From the Guidelines
Cholecystitis is a serious condition that requires prompt medical attention, and the most effective treatment is early laparoscopic cholecystectomy, as recommended by the most recent guidelines 1.
Causes and Risk Factors
Cholecystitis is primarily caused by gallstones obstructing bile flow, but can also be due to infections or tumors. Risk factors include:
- Obesity
- High-fat diet
- Rapid weight loss
- Pregnancy
- Certain medications (e.g., oral contraceptives)
- Genetic predisposition
Preventive Measures
To reduce the risk of developing cholecystitis:
- Maintain a healthy weight
- Eat a balanced diet low in saturated fats
- Exercise regularly
- Avoid rapid weight loss
Signs and Symptoms
Common signs and symptoms of cholecystitis include:
- Severe pain in the upper right abdomen
- Fever and chills
- Nausea and vomiting
- Abdominal tenderness
- Jaundice (in severe cases)
Diagnosis
Ultrasound is the first-line imaging modality for suspected cholecystitis, with a high accuracy rate for detecting gallstones and gallbladder inflammation 1.
Treatment
Early laparoscopic cholecystectomy is the recommended treatment for acute cholecystitis, as it offers a shorter recovery time and lower risk of complications compared to delayed surgery 1. For uncomplicated cholecystitis:
- Early laparoscopic cholecystectomy within 7-10 days of symptom onset
- One-shot prophylaxis with antibiotics
- No post-operative antibiotics
For complicated cholecystitis:
- Laparoscopic cholecystectomy with open cholecystectomy as an alternative
- Antibiotic therapy for 4-7 days based on clinical conditions and inflammation indices
- Cholecystostomy may be considered for patients with multiple comorbidities and unfit for surgery
Management of Intra-Abdominal Infections
The Italian Council for the Optimization of Antimicrobial Use recommends early treatment with laparoscopic or open cholecystectomy, and antibiotic therapy for no more than 7 days 1.
From the Research
Causes and Risk Factors
- Acute cholecystitis is usually caused by gallstone-associated cystic duct obstruction, responsible for 90% to 95% of cases 2
- Acalculous cholecystitis, defined as acute inflammation of the gallbladder without gallstones, typically occurs in the setting of severe critical illness and accounts for approximately 5% to 10% of cases 2
- Obstruction of the cystic duct is the primary cause of acute cholecystitis, but research suggests that there are other contributing factors beyond just obstruction alone 3
Preventive Measures
- No specific preventive measures are mentioned in the provided studies, but early treatment of gallstones and other gallbladder diseases may help prevent the development of acute cholecystitis
Signs and Symptoms
- Typical presentation of acute cholecystitis includes acute right upper quadrant pain, fever, and nausea that may be associated with eating 2
- Physical examination findings may include right upper quadrant tenderness and a positive Murphy's sign, although some cases may present with atypical radiologic or laboratory findings 3
- Congestion and edema are evident symptoms during the first 2-4 days of acute cholecystitis, followed by necrotizing cholecystitis, and eventually suppurative cholecystitis if left untreated 4
Treatment Options
- Laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis and is associated with improved patient outcomes, including fewer composite postoperative complications and a shorter length of hospital stay 5, 2, 6
- Early laparoscopic cholecystectomy, performed within 1-3 days of diagnosis, is recommended for most patients, including those who are pregnant or older than 65 years of age 2, 6
- Percutaneous cholecystostomy tube placement is an effective therapy for patients with exceptionally high perioperative risk, but is associated with higher rates of postprocedural complications compared to laparoscopic cholecystectomy 2