What is this?

It is the acute inflammation of the gall bladder.

Causes and risk factors

Acute cholecystitis is usually of lithiasic origin.

Signs of the disease

Acute cholecystitis is due to obstruction of the cystic duct by a calculation. The bile that is stored in the gall bladder can no longer escape. As the bile is hypertonic, it causes a water call to the vesicle which becomes turgid and inflammatory.

Processing

In rare cases, acute cholecystitis is due to another cause: diabetes, vesicle cancer, periarteritis nodosa, AIDS, trauma, etc.

Processing

The vesicular contents can become infected: we speak of pyocholecyste. The wall of the vesicle in tension may become necrotic and break. These vesicular perforations cause biliary peritonitis, subhepatic suppuration or bilio-digestive fistula with the possibility of bile ileus (intestinal occlusion).

These are usually symptoms suggestive of hepatic colic.

To this pain are associated

- A fever greater than 38 ° C

- Asthenia with anorexia

- Abdominal contracture.

The crisis lasts 2 or 3 days and heals in one week.

There is sometimes a history of hepatic colic, but sometimes it is the first sign of a biliary lithiasis.

Complementary Reviews

Ultrasound is the first-line imaging exam and confirms biliary lithiasis in almost all cases. It often triggers pain when the probe passes through the vesicle area.

The abdominal computed tomography makes it possible to make the differential diagnosis and to identify complications such as a vesicular perforation.

Blood tests show signs of infection and liver damage: increased transaminases and alkaline phosphatases, bilirubin, sometimes amylase.

Radiography of the abdomen without preparation can already show opaque calculations in the gallbladder or bile duct.

Medical treatment includes

- Diet and digestive aspiration

- Rest in bed

- Antispasmodics (atropine)

- Antibiotics.

The evolution with this medical treatment is good in general. The pain decreases, the fever disappears, the intestinal transit is re-established, the NFS returns to normal.

These are usually symptoms suggestive of hepatic colic.

To this pain are associated

- A fever greater than 38 ° C

- Asthenia with anorexia

- Abdominal contracture.

The crisis lasts 2 or 3 days and heals in one week.

There is sometimes a history of hepatic colic, but sometimes it is the first sign of a biliary lithiasis.

Emergency surgery (cholecystectomy with primary bile duct verification) is required in case of complications, or if the signs are severe, or if the signs do not go away with medical treatment.

Cholecystectomy (programmed gall bladder removal) is performed after a few days or weeks in other cases.

Surgery can be done by laparotomy or laparoscopy.