Cholecystitis usually occurs when an obstruction keeps the gallbladder outlet (ductus cystic) or the bile duct (choledochal duct) permanently or temporarily. The biliary fluid then accumulates in the gall-bladder, causing an inflammatory reaction.
The most common cause is a gallstone gland – namely when a stone enters the bile ducts and remains stuck there. This is the case in about a quarter of the people with bile stones once in a lifetime.
Inflammation of the gall bladder without gallstones is rare. It occurs mainly in the severely ill patients in intensive care units. These are often caused by severe infections, accidents or extensive abdominal operations. This form of the disease is also called stress bubble.
Typical symptoms of cholecystitis
If a gallstone becomes clogged, the usually violent colic pain in the right upper abdomen occurs. Colic means that the pain in waves increases and decreases again. The complaints often last for hours. Frequently, the affected persons additionally have a fever.
Depending on the location of the stone, the biliary fluid also accumulates in the liver. Bilirubin can then enter the blood and yellow the skin (jaundice).
How does the doctor diagnose?
The doctor asks the patient about his complaints and his medical history. Then he takes a physical examination. Often, he finds a typical pressure pain in the right upper abdomen (Murphy sign).
With the help of an ultrasound examination, the doctor can usually detect a cholecystitis. Visible sign is a thickened wall of the gallbladder. Often, stones can also be seen or extended bile ducts.
The doctor also looks for certain changes in the blood. Signs of inflammation include an increased rate of blood clotting, increased white blood cell counts, and a high CRP. Markers that can point to Gallstau are gamma-GT, AP and bilirubin as well as other liver values.
If the doctor suspects stones in the bile ducts, further investigations are necessary. One possible method is endosonographic, ie an ultrasound examination through the intestinal wall. The doctor introduces the flexible ultrasound probe through the esophagus and pushes it through the stomach into the intestine.
An ERC (endoscopically retrograde cholangiography) is similar. This is a form of endoscopy with contrast agent presentation of the bile ducts (see section Treatment of inflammation of the bile ducts). A more recent method is nuclear magnetic resonance imaging of the bile ducts, a so-called MRC (Magnetic Resonance Cholangiography).
Treatment of choice: surgery to remove the gallbladder
If the doctor has diagnosed a cholecystitis, specialists recommend removing the gallbladder as soon as possible. This is usually possible with a minimally invasive surgical technique (laparoscopic cholecystectomy). “Soon” means in this context within five days after the start of the complaints.
Until the operation, the doctor treats the colic with anticancer medicines (N-butylscopolamine) and painkillers (for example, diclofenac, indomethacin, metamizole, certain opiates). Antibiotics can help reduce the risk of complications.
Sometimes surgery is not possible within five days, for example, if the diagnosis is known to be delayed or if the operation risk is too high. In such situations, specialists recommend removal of the gallbladder after six weeks.
Conservative therapy: complications are common
Without surgery, cholecystitis complicates up to 30% of the patients. The gall bladder can die (gallbladder gangrene) or its wall can tear (perforation). Then bile fluid empties into the abdomen and can cause a fatal inflammation there. In addition, pus can accumulate in the gallbladder (empyema). Chronic inflammation of the gall bladder is also considered one of the risk factors for the development of a gallbladder carcinoma.
Treatment alternatives for people with a severe illness: cholecystostomy
In the case of severely ill intensive patients, there is often a considerable risk of surgery and narcosis. Then the gallbladder can not be removed. With you, it is sometimes sensible to insert a fine tube into the gallbladder through a small incision in the skin and gall bladder through which the jammed bile can flow (cholecystostomy).
How does the doctor treat inflammation of the bile ducts?
Sometimes bile stones remain so that the bile can no longer flow out of the bile ducts in the liver. This leads to inflammation of the bile ducts (cholangitis). To treat them, the doctor must remove the bile stones from the bile ducts. This is possible with the help of a so-called ERCP, an endoscopically retrograde cholangiopancreatography.
An endoscope is a tube-like examination device equipped with a camera. This device is introduced by the physician through the esophagus to the point where the bile duct and the pancreas duct lead into the twelfth intestine. When the doctor injects contrast medium into this corridor, he can recognize with the aid of an X-ray image, where the bile duct is closed with a stone. Then he can pull the stone out of the bile duct with the aid of a special probe.