CHOLECYSTITIS

Definition

• Inflammation of the gallbladder, can be acute or chronic.
• Usually caused by obstruction of the cystic duct (commonly by gallstones).

Types

• Acute Cholecystitis: Sudden onset, usually gallstone-related.
• Chronic Cholecystitis: Long-standing inflammation, often due to repeated episodes.
• Acalculous Cholecystitis: Without gallstones, due to infections, ischemia, trauma.
• Empyema of Gallbladder: Pus accumulation in gallbladder, usually bacterial.

Causes

• Gallstone-related: obstruction, infection, gallstone formation.
• Acalculous: infections, ischemia, trauma, immune disorders, medications.
• Other: trauma to gallbladder, bile stasis.

Pathology

• Obstruction of cystic duct → bile stasis → inflammation → edema and congestion.
• Bacterial infection may supervene (E. coli, Klebsiella, Enterococcus).
• Chronic inflammation → fibrosis and thickening of gallbladder wall.
• Complications: gangrene, perforation, empyema.

Clinical Features

• Pain: Right upper quadrant, may radiate to right shoulder/back.
• Fever and chills
• Nausea and vomiting
• Jaundice: yellow skin and eyes, dark urine, pale stools.
• Murphy’s sign: tenderness and inspiratory arrest on palpation of gallbladder.
• Abdominal tenderness and guarding

Investigations

• Lab Tests: CBC (leukocytosis), LFTs (bilirubin, ALP), CRP.
• Ultrasound: first-line imaging; gallstones, thickened wall, pericholecystic fluid.
• CT Scan: complex cases, complications.
• ERCP: visualization of bile ducts, stone removal if needed.

Complications

• Gangrene of gallbladder
• Perforation → biliary peritonitis
• Empyema
• Sepsis

Management

Conservative

• Fluid resuscitation
• Pain control (analgesics)
• Antibiotics (if infection suspected)
• NPO (nil per oral) initially

Surgical

• Cholecystectomy: definitive treatment (open or laparoscopic)
• ERCP: for stone removal or biliary drainage in select cases

Blood Supply

• Cystic artery (main)
• Hepatic artery branches (supportive)

Nerve Supply

• Phrenic nerve
• Vagus nerve

Clinical Anatomy

• Gallbladder: sac-like organ storing bile
• Cystic duct: connects gallbladder to common bile duct
• Common bile duct: carries bile to duodenum

Homoeopathic Therapeutics

• Arsenicum album: pain, nausea, vomiting
• Belladonna: pain, fever, inflammation
• Chelidonium majus: pain, nausea, jaundice
• Gelsemium: weakness, fatigue
• Lachesis: pain, inflammation, infection