Cholecystitis Diagnosis and Treatment (Medication, Surgery)

Cholecystitis Diagnosis

Diagnosing an inflamed gallbladder (cholecystitis) may be conducted by a clinical evaluation involving a thorough case history, assessment of signs and reported symptoms and a complete blood count (elevated white blood cell count – leukocytosis). This exact cause should be confirmed by one or more imaging techniques and specific blood tests.

Imaging Techniques

Investigations like an X-ray may be useful for identifying gallstones in calculcous cholecystitis. This however will only show radio-opaque stones and a CT scan should be done even if no gallstones are found upon an X-ray. A CT scan will also help identify complications like an empyema or gallbladder perforation that may require immediate surgical intervention.

Ultrasound examination may only identify gallstones larger than 2 millimeters but is also helpful in indicating thickening of the gallbladder wall and distension of the gallbladder.

A hepatobiliary iminodiacetic acid (HIDA) scan is extremely effective in diagnosing acute cholecystitis but this is matched by a CT scan or MRI. If the facilities are available and calculous cholecystitis is suspected based on initial finding, an endoscopic retrograde cholangiopancreatography (ERCP) may be considered for better visualization of the area and removal of stones as discussed under Gallstones Removal.

The tests are discussed further under Gallbladder Tests.

Blood Tests

• Complete blood count (CBC) – leukocytosis (elevated white blood cell count)
• Liver function test (LFT) – elevated ALP (alkaline phosphatase), alanine aminotransferase (ALT), aspartate aminotransferase (AST). May also be elevated in hepatitis.
• Amylase – moderately elevated, high levels may be indicative of acute pancreatitis.
• Bilirubin – elevated in cases of bile duct obstruction

Cholecystitis Treatment

Treatment is based on the cause of cholecystitis as well as the presenting signs and symptoms.

Medication

• Analgesics (painkillers) – moderate pain : NSAIDs like acetaminophen, severe pain : opioids like pethidine.
• Antibiotics – a cephalosporin plus metronidazole in severely ill patients.
• Antiemetics – for nausea and vomiting.
• Aspiration (nasogastric) – for persistent vomiting.
• IV Hydration – to prevent dehydration in persistent vomiting and avoid oral intake of fluids

* A simple way to remember this is the five A’s – analgesics, antibiotics, antimetics, aspiration (nasogastric) and “aqua” (IV hydration).

Surgery

Laparoscopic cholecystectomy (gallbladder removal surgery) is routinely conducted as cholecystitis tends to recur. The surgery is usually performed within 72 hours of hospital admission or within 5 days from the onset of symptoms. If percutaneous gallbladder drainage is deemed necessary, a cholecystectomy may be delayed for 4 to 6 weeks.

Article reviewed by Dr. Greg. Last updated on March 28, 2012