Acute cholecystitis refers to the inflammation of the gallbladder, a small pear-shaped organ positioned below the liver whose function is to store bile. If acute cholecystitis is suspected, it is advisable to seek treatment promptly from a general surgeon to prevent potentially life-threatening complications.
What causes acute cholecystitis?
Stones in the gallbladder can lead to acute cholecystitis.
Calculus Cholecystitis: The most common cause of acute cholecystitis is calculous cholecystitis, also known as cholelithiasis. Gallstones form in the tube where bile travels in and out from the gallbladder. The presence of gallstones disrupts the natural flow of bile within the gallbladder, leading to elevated pressure levels and the possibility of inflammation within the gallbladder.
Acalculous Cholecystitis: This uncommon condition is defined by the inflammation of the gallbladder without gallstones. The exact cause of acalculous cholecystitis is unknown. However, it usually stems from complications of more serious diseases such as HIV and diabetes, or the result of other infections, or tumours in the gallbladder.
What are the symptoms of acute cholecystitis? Is acute cholecystitis painful?
Besides persistent abdominal pain, there are also other symptoms that can indicate acute cholecystitis.
Pain: The main symptom of acute cholecystitis is a sudden, sharp, persistent pain, that may occur in the upper-right quadrant of the abdomen, or pain that may radiate towards the right side of the shoulder.
Fever: The body's immune response to inflammation in the gallbladdercan lead to an elevated body temperature and chills.
Nausea and vomiting: A feeling of discomfort or queasiness in the stomach, often leading to an inclination to vomit. This is often accompanied by bitterness in the mouth.
Jaundice: Patients may also experience yellowing of their skin or the whites of their eyes (sclera), along with diarrhoea (loose stools).
Who is at risk of acute cholecystitis in Singapore?
Individuals in Singapore with the following predisposing factors are more prone to developing acute cholecystitis:
Family History: A family history of gallbladder disease increases susceptibility.
Obesity: Being overweight or obese elevates the risk due to increased cholesterol levels and bile secretion.
Old Age: Advanced age, particularly over 60 years, raises the likelihood of acute cholecystitis.
Female Gender: Women are more prone to cholecystitis, potentially due to hormonal factors.
Pregnancy: Pregnancy can lead to hormonal changes and increased pressure on the gallbladder, increasing the risk.
Hormone Therapy: Certain hormone therapies, like estrogen replacement therapy, may heighten the risk.
Rapid Weight Changes: Swift weight loss or gain can disrupt gallbladder function, predisposing individuals to cholecystitis.
Our General Surgeon can conduct screening assessments to identify those at risk, evaluate their gallbladder health through imaging tests and clinical evaluations, and provide tailored recommendations on preventive measures.
How is acute cholecystitis diagnosed?
Acute cholecystitis is diagnosed through a combination of clinical assessment and diagnostic tests:
Clinical Assessment: Doctors conduct a thorough physical examination, focusing on symptoms such as abdominal pain, tenderness, and fever. In particular, our surgeon will examine the upper right abdomen for the Murphy's Sign (the patient abruptly stops breathing in response to pressure).
Blood Tests: Laboratory tests, including complete blood count (CBC), liver function tests (LFTs), C-reactive protein (CRP), and serum bilirubin, can help assess inflammation and liver function.
Imaging Studies:
Abdominal / Hepatobiliary ultrasound: The primary imaging modality used to visualise gallstones, gallbladder wall thickening, and pericholecystic fluid, which are characteristic findings of acute cholecystitis.
CT / MRI Scans: These may be performed for further evaluation, especially in complex or atypical presentations.During the procedure, patients will lay flat on the imaging couch and get their abdomen scanned to confirm the diagnosis and detect obstructions in the biliary system and the cause of the cholecystitis.
How serious is acute cholecystitis?
If not treated immediately, acute cholecystitis can be a life-threatening medical emergency that often results in serious complications, such as rupture of the gallbladder (walls of the gallbladder burst or leak), pancreatitis (inflammation of the pancreas) and gangrene (cell death) of the gallbladder.
Should I go to A&E with suspected acute cholecystitis?
If you suspect acute cholecystitis, we advise you to seek help from a general surgery clinic immediately or call 995 to contact a nearby hospital’s Accident & Emergency (A&E) Department. This is because timely treatment of gallbladder inflammation is necessary to prevent serious complications.
Ace Specialist Surgery and Endoscopy Clinic offers round-the-clock emergency services for acute cholecystitis cases. Patients suffering from symptoms of acute cholecystitis can seek medical attention at any time for diagnosis and intervention. You can call us any time of the day (24/7), and we will strive to schedule an appointment or urgent operation with our Endocrine and General surgeon as soon as possible.
What are the treatment options for acute cholecystitis in Singapore?
A common treatment for acute cholecystitis is removing the inflamed gallbladder through laparoscopic (key-hole) surgery.
Following a thorough evaluation, a personalised treatment plan will be proposed, precisely tailored to your unique condition.
For mild cases, non-surgical treatments, such as the prescription of intravenous and oral antibiotic regimens may help to temporarily resolve the inflammation of the gall bladder and an elective surgery can be planned subsequently.
When complications arise and for severe cases, surgery is often necessary to effectively treat acute cholecystitis. The standard treatment for acute cholecystitis is surgical removal of the gallbladder, known as cholecystectomy. The gallbladder is a non-essential organ, so most patients can live a normal life without it. However, some individuals ( < 10%) may experience dietary adjustments and minor digestive changes initially for some weeks.
Laparoscopic Cholecystectomy Surgery
Laparoscopic Cholecystectomyis a minimally invasive surgical procedure where the surgeon removes the gallbladder by just performing a few small incisions into the patient's abdomen.
This is usually the preferred option as there is a shorter recovery time and less scarring for the patient, as compared to Open Cholecystectomy.
Open Cholecystectomy Surgery
Occasionally Surgeons might switch from Laparoscopic Cholecystectomy to Open Cholecystectomy for safety reasons under certain circumstances, for example, extensive bleeding, extensive inflammation or difficult anatomy.
Open Cholecystectomy refers to the traditional method of removing the gallbladder, where the surgeon performs an approximately 15-centimetre incision in the abdomen. After that, the patient's muscle and tissue are pulled back for the surgeon to reveal the gallbladder for removal.
Summary
In conclusion, acute cholecystitis, the inflammation of the gallbladder, is a medical emergency. This is because the serious condition often results in life-threatening complications if left untreated. Patients with acute cholecystitis should seek urgent medical attention as soon as possible to prevent complications.
Visit Ace Specialist Surgery and Endoscopy Clinic
Ace Specialist Surgery and Endoscopy Clinic is experienced and committed to seeing emergency cases. If you have symptoms of acute cholecystitis and require immediate attention, call us anytime, day or night, and we will promptly schedule an appointment or urgent surgery with our Senior Consultant Endocrine and General Surgeon, Dr Reyaz Singaporewalla, as soon as possible. Dr Reyaz has over 25 years of experience in general and endocrine-head neck surgery and has undergone rigorous training in minimally invasive and laparoscopic surgery. Importantly, having helped numerous patients recover from gallbladder inflammation, he is a veteran surgeon well-versed in laparoscopic cholecystectomy.
Frequently Asked Questions:
Can acute cholecystitis be prevented?
Preventing acute cholecystitis largely involves maintaining a healthy lifestyle:
Healthy Diet: Consuming a balanced diet low in fat and cholesterol can help reduce the risk of gallstone formation, a common cause of acute cholecystitis.
Gradual Weight Loss: If overweight, losing weight gradually and avoiding crash diets can help prevent gallstone formation.
Regular Physical Activity: Engaging in regular physical activity can aid in weight management and promote overall health, which may reduce the risk of gallstone formation.
Moderate Alcohol Consumption: Limiting alcohol intake may also help reduce the risk of gallstone formation and subsequent acute cholecystitis.
How long does acute cholecystitis last?
Acute cholecystitis commonly persists for a period of 2 to 3 days in most instances. However, the duration of symptoms can vary from individual to individual.
Can acute cholecystitis recur after treatment?
Yes, acute cholecystitis can still recur after treatment, especially if underlying conditions like gallstones are not adequately addressed. Recurrence rates vary depending on factors such as the effectiveness of treatment and the presence of predisposing factors like gallstone disease.
