Cholecystitis

Cholecystitis is inflammation of the gallbladder, a small organ near the liver that plays a part in digesting food. Normally, fluid called bile passes out of the gallbladder on its way to the small intestine. If the flow of bile is blocked, it builds up inside the gallbladder, causing swelling, pain, and possible infection. A gallstone stuck in the cystic duct , a tube that carries bile from the gallbladder, is most often the cause of sudden (acute) cholecystitis. The gallstone blocks fluid from passing out of the gallbladder. This results in an irritated and swollen gallbladder. Infection or trauma, such as an injury from a car accident, can also cause cholecystitis. Acute acalculous cholecystitis, though rare, is most often seen in critically ill people in hospital intensive care units. In these cases there are no gallstones. Complications from another severe illness, such as HIV or diabetes, cause the swelling. Long-term (chronic) cholecystitis is another form of cholecystitis. It occurs when the gallbladder remains swollen over time, causing the walls of the gallbladder to become thick and hard. Symptoms The most common symptom of cholecystitis is pain in your upper right abdomen that can sometimes move around to your back or right shoulder blade. Other symptoms include:

Nausea or vomiting. Tenderness in the right abdomen. Fever. Pain that gets worse during a deep breath.

Pain for more than 6 hours, particularly after meals. Older people may not have fever or pain. Their only symptom may be a tender area in the abdomen.

Cholelithiasis

A gallstone is a crystalline concretion formed within the gallbladder by accretion of bile components. These calculi are formed in the gallbladder, but may pass distally into other parts of the biliary tract such as the cystic duct, common bile duct, pancreatic duct, or the ampulla of Vater. Presence of gallstones in the gallbladder may lead to acute cholecystitis, an inflammatory condition characterized by retention of bile in the gallbladder and often secondary infection by intestinal microorganisms, predominantly Escherichia coli and Bacteroides species. Presence of gallstones in other parts of the biliary tract can cause obstruction of the bile ducts, which can lead to serious conditions such as ascending cholangitis or pancreatitis. Either of these two conditions can be lifethreatening, and are therefore considered to be medical emergencies.

Symptoms Most people with gallstones do not have symptoms. Gallstones most frequently make their presence known when they become lodged in one of the ducts that carry bile, a digestive juice, from the liver to the small intestine. When such an obstruction occurs, you might experience the following:

Severe and sudden pain in the upper right abdomen and possibly extending to the upper back Fever and shivering Severe nausea and vomiting Jaundice (yellowing of the skin or eyes) Clay colored stools or dark urine

CHOLECYSTECTOMY

Cholecystectomy is the surgical removal of the gallbladder. It is the most common method for treating symptomatic gallstones. Surgical options include the standard procedure, called laparoscopic cholecystectomy, and an older more invasive procedure, called open cholecystectomy.

Definition A cholecystectomy is the surgical removal of the gallbladder. The two basic types of this procedure are open cholecystectomy and the laparoscopic approach. It is estimated that the laparoscopic procedure is currently used for approximately 80% of cases. Purpose A cholecystectomy is performed to treat cholelithiasis and cholecystitis. In cholelithiasis, gallstones of varying shapes and sizes form from the solid components of bile. The presence of stones, often referred to as gallbladder disease, may produce symptoms of excruciating right upper abdominal pain radiating to the right shoulder. The gallbladder may become the site of acute infection and inflammation, resulting in symptoms of upper right abdominal pain, nausea and vomiting. This condition is referred to as cholecystitis. The surgical removal of the gallbladder can provide relief of these symptoms. Precautions Although the laparoscopic procedure requires general anesthesia for about the same length of time as the open procedure, laparoscopy generally produces less postoperative pain, and a shorter recovery period. The laparoscopic procedure would not be preferred in cases where the gallbladder is so inflamed that it could rupture, or when adhesions (additional fibrous bands of tissue) are present. Description The laparoscopic cholecystectomy involves the insertion of a long narrow cylindrical tube with a camera on the end, through an approximately 1 cm incision in the abdomen, which allows visualization of the internal organs and projection of this image onto a video monitor. Three smaller incisions allow for insertion of other instruments to perform the surgical procedure. A laser may be used for the incision and cautery (burning unwanted tissue to stop bleeding), in which case the procedure may be called laser laparoscopic cholecystectomy. In a conventional or open cholecystectomy, the gallbladder is removed through a surgical incision high in the right abdomen, just beneath the ribs. A drain may be inserted to prevent accumulation of fluid at the surgical site. Preparation As with any surgical procedure, the patient will be required to sign a consent form after the procedure is explained thoroughly. Food and fluids will be prohibited after midnight before the procedure. Enemas may be ordered to clean out the bowel. If nausea or vomiting are present, a suction tube to empty the stomach may be used, and for laparoscopic procedures, a urinary drainage catheter will also be used to decrease the

risk of accidental puncture of the stomach or bladder with insertion of the trocar (a sharp-pointed instrument).

Common bile duct (CBD) exploration

The CBD is a tube connecting the liver, gallbladder, and pancreas to the small intestine that helps deliver fluid to aid in digestion. The CBD exploration is a procedure used to see if a stone or some obstruction is blocking the flow of bile from your liver and gallbladder to your intestine. When is it used? If a stone or obstruction is blocking the CBD, bile can back up into the liver causing jaundice. Jaundice is when the skin and white of the eyes become yellow. The CBD might become infected and require emergency surgery if the stone or blockage is not removed. This procedure can be done during the removal of the gall bladder. An alternative would be an ERCP (Endoscopic retrograde cholangiopancreatogram) or not having treatment. You should discuss these options with your doctor.

Preparation for CBD exploration Eat light the day before Have nothing to eat or drink after midnight Take only medicines as instructed the morning of surgery

During the procedure General anesthesia relaxes your muscles and puts you into a deep sleep, so you will feel no pain. The doctor will make a small incision in the abdomen, locate the CBD, and inject a dye into the duct. Your doctor will then take an X-ray, which will show where the stone or obstruction is located. If stones are found, the doctor will make a cut into the duct and remove them. A tube might be inserted into the duct and out the skin to drain bile into a bag. The bag will remain in place anywhere from seven days to many weeks. The doctor might repeat the dye procedure before removing your tube. Post operation instructions You will be required to stay in the hospital for one to four days. You will also be asked to avoid strenuous activity for four to six days, and will require a follow-up visit with your doctor. Benefits of CBD exploration The surgery should alleviate your discomfort and will decrease the chance of infection and jaundice. Risks As with any surgery there are risks, although minimal:

Complications of general anesthesia Swelling or scarring of the duct Bile leak Bleeding Infection Call the doctor if Immediately call your doctor if you have any of the following symptoms: Increased abdominal pain Soreness, redness, warmth, or drainage around the wound Nausea and vomiting Fever