Gallbladder inflammation (cholecystitis) is an inflammation of the gallbladder wall. The most common cause in this case is gallstones that are already present. In this case, it is called acute cholecystitis. Typical signs of gallbladder inflammation are fever and abdominal pain (especially in the upper abdomen). Sometimes the pain can radiate to the chest or shoulder.
What is gallbladder inflammation?
Gallbladder inflammation (cholecystitis) is a common condition of middle and older age. The female sex is clearly preferred. Symptoms include massive pain in the right upper abdomen. These are often so severe that when palpating the gallbladder, breathing reflexively stops (Murphy’s sign). Often, the pain also radiates to the shoulder or between the shoulder blades. Loss of appetite, nausea, vomiting, and sweating are also typical. In the context of complications (sepsis, pancreatitis), high fever may occur, possibly with chills. If the stool is discolored and the color of the urine is dark, there may be bile stasis (cholestasis). The “coloring” bilirubin in the bile is then alternatively excreted by the kidneys. Diagnosis is made by physical examination, laboratory (inflammatory constellation, cholestasis parameters such as AP, bilirubin, and gamma-GT), and ultrasound.
Causes
In gallbladder inflammation, the cause in up to 95 percent is gallstone disease. Accordingly, patients with the well-known five F’s are often affected: female (female), forty (age at or over 40), fat (overweight), fertile (fertile), and fair (blond or fair complexion). Additionally, there is a familial predisposition. Stones lodged in the gallbladder either mechanically irritate the gallbladder wall (abacterial inflammation) or may become lodged in the excretory duct and obstruct it. The bile backs up and expands the gallbladder (hydrops). In addition to mechanical irritation, ascending intestinal germs (e.g., E. coli) can then lead to inflammation. Other causes are rare, e.g., toxic substances, chronic hemolysis (with formation of bilirubin gallstones), trauma, diseases of the bile ducts, prolonged parenteral nutrition, disseminated infections of, for example, the liver, or tumors in the gallbladder.
Symptoms, complaints, and signs
Symptoms of cholecystitis depend on both the age of the affected person and whether the condition is acute or chronic. Typical symptoms of acute cholecystitis are pain that slowly moves from the upper abdominal regions (above the stomach) to the entire right upper abdomen. At first, the pain usually appears as so-called biliary colic in cramp-like waves. Then they intensify into a continuous pain in the right upper abdomen lasting several hours. The pain may radiate to the shoulder or back. It intensifies when pressure is applied. In addition to abdominal pain, some patients also suffer from nausea, vomiting, loss of appetite, fever or palpitations. When the bile ducts are involved, jaundice with yellowing of the eyes and skin also frequently occurs. In young children, in addition to similar symptoms, jaundice occurs more quickly than in adults. The stool often turns white to gray. Older children suffer more often from nausea and vomiting. They initially experience an uncomfortable feeling of pressure instead of upper abdominal pain, which intensifies into cramping pain. Older patients often have no pain at all. They only complain of tiredness and fatigue. If they do experience pain, it is mild upper abdominal pain along with bloating. Chronic cholecystitis is characterized by symptoms similar to those seen in elderly patients.
Course
If gallbladder inflammation is not treated as soon as possible, serious complications may develop. Thus, recurrent gallbladder inflammation soon becomes chronic. Furthermore, a gallbladder perforation or even bursting of the gallbladder can occur in the course of the disease. These complications should not be taken lightly, as they can be life-threatening.
Complications
In the context of gallbladder inflammation, there is a risk of various complications.Consequential symptoms are particularly likely if cholecystitis is treated late. For example, pus can accumulate in the gallbladder. If the pressure on the gallbladder wall increases, the gallbladder may rupture. Doctors then speak of a perforation. If the bile and bacteria enter the peritoneum, this in turn leads to peritonitis, which can be life-threatening. Another dangerous complication is the transfer of bacteria from the gallbladder into the bloodstream, resulting in inflammation. In such cases, there is a risk of blood poisoning (sepsis), which spreads to the patient’s entire body. If the inflamed gallbladder wall is breached at a certain point that runs along the intestine, it is possible that a fistula will form, connecting the two organs. Occasionally, a gallstone can also enter the intestine and cause intestinal obstruction, which in turn causes a life-threatening intestinal obstruction that requires rapid surgery. Jaundice (icterus) is also one of the sequelae of gallbladder inflammation. This occurs because the bile pigment bilirubin can no longer be drained due to stuck gallstones. In addition, bile secretions accumulate in the liver. This in turn causes infections such as hepatitis or liver abscesses.
When should you see a doctor?
Pain that occurs in the area of the upper or middle abdomen gives reason to see a doctor. If the discomfort continues abruptly for several days or increases in intensity, a doctor is needed. If cramps occur or a stooped posture occurs due to the pain, a medical clarification of the complaints should be made. If symptoms such as fever, nausea, vomiting or diarrhea occur repeatedly or persist for several days, a doctor should be consulted. Intestinal obstruction is a cause for concern. A doctor should be consulted so that the cause can be determined. If the affected person suffers from a general feeling of illness or a decrease in his or her usual ability to perform, he or she should contact a physician. If everyday duties can no longer be performed due to the discomfort, it is also necessary to consult a physician. Consultation with a medical professional is necessary before taking a pain medication in order to rule out further complications. If loss of appetite, listlessness or a general feeling of malaise develop, a visit to the doctor is necessary if the signs persist for several weeks. In the case of acute symptoms that occur suddenly and unexpectedly, a doctor should be consulted immediately. In severe cases, it is advisable to inform the emergency services and follow their instructions.
Treatment and therapy
The therapy of cholecystitis depends on the extent of the disease. Preference is given to inpatient conservative treatment. This is done with bile-permeable antibiotics intravenously, usually as a combination therapy of two antibacterial agents. In addition, analgesics (also with antispasmodic components, e.g., butylscopolamine or metamizole) and physical measures should be used (most patients find an ice bubble soothing). In severe courses or in the generalized stage (chologenic sepsis), strict bed rest is recommended. Once the acute infection has healed, surgical removal of the gallbladder (cholecystectomy) follows. This is necessary because the triggering risk factors (e.g. gallstones) are still present and a relapse is therefore likely. Elective cholecystectomy is usually performed minimally invasively by means of laparoscopy. This requires two to three small incisions. Early hospital discharge and mobilization and correspondingly fewer complications are possible due to the gentle procedure. If an isolated, obstructed stone is the cause, ERCP (endoscopic retrograde cholangiopancreatography, an invasive procedure similar to gastroscopy) plus antibiotic therapy may be sufficient. If complications are already present or conservative therapy has been unsuccessful, surgery must be performed during the florid inflammation.
Outlook and prognosis
The prognosis of cholecystitis is considered favorable with early and good treatment.If gallstones are the cause of the inflammatory process, they must be removed to ensure permanent freedom from symptoms. Otherwise, a chronic course will result. If the stones are removed without further complications, the inflammation is treated with medication until complete recovery. If the gallstones and gallbladder inflammation recur in the course of life, the prognosis is also optimistic. Nevertheless, the possible removal of the gallbladder should be considered in case of recurrence. In the case of acute cholecystitis, the gallbladder is removed in a surgical procedure so that the patient’s life is not put at unnecessary risk. Although it is an operation with the usual risks and side effects, the procedure is rarely associated with disorders or sequelae. Removal is a routine procedure, after which the patient can be discharged from treatment within a few days. If the wounds heal as planned, there is a lifetime of freedom from symptoms from further inflammation of the gallbladder. The patient can normally continue his or her normal lifestyle without the organ. There are no significant impairments or necessary restructuring of daily routines.
Prevention
The most important preventive measure against gallbladder inflammation is to avoid gallstones. This is most likely to be achieved by a diet low in fat and cholesterol. Overall, weight reduction to the normal weight should be aimed for. Other risk factors can hardly be influenced. If biliary colic has occurred for the first time (symptomatic gallstones), gallbladder removal should be performed during a symptom-free period. This can prevent subsequent colic with the risk of gallbladder inflammation.
Follow-up care
In most cases of gallbladder inflammation, the options for aftercare are relatively limited, so the patient is primarily dependent on medical treatment for this condition. This is the primary focus, with early diagnosis and treatment having a positive effect on the further course of this disease. Gall bladder inflammation is usually treated with the help of antibiotics. There are no particular complications. However, the patient should make sure that the antibiotics are taken regularly and avoid alcohol during treatment so as not to weaken the effect of the medication. Attention should also be paid to correct dosage and possible interactions with other medications. Since cholecystitis can also lead to further complaints or complications, regular examinations by a doctor are also advisable after treatment in order, for example, to detect and treat gallstones at an early stage. In some cases, surgical intervention is also necessary, after which the affected person should always rest. In any case, strenuous or stressful activities should be avoided. The gallbladder inflammation can usually be treated well, so that it also does not come to a reduced life expectancy of the affected person.
What you can do yourself
Since in most cases the formation of gallstones leads to gallbladder inflammation, it is important to prevent it in everyday life through a healthy lifestyle. A diet high in fat and low in fiber promotes the formation of gallstones. Therefore, eating habits and food intake should be examined. If possible, these should then be changed. A diet rich in vitamins with sufficient trace elements and nutrients prevents disease. The intake of sufficient fluids should be checked and, if necessary, adjusted to the body’s needs. In addition, adequate exercise, playing sports and maintaining a normal weight are beneficial. Toxins and harmful substances, such as alcohol or nicotine, are to be avoided. In order for the organism to produce sufficient defenses to fight inflammatory diseases, it needs a stable immune system. In order for it to function properly, factors such as stress, hectic activity and psychological strain must be reduced, in addition to a healthy diet. Permanent dissatisfaction, pessimism and negative thoughts about the future are a hindrance in the healing process as well as in the prevention of diseases.If the disease of gallbladder inflammation is known within the family, there is an increased risk of also falling ill. For this reason, special attention should be paid to the lifestyle of these people in everyday life. To prevent life-threatening conditions, timely consultation with a physician is necessary.
