"I ate pork chops and gravy last night."
Progressing Right upper stomach pain with Bloating.
Pain radiates to mid back and in the right shoulder.
The pain may be exacerbated by fatty food intake, also
food intolerances (especially greasy and spicy foods).
Often the symptoms occur in the evening or at night.
Sometimes Nausea, vomiting, and occasionally fever.
This pain could be present for years until diagnosis.
This condition is Chronic cholecystitis.
symptoms can be accompanied by acute exacerbations of more pronounced symptoms, which is called - acute biliary colic.
or it can progress to a more severe form of cholecystitis requiring urgent intervention it is acute cholecystitis).
Cases of acute cholecystitis have similar symptoms only more severe.
More than 90% of the time acute cholecystitis is caused from blockage of the cystic duct by a gallstone.
Treatment is usually with laparoscopic gallbladder removal, within 24 hours if possible.
While Chronic cholecystitis is a prolonged, subacute condition caused by the mechanical or functional dysfunction of the emptying of the gallbladder.
Chronic cholecystitis can be two types.
Calculous, it means stones in the gallbladder. Called cholelithiasis,
and acalculous (without gallstones).
However most cases of chronic cholecystitis are commonly associated with cholelithiasis.
Gallstones, by causing intermittent obstruction of the bile flow, most commonly by blocking the cystic duct lead to inflammation and edema in the gall bladder wall.
Chronic irritation from gallstones invoking an inflammatory response in the gallbladder wall.
Sometimes resulting from dysfunction in the emptying of the gallbladder.
This overlaps with Sphincter of Oddi dysfunction and is best referred to as biliary or gallbladder dyskinesia.
It has been proposed that lithogenic bile, leads to increased free radical-mediated damage from hydrophobic bile salts.
That, in association with reduced mucosal protection due to lower levels of prostaglandin E2 results in a continuous inflammatory state. When the cholecystokinin receptors of the smooth muscle are affected, there is impaired gall bladder contraction that leads to stasis and worsens the permissive environment where lithogenic bile promotes inflammation.
Risk factors for cholelithiasis include:
Female gender
Obesity
Rapid weight loss
Pregnancy
Advanced age
Hispanic or Pima Indians.
Gallstone disease is very common. About 10-20% of the world population will develop gallstones at some point in their life and about 80% of them are asymptomatic.
Diagnosis:
Laboratory testing is not specific or sensitive in making a diagnosis of chronic cholecystitis. Leukocytosis and abnormal liver function tests may not be present in these patients, unlike the acute disease. However basic laboratory testing in the form of a metabolic panel, liver functions, and complete blood count should be performed.
Computerized tomography (CT) with intravenous contrast usually reveals cholelithiasis.
A magnetic resonance imaging (MRI) study is a useful alternative in patients who are unable to undergo a CT scan due to radiation concerns or renal injury.
Endoscopic retrograde cholangiopancreatography (ERCP) is usually done when choledocholithiasis is a concern.
There are other common medical conditions that can mimic the presentation of chronic cholecystitis.
Including: Gall bladder cancer: Peptic ulcer disease: GERD; Gastric cancer: Myocardial infarction. Mesenteric ischemia and Mesenteric vasculitis.
Treatment:
The preferred treatment for chronic cholecystitis is elective laparoscopic cholecystectomy.
conservatively. A low-fat diet can help reduce the frequency of symptoms. In patients with symptomatic cholelithiasis, the use of ursodeoxycholic acid (UDCA or ursodiol) has been shown to decrease rates of biliary colic and acute cholecystitis.
Prognosis:
The majority of uncomplicated cases of cholecystitis have an excellent outcome.
By BruceBlaus. When using this image in external sources it can be cited as:Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. - Own work, CC BY 3.0, [ Ссылка ]
By Nanoxyde - own, from File:Biliary system multilingual.svg, CC BY-SA 3.0, [ Ссылка ]
By www.scientificanimations.com - [ Ссылка ], CC BY-SA 4.0, [ Ссылка ]
