Cholecystitis - Medical Malpractice Lawyers

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Cholecystitis - Medical Malpractice

Cholecystitis is an inflammation and infection of the gallbladder that often occurs as a result of blockage of the cystic duct that leads from the gallbladder to the common bile duct. The most common cause of this blockage is cholelithiasis or gall stones. About ninety percent of all cases of cholecystitis occur because of stones in the cystic duct. Ten percent of cholecystitis cases are due to acalculous cholecystitis or cholecystitis without any gallstone present.

Risk factors for cholecystitis include being of a female gender, being of an increased age, being of certain ethnic groups, having rapid weight loss or obesity, certain drugs and being pregnant. There are bacteria in the bile cultures in about 50-75 percent of cases, which may be due to the cholecystitis or the cause of the cholecystitis. In acalculous cholecystitis, there tends to be sludge in the gallbladder instead of an actual gallstone. This can happen in cases of debilitation, severe trauma, major surgery, septic conditions, and long term parenteral nutrition. Prolonged fasting can cause acalculous cholecystitis as well.

About ten to twenty percent of people have gallstones but only about a third of these folks will develop cholecystitis from their stones. There are approximately 500,000 cholecystectomies done in the US each year due to cholecystitis. The number of procedures increases with age and is worse in postmenopausal women. Two to three times more women get the disease when compared to men. It is more common in those of Scandinavian descent as well as with those who are Hispanic. Whites have a higher rate of cholecystitis when compared to blacks.

If the cholecystitis is uncomplicated, the prognosis is excellent and the mortality rate with or without surgery is extremely low. Perforation of the gallbladder and gangrene of the gallbladder have a worse prognosis. About 25 to 30 percent of people need surgery or have some kind of severe complication of their cholecystitis.

The main symptoms of cholecystitis are right upper quadrant abdominal pain, although some people can have other kinds of pain, such as chest pain or central abdominal pain. There may be a rapid heartbeat, fever and tenderness in the abdomen, particularly in the right upper quadrant. The longer it takes to diagnose the cholecystitis, the worse the outcome can be and the greater the incidence of morbidity and mortality from the condition.

The diagnosis of cholecystitis comes from blood testing showing abnormal liver function studies and an elevated white blood cell count. An ultrasound of the gallbladder can show thickening of the gallbladder walls along with the presence of gallstones. There may be widening of the gallbladder and bile ducts due to blockage of the ducts. A CT scan or MRI scan of the gallbladder may be able to show the possibility of perforation or gangrene of the gallbladder. A laparoscopic evaluation can show the appearance of the gallbladder and can be used to remove the gallbladder at the time of the evaluation.

The initial treatment of the acute cholecystitis involves resting the bowels, giving IV fluids and correcting any electrolyte disturbances that may be present. Antibiotics can be given to settle down the infection of the gallbladder. Pain control is important as well. After this has been accomplished, an open or laparoscopic cholecystectomy can be done to remove the gallbladder and clean out any infection. Most of the time, the laparoscopic cholecystectomy is performed over the open cholecystectomy unless there is severe perforation or damage to surrounding tissues.

In acalculous cholecystitis, there is no obvious obstruction of the gallbladder but the gallbladder is still inflamed and infected, in some cases. This is harder to diagnose but an ultrasound or CT scan of the abdomen can show thickened walls of the gallbladder in the absence of a gall stone. It is still treated with doing a laparoscopic cholecystectomy and using antibiotics.

The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here