Cholecystitis: Gallbladder Disease

Cholecystitis, a condition also referred to as gallbladder disease, occurs when an individual’s gallbladder becomes inflamed. This inflammation is usually caused by gallstones, which block the tube through which bile is usually released. The buildup is responsible for the inflammation. Gallstones are common, particularly in Western populations. In the United States, gallstones are seen in approximately 6% of men and 9% of women. The incidence in children is not known; however, gallstones/biliary sludge are likely to form in one and five children with hemolytic anemia before their adolescent years. Most patients with an acute attack of cholecystitis have complete remission in 1-5 days; however, approximately 20% require surgical intervention. Mortality related to cholecystitis is 5%-10%, with the highest risk for patients older than age 60. The most commonly encountered complication of this condition is the development of gallbladder gangrene with the potential for subsequent perforations (2%). Gangrenous cholecystitis is reported most commonly in older patients, diabetics, or patients who delay treatment. The majority of patients with gallstones are asymptomatic and will remain so throughout their lives. Of those with incidental (asymptomatic) gallstones, approximately 20% will develop symptoms over 15 years of follow up, but their initial symptoms are typically not severe. The mortality rate related to gallstone disease is significantly less than that associated with treatment, which is why most experts advise against cholecystectomy for patients with asymptomatic gallstones. Among patients who develop symptoms a significant number will subsequently develop complications, which is why prophylactic cholecystectomy is advised once biliary symptoms develop (Zakko, 2018) Reports from a number of studies on the prevalence of gallstone disease indicate that once the initial uncomplicated biliary symptoms develop, the chance of recurrent symptoms is approximately 30% per year in the first two years, and the chance of developing complication is approximately 2-3% per year. Once a complication develops the chance of having additional, often more severe complications is approximately 30% per year. Complications that may develop in patients with gallstones include acute cholecystitis, choledocholithiasis, choledocholithiasis with or without acute cholangitis, and gallstone pancreatitis. Acute cholecystitis is the most common complication. In a systematic review it was seen …show more content…
Estrogen usage and hormone replacement therapy has been known to increase stone formation by increasing biliary cholesterol saturation. Other predisposing factors would include bile acid malabsorption, obesity, total parenteral nutrition, status post-bariatric surgery, hemolytic anemia, diabetes, increasing age, pregnancy secondary to elevated progesterone, and genetic predisposition (Native Americans and those of Chinese or Japanese descent). Most individuals with gallstones are asymptomatic throughout their lives. When the stones start causing symptoms the condition is referred to as “gallstone disease.” Uncomplicated gallstone disease refers to stones in the gallbladder that are associated with biliary colic in the absence of complications such as acute cholecystitis, cholangitis, or gallstone pancreatitis. Patients with uncomplicated gallstone disease typically present with biliary colic, normal physical examination findings, and normal laboratory test results. Patients often report associated diaphoresis, nausea, and vomiting. While patients may present with atypical symptoms such as chest pain or nonspecific abdominal discomfort, the absence of biliary colic should prompt an investigation of alternative diagnosis. On the other hand, biliary colic that is associated with fevers, jaundice, or abnormal blood tests (leukocytosis, liver tests, pancreatic tests) suggests the development of a complication of gallstone disease (Family Practice Guidelines,