Acute Cholecystitis

Acute Cholecystitis: Causes, Symptoms and Diagnosis

Acute cholecystitis is a nonspecific inflammation of the gallbladder, which in most cases is associated with the presence of gallstones. Acute cholecystitis can also occur when pancreatic enzymes are blocked, infection or tumor damage to the gallbladder. In this article we will look at the causes of acute cholecystitis, its symptoms and diagnostic methods.

Causes of Acute Cholecystitis

Acute cholecystitis usually develops in the presence of gallstones, which lead to obstruction of the cystic duct. Stagnation of bile in the gallbladder with the subsequent development of infection leads to inflammation of the walls of the bladder and disruption of its barrier function. As a result, inflammation may spread to all layers of the gallbladder wall, which causes somatic pain.

Acute cholecystitis can also occur when pancreatic enzymes leak into the gallbladder (enzymatic cholecystitis) or when an infection enters the gallbladder during sepsis. Tumor damage to the gallbladder can also lead to obstruction of the cystic duct and the development of acute cholecystitis.

Symptoms of Acute Cholecystitis

Early symptoms of acute cholecystitis are very diverse. While the inflammation is limited to the mucous membrane of the gallbladder, there is only visceral pain without clear localization, often involving the epigastric region and the navel area. The pain is usually dull in nature, and muscle tension and local tenderness are not detectable. There may be no changes in the blood during this period.

However, when complete obstruction of the cystic duct occurs and infection quickly attaches, the pain intensifies significantly, moves to the right hypochondrium, radiates to the supraclavicular region, interscapular space, and lumbar region. Nausea, vomiting, sometimes repeated (especially with cholecystopancreatitis). The skin may be icteric (in 7-15% of cases acute cholecystitis is combined with choledocholithiasis). The temperature is low-grade, but it can rise quickly and reach 39 °C.

When examining patients with acute cholecystitis, you can often observe increased nutrition and a coated tongue. The abdomen is tense, painful to palpation in the right hypochondrium, and there may be tenderness at Murphy's point.

Diagnosis of Acute Cholecystitis

Diagnosis of acute cholecystitis includes a clinical examination, laboratory and instrumental studies.

A clinical examination by a doctor may reveal characteristic pain in the right hypochondrium, elevated body temperature, icterus skin and other symptoms.

Laboratory tests include a complete blood count, biochemical blood test, urine and stool analysis for the presence of bile pigments and microorganisms.

Instrumental studies include ultrasound examination of the gallbladder and bile ducts, X-ray examination of the bile ducts with a contrast medium, magnetic resonance cholangiography, etc.

If the diagnosis of acute cholecystitis is confirmed, immediate treatment is required, which may include conservative therapy or surgery depending on the severity and stage of the disease.