What is cholecystitis?
  1. Calculous cholecystitis: an inflammation process mostly occurs in the setting of cystic duct obstruction caused by gallstone, resulting in that the bile can not being excreted from gallbladder. Blockage of bile flow leads to thickening and buildup of bile causing an enlarged and red gallbladder. The gallbladder becomes infected by bacteria.
  2. Acalculous cholecystitis: it happened when bacteria go through blood or lymph into gallbladder. The disease usually occurs in patients with diabetes mellitus, sepsis, long period without eating, systematic arteritis, using peripheral parenteral nutrition, etc. 
 
Diagnosis:
  1. Palpation: patients may experience pain over upper or right portion of abdomen while being palpated.
  2. Laboratory tests: blood drawing for lab tests may show increased white blood cell counts (inflammation reaction) and inflammatory index(e.g. CRP).
  3. Ultrasonography: distended gallbladder and thicken gall bladder wall can be readily detected on ultrasonography. The accuracy of ultrasonography for acute cholecystitis are high.
  4. CT or MRI: The most common CT or MRI finding in acute cholecystitis is gallbladder distended, gallbladder wall thickening and gallstones. Gallbladder wall edema and thickening is regarded as highly suggestive of acute cholecystitis.
 
Clinical presentations:
  1. Acute cholecystitis:
    1. Pain: the location of pain often presented over upper or right portion of abdomen and sometimes radiating to the right scapular region.
    2. Fever and chills.
    3. Jaundice (yellowing of the skin)
    4. Vomiting.
  2. Chronic cholecystitis (long-standing gallbladder inflammation):
    1. Right upper quadrant pain or abdomen distension, its might be associated with high-fat foods.
    2. Poor appetite and nausea.Those above symptoms do not mean that there is cholecystitis. Please seek medical.
 
Treatment:
  1. Fasting until inflammation subsided. 
  2. Intravenous infusion supplement for maintain body fluid and electrolyte balance
  3. Use antibiotic or pain killer if necessary.
  4. A procedure of percutaneous transhepatic biliary drainage to drain bile may be needed.
  5. Consult surgeon for removal of gallbladder (cholecystectomy) if indicated.
 
Discharge and Home Care Guidelines:
  1. Diet
    1. Eating more frequent and smaller meals. Avoid overeating.
    2. Tacking low-fat diet, and avoid high-fat food include organ meats, fatty meat, fried food, nut, cake, ice cream, chocolate, and whole milk, etc.
    3. Choose lean meats. Selection of meats in the following order: skinless chicken, fish(without fish belly), skinless duck, beef, lamb and pork.
    4. Cooking method: baking, stewing, steaming are better than fried.
    5. Refrigerating the soup then removing the upper layer fatty before eating.
    6. Avoid eating the gravy of roast chicken and the juice of pork, which contain high fat.
    7. Take fat-soluble vitamins under doctor’s or dietician’s order when the long-term low-fat diet is necessary.
    8. Using water to wash the gravy food while eating out.
  2. Do some activity that you can tolerance, e.g. take a walk, etc.
  3. After discharge, if you have following symptoms please visit your doctor as soon as possible:
    1. Dark brown and tea-color urine.
    2. Clay-colored stool.
    3. Yellowing of skin or eyes.
    4. Fever with chills.
    5. Abdominal pain.
    6. If you have a biliary drainage tube, please see the VGH health e-point network care guide "gastrointestinal hepatobiliary", "self-care/home care", "care of patients with percutaneous transhepatic cholangial drainage".
 
References
  1. Mayumi, T., Okamoto, K., Takada, T., Strasberg, S. M., Solomkin, J. S., Schlossberg, D Yamamoto, M. (2018). Tokyo Guidelines 2018: Management bundles for acute cholangitis and cholecystitis. Journal of Hepato-Biliary-Pancreatic Sciences, 25(1), 96-100. doi:10.1002/jhbp.519
  2. Okamoto, K., Suzuki, K., Takada, T., Strasberg, S. M., Asbun, H. J., Endo, I. Yamamoto, M. (2018). Tokyo Guidelines 2018: Flowchart for the management of acute cholecystitis. Journal of Hepato-Biliary-Pancreatic Sciences, 25(1), 55-72. doi:10.1002/jhbp.516
  3. Yokoe, M., Hata, J., Takada, T., Strasberg, S. M., Asbun, H. J., Wakabayashi, G., Yamamoto, M. (2018). Tokyo Guidelines 2018: Diagnostic criteria and severity grading of acute cholecystitis (with videos). Journal of Hepato-Biliary-Pancreatic Sciences, 25(1), 41-54. doi:10.1002/jhbp.515
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    2019-07-25 00:00:00