Acute cholecystitis is a disease of the gallbladder, which is characterized by inflammation of the body of the organ and clinically by a syndrome of acute abdominal pain accompanied by fever and local organ changes.
Acute cholecystitis has several causes and mechanisms of production of which the most important are: obstruction of the cystic duct, gallbladder wall infection and reflux of pancreatic juice in the bile ducts.
Acute Cholecystitis Causes
Cystic duct obstruction is the cause and mechanism most commonly encountered in the development of acute cholecystitis. In aproximately 95% of cases, the obstruction is caused by a bile stone, which is situated in the gallbladder neck or cystic duct. The stagnation of bile in the gallbladder has several consequences: concentration of bile, increased intravesical pressure, compressed blood vessels that nourish the gallbladder wall, and finally acute inflammation of the gallbladder wall. Resorption of water and salts by the gallbladder increases the concentration of bile pigments, calcium carbonate, and cholesterol. This mix of concentrated substances cause irritation of the gallbladder (chemical inflammation) and increased osmotic pressure inside the gallbladder resulting in pain.
Primary and secondary infection. Infectious cholecystitis is rare and can be found mostly in children. The infection is most often the result of changes in gallbladder content and wall after obstruction. The infection is easily installed due to low resistance of the walls suffering from ischemia. Among the germs that infect the gallbladder, the most common are those coming from the intestine and especially E. coli bacillus. Rarely the infection can be caused by clostridium, salmonella, pneumococcus and staphylococcus.
Other causes and mechanisms. In cholecystitis associated with pancreatitis, pancreatic juice reflux into the gallbladder appears to represent the basic mechanism.
Surgical interventions, trauma, anesthesia, administration of drugs and analgesics, can create conditions for the occurrence of acute cholecystitis.
The intervention of immune-allergic mechanisms is also possible.
Accute Cholecystitis Symptoms
The main symptom is abdominal pain plus other symptoms like nausea, vomiting, chills, shortness of breath, and a general malaise. In over 90% of the patient shows nausea and vomiting due to a bile stone stuck in the cystic duct or common bile duct mucosa. When biliary tract infection predominates, the patient presents chills, with or without hipertermia (increased temperature)
Pain attack in acute cholecystitis is usually accompanied by fever.
Intensity of fever reflects the proportions of the inflamatory phenomena and their extension to the intra and extra hepatic bile ducts. An increased sensitivity of the right hypochondrium is also present. When inflammation of the gallbladder wall causes gangrene, muscle contracture will be present due to peritoneal irritation (bile peritonitis). Jaundice is rare and is caused by expansion of the inflammatory phenomena to the intrahepatic bile ducts.