Gallbladder Inflammation

Definition

Gallbladder inflammation is the inflammatory damage to the walls of the gallbladder. This condition is considered one of the most common diseases in the digestive system. According to statistics, approximately 20% of adults face this disease, with women over 40 years of age being predominant among the affected individuals.Gallbladder inflammation is associated with a decrease in the movement of bile ducts and changes in the characteristics of bile. Stagnation cases increase pressure inside the gallbladder, leading to damage to the blood supply to the organ’s walls. As a result, inflammation occurs, along with a decrease in its ability to contract, fluid resorption processes, and weakened defensive functions.

About the Disease
Under conditions of increased pressure inside the gallbladder vein, infections can penetrate the walls. The inflammatory changes exacerbate the situation, further increasing the internal pressure of the gallbladder. Tissue decay conditions are conducive to tectonic, ulcerative, and purulent changes in the walls. Organ damage exposes it to abdominal poisoning and death.
Types:

1. Calculous cholecystitis: Caused by changes in the characteristics of bile, stone formation, and blockage of the ducts by stones.
2. Non-calculous cholecystitis: Inflammation occurs due to the penetration of parasites into the gallbladder, enzyme activity disorders, vascular diseases, and decreased blood supply to the gallbladder walls.

Based on the characteristics of disease progression, gallbladder inflammation can be divided into:

• Acute: Characterized by acute symptoms and clear signs of poisoning and inflammatory processes.
• Chronic: Characterized by an intermittent course with periods of exacerbation and improvement; symptoms are often unclear.

Another classification of gallbladder inflammation is based on the type of inflammatory process, including:

• Phlegmonous cholecystitis: Characterized by swelling of the gallbladder walls, fluid accumulation, and duct narrowing.
• Purulent cholecystitis: Accompanied by purulent changes.
• Gangrenous cholecystitis: Leads to tissue necrosis (damage).
• Destructive cholecystitis: Characterized by the appearance of ulcerative lesions and perforations in the organ walls.

Based on the severity of symptoms, chronic cholecystitis can manifest in three forms:

1. Mild: Episodes occurring twice a year, accompanied by moderate pain that improves spontaneously.
2. Moderate severity: Disease exacerbation three times a year, with severe pain and digestive disturbances lasting for 3-4 weeks.
3. Severe: Disease exacerbation more than 3 times a year, with long periods exceeding a month, accompanied by clear symptoms. Traditional treatment is of limited effectiveness and may be associated with liver and pancreatic inflammation.

Symptoms of acute cholecystitis include:

• Severe pain on the right side (radiating to the shoulder and neck).
• Weakness.
• Excessive sweating.
• Sleep disturbances.
• Bitter taste with gall.
• Nausea and vomiting (with gall).
• Elevated body temperature.
• Tremor.

In the case of calculous form, when stones develop and block the ducts, jaundice (yellowing of the skin and mucous membranes) can occur. Unhealthy diet, psychological stress, intense physical activities, and excessive alcohol consumption exacerbate the attacks.

In the chronic form of the disease, during the quiet stage, there are no symptoms. Some patients complain of intermittent dull pain on the right side under the ribs, digestive disturbances, and bloating. The exacerbation stage of chronic cholecystitis is accompanied by symptoms resembling those in acute form.

The main causes of gallbladder inflammation are:

1. Biliary colic disease: Duct blockage by stones leads to difficulty in bile drainage, causing injury to the gallbladder walls and excessive dilation, sometimes obstructing the gallbladder passage.
2. Congenital factors: Malformations in bile drainage with bends, adhesions, or abnormal narrowing.
3. Motor disorders: Disharmony in gallbladder drainage leads to incomplete emptying of the gallbladder and contributes to stone formation.
   When bile congestion occurs, an ideal scenario is formed for the penetration and proliferation of microbes in the gallbladder. Harmful organisms (bacteria, parasites) can enter the organ from the intestines. In some rare cases, harmful organisms may infiltrate through the blood or lymph from areas affected by chronic inflammation.

The likelihood of developing gallbladder inflammation increases in women during pregnancy and with the onset of menopause. The risk group also includes those with unhealthy dietary habits, alcohol consumption, and smoking.

Disease Diagnosis:

A gastroenterologist establishes the initial diagnosis based on the patient’s complaints, medical history, and physical examination findings. A comprehensive examination helps identify the causes and type of gallbladder inflammation, aiding in selecting an effective treatment strategy. Laboratory diagnosis includes:

1. Complete blood count: To assess the extent of systemic inflammation.
2. Biochemical analysis: To evaluate the condition of other internal organs.
3. Microscopic analysis of bile: To determine its characteristics and detect inflammatory-causing organisms.
   The primary method for diagnosing the disease is ultrasound examination (ultrasonography) of the gallbladder. During the examination, the doctor evaluates the organ’s size, wall condition, checks for stones, and assesses duct integrity. In cases of diagnostic uncertainty with ultrasonography, computed tomography imaging with contrast intake is performed, allowing for a detailed study of the gallbladder, surrounding organs, the extent of inflammatory and ischemic processes.

Treatment Methods for Gallbladder Inflammation:

Selecting a treatment method for gallbladder inflammation in adults depends on the underlying cause of the disease, symptom severity, and the presence or absence of signs of damage to other organs, especially the pancreas. All procedures aim to stop inflammation, improve bile drainage, and prevent disease recurrence. In complex cases, where there is a threat to the patient’s life, or traditional treatment is ineffective, surgery is performed.
Traditional treatment for gallbladder inflammation: During the acute phase, treatment is carried out in the hospital under specialist supervision. The doctor prescribes pain relievers, anti-inflammatory drugs, antispasmodics, and antibiotics. After alleviating acute inflammation, medications that restore bile properties and flow to their normal state are used, relieve gallbladder wall tension, and contain vitamins.
As 85-95% of patients with chronic gallbladder inflammation have stones (a calculous form) of the disease, associated with the development of serious complications, gallbladder removal is the only possible and most effective way to prevent this. Finally.
A significant role is assigned to the diet to calm the inflammatory process, including frequent small meals. Alcohol and all harmful substances (sauces, fast food, sweets) are excluded from the diet. To achieve stabilization, it is preferable to drink mineral water. In the case of chronic gallbladder inflammation, the patient must adhere to a diet continuously and undergo biannual check-ups.
Surgical treatment for gallbladder inflammation: Surgical treatment is required for chronic calculous gallbladder inflammation, as well as the non-calculous type carrying high risks of complications. Gallbladder removal (cholecystectomy) can be performed via traditional “open” method or laparoscopically. Minimal shock procedures involve entry through several points in the anterior abdominal wall. Doctors review the gallbladder and surrounding organs using an optical device, then proceed to remove the gallbladder. Minimal shock procedures provide good cosmetic results, minimal blood loss, and reduce the risk of postoperative complications. Additionally, patients leave the hospital after only 2-3 days of such procedures, with a sufficiently rapid recovery period.

References:

1. “Acute Cholecystitis. Clinical Recommendations.”
2. “Acute Calculous Cholecystitis: Recommendations of the World Society of Emergency Surgery (WSES) 2016.”
3. Prof. T.D. Zvyagintseva, Assoc. I.I. Shargorod, Kharkov Medical Academy of Postgraduate Education, Gastroenterology Department. “Chronic Acalculous Cholecystitis: Clinical Manifestations, Diagnosis, and Treatment.”