In this video, Armando Hasudungan explains acute cholecystitis, which is the inflammation of the gallbladder caused by the obstruction of the cystic duct by gallstones. Acute cholecystitis is the most common complication of cholelithiasis, which is the formation of gallstones in the gallbladder.
- What is the gallbladder?
- What is Bile?
- The Importance of Fat-Soluble Vitamins
- The Possible Causes of Low Bile and How to Address them.
- What are Gallstones?
- The Real Cause of Gallstones
- Symptoms of Gallstones
- How to Stop Gallbladder Pain
- Best Supplements and Foods to Help with Gallstones
- 5 Tips for Dissolving Gallstones and Cleansing Gallbladder
- Liver and Gallbladder Flushing with Acupressure
- 9 Important Benefits of Purified Bile Salts
- 12 Complications After Gallbladder Removal
Anatomy of the Upper GI Tract
The gallbladder has a body, neck, and fundus. The cystic duct comes out from the gallbladder and connects to the common hepatic ducts that arise from the liver. The joining of the cystic duct and common hepatic ducts forms the common bile duct, which runs all the way down and joins with the pancreatic duct from the pancreas before moving to the small intestine.
The small intestine consists of the duodenum, which is the first part, and the jejunum, which is the second part. The newly formed duct releases bile and enzymes from the pancreas into the duodenum through the ampulla of Vater to help digest food.
Symptoms of Acute Cholecystitis
Acute cholecystitis occurs when a gallstone formed in the gallbladder gets stuck in the cystic duct. This obstruction results in inflammation of the gallbladder, which can cause fever, nausea, vomiting, and right upper quadrant pain that may radiate to the right side of the back on examination.
Differences between Biliary Colic, Acute Cholecystitis, and Cholangitis
Biliary colic, acute cholecystitis, and cholangitis are three conditions that share similar features. However, these conditions differ in some aspects such as pain, fever, white cell count, and jaundice. In this article, we will discuss the differences between these three conditions, their signs and symptoms, and possible complications.
1. Biliary Colic
Biliary colic is a temporary obstruction of the gallstone at the neck of the gallbladder. This obstruction can go in and out, causing pain in the right upper quadrant.
2. Acute Cholecystitis
Acute cholecystitis is a condition where a gallstone is stuck at the cystic duct, causing inflammation of the gallbladder. Its signs and symptoms include fever, nausea, vomiting, pain in the right upper quadrant, and a positive Murphy sign. The Murphy sign is a diagnostic maneuver where a hand is placed at the mid-inferior border of the liver, and the patient is asked to take a deep breath in. If the hand placed in this area irritates the gallbladder and triggers pain, it's considered a positive Murphy sign.
3. Cholangitis
Cholangitis is a complication of gallstones where an infection develops in the common bile duct. This condition is life-threatening and presents with right upper quadrant pain, fever, increased white cell count, and jaundice. The combination of these three symptoms is known as Charcot's triad.
Complications of Cholecystitis include:
- Tumor of the gallbladder
- Chronic cholecystitis, where mucus is secreted into the gallbladder
- Empyema, where pus accumulates in the gallbladder due to infection
- Mirizzi's syndrome, where a gallstone in the cystic duct obstructs the hepatic duct. This obstruction causes bile to backflow and cause obstructive jaundice.
- Perforation of the gallbladder
- Gallbladder-duodenum fistula that allows large gallstones to pass through, causing gallstone ileus at the terminal ileum
- Cholangitis triggered by choledocholithiasis or cholelithiasis when it obstructs the common bile duct
- Pancreatitis if gallstones obstruct the passage of contents from the pancreas into the duodenum
- Obstruction at the common bile duct or above, which causes backflow of bile to the liver, leading to obstructive jaundice.
Understanding Biliary Tree Problems and Management
The biliary tree is an important system that helps in digestion by releasing bile from the liver into the small intestine. Obstruction in this system can lead to various complications, including obstructive jaundice. This article discusses the investigation, diagnosis, and management of biliary tree problems.
1. Investigations for Biliary Tree Problems:
When a person is suspected to have biliary tree problems, several investigations can be performed, including:
- Full blood count to check for raised white cell counts
- Amylase and lipase to check for pancreatitis
- CRP, EU seas, and LFT to assess liver function
- Ultrasound to detect gallstones and elicit Murphy's sign
- Abdominal X-ray, which can only pick up 10% of gallstones
- Haida scan, a contrast scan that lights up the biliary tree to detect obstruction
2. Management of Acute Cholecystitis:
The management of acute cholecystitis includes nil by mouth, fluids, and IV antibiotics. Pain relief with analgesia is also provided. Surgery is done for symptomatic people or those with recurrent gallstone disease. Asymptomatic people with gallstones need not undergo surgery unless they have risk factors for future complications.
3. Laparoscopic Cholecystectomy:
Laparoscopic cholecystectomy is a surgical procedure that removes the gallbladder through a few ports or holes in the abdomen. The procedure is done under general anesthesia. Carbon dioxide is pumped into the abdominal cavity to create space for the surgeon to work. The surgeon can then view the area through the laparoscopic light and two assistant ports.
Steps in Laparoscopic Cholecystectomy:
The first step in laparoscopic cholecystectomy is to expose the gallbladder, which is surrounded by the visceral peritoneum. The cystic artery and duct are then clipped, and incisions are made in between the clips to prevent spillage of contents within the duct. The gallbladder can then be safely removed, and the cystic duct is clipped to prevent bleeding. Once the gallbladder is removed, everything is put back under the visceral peritoneum, and the surgery is completed. Watch Laparoscopic Cholecystectomy Surgery Video (Age Restricted)
4. Open Cholecystectomy:
In some cases, an open cholecystectomy may be necessary, especially if there are complications from gallstones or complications during laparoscopic surgery. Open cholecystectomy is a more invasive procedure, but it is quicker than laparoscopic cholecystectomy.
5. Co Voici and Colossus Law:
Co Voici and Colossus Law are two medical principles that are useful in diagnosing pancreatic and gallbladder diseases. Co Voici's law states that the presence of a large gallbladder with Jonas is unlikely due to gallstones but rather a carcinoma of the head of the pancreas. Colossus Law states that a large gallbladder with no stones is unlikely to be due to cancer but is more likely to be a result of an infection or inflammation.