Treatment of Cholecystitis

The treatment of acute cholecystitis should be done in a hospital in order to ensure that the diagnosis is correct. There are three main approaches to the treatment of gallstones including expectant management, surgical and non-surgical removal of the stones.

If the person has gallstones but doesn’t have any symptoms, a "wait and see" (expectant management) approach can be taken. In such patients, the risks of nonsurgical and surgical treatment of gallstones dwarf the benefits. There are exceptions to this approach when the patient is at risk of complications:

• The patient has a familial history of gallbladder cancer;
• The patient has a Native American ethnicity;
• If the gallstones are larger than 3cm in diameter.

Moreover, one study has shown that small gallstones (under 5mm in diameter) create a risk of acute pancreatitis (a very serious complication), which warrants an immediate surgery.

Since the gallstones increase the risk of cancer of the gallbladder, it is advised for the young people with gallstones to have their gallbladder surgically removed, even if the gallstones do not create any discomfort.

Management of gallstones

After the patient was hospitalized with an abdominal pain and was diagnosed with gallstones, there are a number of approaches that can be taken depending on the clinical picture:

• If the patient doesn’t have severe pain, complications, and the test results are normal. The patient can be sent home with pain relievers and antibiotics.
• If the patient suffers from severe pain, but there is no infection. A patient whose test results indicate the presence of gallstones but there are no sign of inflammation goes through the following treatment:
  1. If the pain is severe, intravenous painkillers are given to the patient. Meperidine, ketorolac, or opioids can be used for this procedure.
  2. The patient has the option to have the gallbladder removed.
  3. Lithotripsy can be used. Lithotripsy is a technique of breaking down stones using an endoscope. This technique works well if the stones are not larger than 2cm in diameter.
  4. If the stones are very small a special drug treatment can be used to dissolve the gallstones. However, this treatment is contraindicated for patients who have inflammation of the gallbladder or if the stones are located in the common bile duct, since delaying the surgery could be fatal.
• If the patient suffers from severe pain, and there is infection in the gallbladder. This condition is known as acute cholecystitis (inflammation of the gallbladder). The first step of treatment of acute cholecystitis is "resting" the gallbladder, which reduces the inflammation. The following treatments are usually involved:
  1. Fasting – since the food triggers the secretion of pancreatic enzymes and bile, it will only increase the pressure within the gallbladder, worsening the condition of the patient.
  2. Intravenous fluids and oxygen therapy – intravenous fluids allow for the toxins that circulate within the bloodstream to be quicker expelled by the kidneys. Oxygen therapy increases the oxygen content within the bloodstream which helps reduce the damage to gallbladder caused by hypoxia.
  3. Intravenous painkillers – include meperidine and indomethacin. Not only do they lessen the pain, they also cause the inflammation to subside. Morphine can also be used if the pain the very severe, however, some doctors advise against it.
  4. Intravenous antibiotics – are needed to treat the infection within the gallbladder and reduce the inflammation, preventing possible complications. For example, a third-generation (and above) cephalosporin can be used in combination with nitroimidazole antibiotic. Such combination of antibiotics should be administered every 8 hours intravenously to achieve optimal result.
  5. Surgical removal of the gallbladder – infected gallbladder is almost always surgically removed in order to prevent possible complications, including perforation, abscess, gangrene, etc. Timing is crucial, since an untreated infected gallbladder can cause peritonitis wish poses a serious danger to the patient’s life.
• Gallstone-associated pancreatitis. The patient that develops a gallstone-associated pancreatitis, in almost all cases, requires an open or laparoscopic surgery to remove the gallbladder.
• Common duct stones. If the tests indicate that the stones have obstructed the common bile duct, the doctor may perform endoscopic retrograde cholangiopancreatography in order to verify the diagnosis and then remove the stones. This is an urgent procedure, since procrastination can lead to pancreatitis and post-hepatic jaundice.