Gallbladder pain is an emergency

Inflammation of the gallbladder

Inflammation of the gallbladder(Cholecystitis): Acute or chronic recurrent (recurrent) inflammation of the gallbladder, with gallstones in 90% of cases. Acute gallbladder inflammation (acute cholecystitis) is accompanied by severe pain on the right side and is treated with painkillers, antibiotics and removal of the gallbladder within 24 hours. Chronic (recurrent) gallbladder inflammation often occurs as a consequence of the acute illness and causes varying, but usually less pronounced, symptoms. Here, too, removal of the gallbladder is recommended.

Leading complaints

Acute gallbladder inflammation

  • Persistent pain in the right upper abdomen, radiating to the right shoulder
  • Fever and chills.

When to the doctor

Immediately if

  • severe pain in the upper abdomen, fever and chills occur.

The illness

Acute gallbladder infections

At 90%, gallstones are by far the most common cause of acute gallbladder inflammation. This is because stones trapped in the bile ducts prevent the bile from flowing into the duodenum. The bile congestion (cholestasis) favors the colonization of the gallbladder with ascending intestinal bacteria such as Escherichia coli or Klebsiella. Acute inflammation of the gallbladder therefore usually occurs as a result of biliary colic, in which the biliary tract is blocked by gallstones.

The acute form involves severe pain in the right upper abdomen, often with nausea, vomiting, fever and chills. If bacteria settle in a bile duct blocked by a gallstone, it often leads to acute inflammation of the bile ducts (acute purulent cholangitis).

Shock gall bladder. A rare form of acute gallbladder inflammation is shock or Stress gall bladder (ischemic cholecystitis) as a result of a lack of oxygen with insufficient blood circulation. Reduced blood flow and a lack of oxygen in the gallbladder wall favor the immigration of germs and gallbladder inflammation develops with symptoms similar to those of the stone-related form. The shock gallbladder is caused by serious illness, multiple trauma and operations. Occasionally, gallbladder inflammation of this type also develops in patients who are fed via infusions. The reason for this is the bypassing of the normal digestive process, which leads to a reduced blood flow to the gallbladder and a thickening of its secretion.

Chronic gallbladder inflammation

If the acute inflammation is not adequately treated, it sometimes turns into chronic gallbladder inflammation. Chronic gallbladder inflammation often causes little or no symptoms. Occasionally, however, severe upper abdominal pain, nausea and even fever return over time - this is then considered a relapse of an acute gallbladder inflammation (chronic recurrent form). In some cases, the chronic form is caused by asymptomatic gallstones.

Complications

In acute gallbladder inflammation, there is a risk of serious complications such as gallbladder hydrops (an enlarged gallbladder due to bile drainage disorders in the area of ​​the gallbladder neck), gallbladder empyema (a gallbladder filled with pus) and a perforation with subsequent peritonitis. This necessitates an emergency operation, which is far more dangerous than a planned operation if there are no symptoms.

The main danger with the chronic form is the shrinking of the gallbladder (shrinking gallbladder). This increases the risk of developing gallbladder cancer. The same applies to the so-called porcelain gallbladder, i.e. when calcium deposits in the gallbladder wall due to chronic inflammation.

Diagnostic assurance

The typical complaints in connection with severe pressure pain and immune tension during the physical examination are often sufficient for the doctor to diagnose acute gallbladder inflammation. Further examinations then confirm the diagnosis and help to find the best therapeutic approach.

The most important procedures include ultrasound of the abdomen, the laboratory (liver and gallbladder values ​​such as transaminases, gamma-GT and bilirubin, signs of inflammation such as CRP, as well as blood count and coagulation values) and, if stones in the bile duct are suspected, the ERCP, i.e. an examination of the bile ducts with the help of a camera and X-ray contrast medium, which is injected directly into the duct system through a tube inserted into the mouth into the duodenum. In unclear cases, the doctors also order a computed tomography or MRI of the abdominal cavity.

Differential diagnoses. Increasing, severe, dull pain in the abdomen and fever also cause acute pancreatitis and appendicitis.

CT scan of a 58-year-old patient with acute gallbladder inflammation. Because the previous biliary colic occurred while on vacation, it was only treated with painkillers. The finding surprised the doctors twice: on the one hand, the gall bladder had already broken through (luckily, however, not into the abdominal cavity, but towards the liver side, so that the peritonitis did not occur), and on the other hand, it did not show the expected gallstones, but rather tumor parts (arrows) turned out to be gallbladder cancer.
Georg Thieme Verlag, Stuttgart

treatment

Today, doctors usually remove the gallbladder within 24 hours. This operation is called cholecystectomy, is performed laparoscopically and is a routine procedure with a very low rate of complications. At the same time, the patient is given antibiotics and pain relievers to reduce inflammation and pain.

Doctors only refrain from an immediate operation in the case of seriously ill patients with a high risk of surgery. These patients are cared for conservatively with antibiotics and painkillers under close supervision. However, if complications such as gallbladder hydrops or gallbladder perforation appear, doctors have to intervene surgically despite the high surgical risk, either with a laparoscopic operation or an open abdominal incision.

Chronic gallbladder inflammation also requires surgical removal of the gallbladder. Here, however, the doctor and patient have time for an operation outside of inflammatory episodes.

forecast

Normal gallbladder removal is a routine surgery with a very low mortality rate below 0.1%. Complications such as bleeding or injuries to the bile duct are very rare. Complications are more likely to occur in patients in poor general condition, as well as when it comes to emergency surgery, e. B. due to a gallbladder perforation.

Your pharmacy recommends

Do not use warm applications such as hot water bottles or heat pillows on your stomach. In the case of gallbladder inflammation, local heat is not only useless but also harmful because it further heats the inflammation.

Diet after gallbladder removal

  • Help your body adapt to the changed conditions resulting from a life without a gallbladder: A special diet is not necessary, but foods that are difficult to digest should be avoided for the first 14 days. These include legumes, foods that are very high in fat, or spicy fried foods.
  • Drink enough, about 1–1.5 liters a day. You can easily tell whether you have drunk enough by the color of your urine: it should be light yellow. Dark yellow urine indicates that you are not drinking enough.
  • A low-fiber diet helps with flatulence and diarrhea. B. Macrogol. Contact your family doctor if you experience long-term digestive disorders.

Authors

Dr. med. Arne Schäffler, Dr. Bernadette Andre-Wallis in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 09:17


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.