in many there will be an infiltrate of foamy histiocytes. There is very little inflammation of the acute or chronic type here, and if there is any at all, it will be found in the muscular wall and serosal fat. This is a very common and benign process, and very likely is the starting point for some types of gall stones. 

The physical examination may reveal fever, tachycardia, and tenderness in the RUQ(right upper quadrant) or epigastric region, often with guarding or rebound.

The Murphy sign, which is specific but not sensitive for cholecystitis, is described as

tenderness and an inspiratory pause elicited during palpation of the RUQ. A palpable

gallbladder or fullness of the RUQ is present in 30-40% of cases. Jaundice may be noted in

approximately 15% of patients.

Clinical manifested

Many patients present with diffuse epigastric pain without localization to the RUQ. Patients with chronic cholecystitis frequently do not have a palpable RUQ mass secondary to fibrosis involving the gallbladder.

The main symptoms is pain in the upper right side or upper middle of the abdomen. The pain may :

Be sharp, cramping, steady Spread to the back or below the right

shoulder blade

Other symptoms : clay-colored stools, fever, nausea or vomitting, yellowing of skin(jaundice)

Symptoms

Cholecystitis is diagnosed by doctors mainly based on symptoms and results of imaging tests.

Ultrasonography is the best way to detect gallstones in the gallbladder or the thickening of its wall.

Diagnostic

Ultrasound of the Abdomen. Ultrasound is a simple, rapid, and noninvasive imaging technique. It is the diagnostic method most frequently used to detect gallstones and is the method of choice for detecting cholecystitis.

If possible, the patient should not eat for 6 or more hours before the test, which takes only about 15 minutes. During the procedure, the doctor can check the liver, bile ducts, and pancreas, and quickly scan the gallbladder wall for thickening (characteristic of cholecystitis.

Cholescintigraphy, another imaging test, is useful when acute cholecystitis is difficult to diagnose.

For this test, a radioactive substance (radionuclide) is injected intravenously. A gamma camera detects the radioactivity given off and a computer is used to produced an image. Thus the movement of the radionuclide from the liver through the biliary tract can be followed.

Images of the liver, bile ducts, gallbladder and upper part of small intestines are taken. If the radionuclide does not fill the gallbladder, the cystic duct is probably blocked by a gallstones.

Liver blood test are often normal unless the person has an obstructed bile duct. Other blood test can detect some complications such as high level of a pancreatic enxyme (lipase or amylase) in pancratitis.

A high count of WBC suggest inflammation, an abscess, gangrene or a perforated gallbladder.

…continue

Surgical – removal of the gallbladder (cholecystectomy) is usually done by using a flexible tube called a laproscope.

How to treat?

This surgery uses a smaller surgical cuts, which results in a faster recovery. Patients are often sent home from the hospital on the same day as surgery or the next morning. Open cholecystectomy requires larger cut in the upper-right part of the abdomen.

Gall stones may also be dissolved with medication taken by mouth. But may take 2 years or longer to work.

Pain after surgery : a few people have new or recurring episodes of pain that felt on gallbladder even thought the gallbladder and the stones have been removed.

It may be the malfunction of the sphincter of Oddi, the muscle that control the released of bile and pancreatic secretion.

Complications

Cancer of gallbladder (rarely) Jaundice Pancreatitis Worsening of the condition

+ info jaundice : The pancreas and liver drain into the same duct

into the gut. When the pancrease becomes inflamed and swollen the outflow from the liver does not drain into the gut. The bile salts do not get into the gut and stay in the body leading to jaundice.

…Other possible complication

The condition is not always preventable. Eating less fatty food may relieve symptoms

who have not had their gallbladder removed.

Management

www.nlm.nig.gov/medlineplus/ency/article/000217.htm

www.webmd.com/digestive-disorders/tc/cholecystitis-overview

Medical-dictionary.thefreedictionary.com/cholecystitis

en.wikipedia.org/wiki/cholecystitis en.wikipedia.org/wiki/Gallbladder http://www.umm.edu/patiented/articles/how

_gallstones_gallbladder_disease_diagnosed_000010_6.htm#ixzz21kbeCKm7

references

Thank you.