Cholecystitis

Cholecystitis (Greek, - cholecyst, " gallbladder", combined with the suffix -itis, " inflammation") is inflammation of the gallbladder, which occurs most commonly due to gallstones (cholelithiasis). Blockage of the cystic duct with gallstones causes accumulation of bile in the gallbladder and increased pressure within the gallbladder. Concentrated bile, pressure, and sometimes bacterial infection irritate and damage the gallbladder wall, causing inflammation. Inflammation and swelling of the gallbladder can be reduced to areas of the gallbladder, which can lead to cell death. The main forms of cholecystitis are the following: catarrhal, purulent and gangrenous.

Risk factors for cholelithiasis and cholecystitis are similar and include increasing age, female sex, pregnancy, certain medications, obesity, and rapid weight loss. Females are twice as likely to develop cholecystitis as males. Uncomplicated cholecystitis has an excellent prognosis; however, more than 25% of patients require surgery or develop complications. Complications of acute cholecystitis increases morbidity and mortality. The patient with cholecystitis is known to complain of intense pain, localized in the right hypochondrium and in the umbilical area

The gallbladder may be tender and distended. During the attack of pain the face is moist with cold perspiration, the skin is pale, and the tongue and lips are dry. Even a slight palpation reveals severe tenderness due to irritation of the peritoneum. Approximately in 50% of cases there is slight jaundice of sclerae. The pain grows much worse when the patient is lying on his right side. It may also correlate with eating greasy, fatty, or fried foods. Diarrhea, vomiting, and nausea are common.

The chemical blood analysis is known to reveal some changes; they result from the effect of toxic substances in the liver. For most patients diagnosed with acute cholecystitis, the definitive treatment is surgical removal of the gallbladder, cholecystectomy.

Purulent form of cholecystitis is highly dangerous to life and requires an emergency operation. An even more severe course is observed in gangrenous cholecystitis. Recovery is achieved by surgical treatment, it being followed by prolonged antibiotic therapy and chemotherapy.

Since the advent of laparoscopic surgery in the early 1990s, laparoscopic cholecystectomy has become the treatment of choice for acute cholecystitis. Laparoscopic cholecystectomy is performed using several small incisions located at various points across the abdomen. Several studies have demonstrated the superiority of laparoscopic cholecystectomy when compared to open cholecystectomy. Patient undergoing laparoscopic surgery report less incisional pain postoperatively as well as fewer long - term complications and less disability following the surgery. Additionally, laparoscopic surgery is associated with a lower rate of surgical site infection.

Exercise 5. Answer the questions to the text:

1. What is cholecystitis?

2. What are the main forms of cholecystitis?

3. What are the manifestations of cholecystitis?

4. Where is the pain localized in attack of cholecystitis?

5. When does the pain grow worse in acute cholecystitis?

6. Where can the pain irradiate in case of acute cholecystitis?

Exercise 6.Memorize the meaning of the following term-elements: