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Diagnosis / Infected Gallbladder

Your gallbladder is a small organ that is located in the upper right portion of your abdomen, just below the liver. Its primary purpose is to store and concentrate bile, a liquid that carries toxins away from the liver via bile ducts, and into the gallbladder. The bile is then released into the small intestine, where it helps fat-soluble vitamins and nutrients to be absorbed into your bloodstream. The more concentrated the bile is, the more effective it is at digesting fat. While the function of the gallbladder is helpful, it is not essential, and can be removed without affecting your ability to properly digest food.

Acute Cholecystitis

Acute cholecystitis, or inflammation of the gallbladder, is caused by either calculous cholecystitis or acalculous cholecystitis. It is not a condition that will naturally run its course, but is potentially serious and needs to be treated.

Calculous cholecystitis is the most common type of acute cholecystitis, accounting for nearly 95 percent of cases. It develops when the cystic duct, which is the main opening of the gallbladder, becomes blocked – either by a gallstone (hardened cholesterol deposits) or a mixture of bile, salt crystals and cholesterol that form what is known as biliary sludge. The blockage causes a buildup of bile in the gallbladder, which then causes inflammation, resulting in infection and pain. Chronic inflammation in the gallbladder can eventually damage it enough so that it no longer functions correctly and needs to be removed.

Acalculous cholecystitis is less common, but often more serious than calculous cholecystitis. It develops as a complication of a serious injury, infection or illness, and is usually caused by damage to the gallbladder during surgery, sepsis (blood poisoning), severe malnutrition, or serious injuries.

Symptoms of Cholecystitis

The most frequent symptom of acute cholecystitis is a sudden sharp pain where your gallbladder is located – the upper right-hand side of your abdomen – spreading up to your right shoulder. This area may be extremely tender, and even breathing deeply can worsen the pain. You may also experience:

  • Fever
  • Sweating
  • Nausea or vomiting
  • Appetite loss
  • Abdominal bulge
  • Jaundice

The pain of acute cholecystitis is persistent, and does not go away with time, so you should contact your doctor immediately if you develop severe and sudden abdominal pain and it either lasts more than a few hours or you experience other symptoms along with it. Serious complications can occur if acute cholecystitis is not diagnosed and treated as soon as possible.

Diagnosing Acute Cholecystitis

If your main symptom is severe, persistent abdominal pain, your doctor may conduct a test known as Murphy’s sign. Your doctor will press on your abdomen, just below your rib cage, and ask you to breathe in deeply. As you breathe in, your gallbladder will move downwards, and if you feel a sudden pain when it reaches your doctor’s hand, you have cholecystitis. Further tests to diagnose acute cholecystitis may include:

  • Blood tests, to detect signs of inflammation in your body
  • Ultrasound, which is used to detect gallstones or other issues with your gallbladder
  • CT scan, MRI or x-ray, which can be used for a more detailed examination and confirm your diagnosis

Once you are diagnosed with acute cholecystitis, you will most likely need to be admitted to the hospital to undergo treatment.

Treatment of Acute Cholecystitis

Once you’re admitted into the hospital, initial treatment of acute cholecystitis will usually include:

  • Fasting, in order to reduce the strain on your gallbladder
  • IV fluids to prevent dehydration
  • Antibiotics to address suspected infection
  • Pain medication, if necessary

Once you’ve completed your initial treatment, the gallstones that may have caused your acute cholecystitis typically fall out of the duct and back into the gallbladder, and the inflammation will gradually lessen.

After your initial treatment, some patients may need surgery to remove their gallbladder, in order to prevent recurring acute cholecystitis episodes. This is known as a cholecystectomy, and reduces your risk of developing any potentially serious complications. If surgery isn’t the right option for you, your doctor may recommend a cholecystostomy, a procedure where a tube is inserted into your gallbladder to drain the fluid buildup.

Depending on your specific case, you may undergo surgery immediately, or your doctor may choose to wait until the inflammation has receded.

Possible Complications of Acute Cholecystitis

If left untreated, acute cholecystitis could result in complications that are potentially life-threatening, including:

  • Perforated (or ruptured) gallbladder, leading to an abscess or infection in your abdomen
  • Gangrenous cholecystitis, which is the dying off of gallbladder tissue, resulting in infection that can spread throughout your body

These complications may occur in about 20 percent of patients with acute cholecystitis, and can only be treated with emergency gallbladder removal surgery.

If you are experiencing sudden, persistent abdominal pain, or any other symptoms related to acute cholecystitis, it is vital that you get immediate treatment to prevent further complications. Call IVC today at 503-612-0498 and schedule an appointment with one of our interventional radiologists.

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