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[Major points]

  1.  Acute cholecystitis can be diagnosed by abdominal ultrasounds, CT scan and MRI.
  2. Common clinical presentations: pain in the upper right abdomen, fever, nausea,vomiting and jaundice.
  3. Avoid overeating and consuming foods that are high in fat content, as well as pan-fried or deep-fried foods.
 
What is cholecystitis?
Inflammation that occurs in the gallbladder can be classified into two types based on the cause of occurrence: calculous cholecystitis and acalculous cholecystitis.
  1. Calculous cholecystitis: an inflammation process mostly occurs in the setting of cystic duct obstruction caused by gallstone, resulting in 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 happens when bacteria go through blood stream or lymph into gallbladder. This disease usually occurs in patients with diabetes mellitus, sepsis,  using peripheral parenteral nutrition, obesity, etc. 
 
How to diagnosis cholecystitis?
  1. Palpation: patients may experience pain over upper or right portion of abdomen while being palpated.
  2. Laboratory blood tests: blood drawing for lab tests may show increased white blood cell counts (inflammation reaction) and elevation of liver function index.
  3. Abdomen 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 are regarded as highly suggestive of acute cholecystitis.
 
What are the common symptoms of cholecystitis?
  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 (yellowish of skin)
    4.  Nausea and Vomiting.
  2. Chronic cholecystitis (long-standing gallbladder inflammation):
    1. Right upper quadrant pain or abdomen distension, it’s might be associated with high-fat foods.
    2. Poor appetite and nausea.
      Experiencing above symptoms do not indicate the cholecystitis diagnosis. Please seek medical attendtion for diagnosis.
 
What are the common treatment strategies?
  1. During the acute inflammatory period, antibiotic treatment is administered according to the doctor's orders, and no food is allowed. Intravenous infusion supplement for maintain body fluid and electrolyte balance. 
  2. Use pain killer if necessary.
  3. A procedure for percutaneous transhepatic biliary drainage to drain bile may be needed.
  4. Consult surgeon for removal of gallbladder if cholecystectomy is indicated.
 
Principles of care:
  1. Diet
    1. Eating more frequent and smaller meals. Avoid overeating.
    2. Take low-fat diet, and avoid high-fat food including organ meats, fatty meat, fried food, nut, cake, ice cream, chocolate, and whole fat 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 methods than fried.Using water to wash the gravy food while dining out.
    5. Refrigerating the soup then removing the upper layer fatty before eating.
    6. Take fat-soluble vitamins under doctor’s or dietician’s order when the long-term low-fat diet is necessary(vitamin A, D, E, K).
  2. Do some activity that you can tolerance, e.g. take a walk, etc.
  3. After discharge, if following symptoms occur please visit your doctor as soon as possible:
    1. Dark brown and tea-color urine.
    2. Clay-colored stool.
    3. Yellowish of skin or eyes.
    4. Fever with chills.
    5. Abdominal pain.
  4.  If you have a biliary drainage tube, please record the amount of drainage daily.
 
References
  1. Gallaher, J. R., & Charles, A. (2022). Acute cholecystitis: A review. Journal of American Medical Association, 327(10), 965-975. https://doi.org/10.1001/jama.2022.2350
  2. Pisano, M., Allievi, N., Gurusamy, K., Borzellino, G., Cimbanassi, S., Boerna, D., Coccolini, F., Tufo, A., Di Martino, M., Leung, J., Sartelli, M., Ceresoli, M., Maier, R. V., Poiasina, E., De Angelis, N., Magnone, S., Fugazzola, P., Paolillo, C., Coimbra, R., …, Ansaloni, L. (2020). 2020 World society of emergency surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World Journal of Emergency Surgery, 15, 61. https://doi.org/10.1186/s13017-020-00336-x
  3. Tufo, A., Pisano, M., Ansaloni, L., De Reuver, P., Van Laarhoven, K., Davidson, B., & Gurusamy, K. S. (2021). Risk prediction in acute calculous cholecystitis: A systematic review and meta-analysis of prognostic factors and predictive models. Journal of Laparoendoscopic and Advanced Surgical Techniques, 31(1), 41-53. https://doi.org/10.1089/lap.2020.0151.
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    Taipei Veterans General Hospital 
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