Cholecystitis is inflammation of the gallbladder. Inflammation usually forms when a gallstone blocks the cystic duct that transports bile. Cholecystitis is the most common problem resulting from gallbladder stones (90% of the cases). Cholecystitis affects women more often than men and is more likely to occur after age 40. People who have a history of gallstones are at increased risk for cholecystitis. Cholecystitis has an increased prevalence among people of Scandinavian descent, Pima Indians, and Hispanic populations. It affected 20 million people with a mortality record of 1,092 deaths in 2004.
Hospitalizations total up 622,000 in the same year and over 700,000 have undergone cholecystectomies. (http://digestive. niddk. nih. gov/statistics/statistics. htm#all) Cholecystits is usually classified as either acute or chronic. Acute cholecystitis is a sudden pain in the hypochondriac region resulting in severe and steady pain. Chronic cholecystitis is gallbladder inflammation that has lasted a long time. The attacks are repeated and the gallbladder eventually becomes damaged. Gallstones are pebble-like, hardening deposits of bile that are formed inside of the gallbladder.
Bile is made in the liver and it is a digestive fluid which contains water, cholesterol, fats, bile salts, or bilirubin. Bile aids in digesting fats and is stored in the gallbladder until the body needs it. When in use the gallbladder contracts and pushes the bile through the common bile duct, which carries it to the small intestines. Bile salts break up fat, and bilirubin gives bile and stool a yellowish-brown color. If the liquid bile contains too much cholesterol, bile salts, or bilirubin, it can harden into gallstones.
Two types of gallstones are cholesterol stones, which account for 8o percent of gallstones cases, and pigment stones. Cholesterol stones are yellow-green in color and are mainly composed of undissolved cholesterol. Pigment stones are a dark brown or black color and appear when bile contains too much bilirubin. Stones can range from a grain of salt to the size of a golf ball. People may have as many as one huge gallstone to hundreds of tiny stones or a combination of both. Risk factors that may contribute to the formation of gallstones are: Sex; women are twice as likely as men to develop gallstones.
Excess estrogen from pregnancy, hormone replacement therapy, and birth control pills appears to increase cholesterol levels in bile; Family history, Obesity; Diets high in fat and cholesterol and low in fiber, increase the risk of gallstones due to increased cholesterol in the bile and reduced gallbladder emptying; Rapid weight loss, as the body metabolizes fat the liver secretes extra cholesterol into bile which can cause gallstones; Age, people older than age 60 are more likely to develop gallstones than younger people.
As people age, the body tends to secrete more cholesterol into bile; Ethnicity, American Indians have the highest rate of gallstones in the United States. They have a genetic predisposition to secrete high levels of cholesterol, Mexican American men and women of all ages also have a high rate of gallstones; Cholesterol lowering drugs and Diabetes. Gallstones can block the normal flow of bile if they move from the gallbladder and lodge in any of the ducts ( hepatic duct, cystic duct, common bile duct) that carry bile from the liver to the small intestine.
If the bile hardens and becomes trapped in these ducts it can cause inflammation in the gallbladder and the ducts. Signs and symptoms of gallstones are sudden and rapid intensifying pain in the hypochondriac region and epigastric region which is in the upper and center abdomen right below the breastbone, back pain between your shoulder blades and pain in the right shoulder, nausea and vomiting. Pain can last anywhere between several minutes to several hours.
Warning signs are abdominal pain so intense that you can’t sit still or find a comfortable position, yellowing of your skin and the whites of your eyes, clay colored stool and high fever with chills. Complications that can occur from gallstones if left untreated are inflammation of the gallbladder (cholecystitis), blockage of pancreatic duct (gallstone pancreatitis), rupturing of the gallbladder, peritonitis, liver damage, cirrhosis and gallbladder cancer. When gallstones are suspected to be the cause of symptoms, the doctor is likely to do an ultrasound exam or
CT Scan, the most sensitive and specific test for gallstones. Other exams that may be performed are a Cholescintigraphy a. k. a. HIDA (hepatobiliary iminodiactec acid) Scan, ERCP (endoscopic retrograde cholangiopancreatography), and blood tests. Treatments include Surgery and medications to dissolve the gallstones. Nearly all cholecystectomies are performed with laparoscopy. If tests show the gallbladder has severe inflammation, infection, or scarring from other operations, the surgeon may perform open surgery to remove the gallbladder.
In some cases, open surgery is planned; however, sometimes these problems are discovered during the laparoscopy and the surgeon must make a larger incision. If gallstones are present in the bile ducts, the physician—usually a gastroenterologist—may use ERCP to locate and remove them before or during gallbladder surgery. Occasionally, a person who has had a cholecystectomy is diagnosed with a gallstone in the bile ducts weeks, months, or even years after the surgery.
The ERCP procedure is usually successful in removing the stone in these cases. Prevention of cholecystitis and gallstones consist of maintaining a healthy body weight, If you need to lose weight, do so slowly and sensibly. When you lose weight by dieting and then you gain weight back again, you increase your risk for gallstones, especially if you are a woman. Try not to skip meals. Eat on a regular schedule. And eat meals that contain some fat, this causes the gallbladder to empty.
Eat plenty of whole grains and fiber. And be sure to often have servings of foods that contain calcium. Limit saturated fat and foods high in cholesterol. Some evidence shows that taking hormones such as estrogen after menopause or taking high-dose birth control pills may increase a woman’s risk of gallstones that cause symptoms. If you are taking such hormones, talk with your doctor. Fortunately, the gallbladder is an organ people can live without. Your liver produces enough bile to digest a normal diet.
Once the gallbladder is removed, bile flows out of the liver through the hepatic ducts into the common bile duct and directly into the small intestine, instead of being stored in the gallbladder. Because now the bile flows into the small intestine more often, softer and more frequent stools can occur in about 1 percent of people. If any of the bile ducts remain blocked for a significant period of time, severe damage or infection can occur in the gallbladder, liver, or pancreas. Left untreated, the condition can be fatal. Warning signs of a serious problem are fever, jaundice, and persistent pain.
Works Cited
http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones/
http://www.mayoclinic.com/health/gallstones/DS00165/DSECTION=complications