Diseases

Cholecystitis

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The cholecystitis (Cholecystitis) is usually triggered by gallstones. Often this leads to an infection with bacteria. In almost all cases, cholecystitis is treated by surgical removal of the gallbladder. This avoids severe complications such as pus buildup or dangerous abdominal inflammation. Read all about the causes, symptoms and treatment of gallbladder inflammation here.

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in medical reports or on incapacity certificates. K81

Heavy obesity is a risk factor for gallstones. However, you should not reduce their weight too quickly, as this may also favor gallstones.

Dr. med. Mira SeidelArticle overviewGallenblasenentzündung
  • description
  • symptoms
  • Causes and risk factors
  • Examinations and diagnosis
  • treatment
  • Disease course and prognosis

Gallbladder inflammation: description

Gallbladder inflammation is a disease of the wall of the gallbladder. It arises in most cases by a gallstone disease (cholelithiasis). The gallbladder is a hollow organ that is below the liver. Their appearance is reminiscent of a pear. The human gallbladder is usually eight to twelve inches long and four to five inches wide. It stores the bile (bile) that is produced in the liver cells. She thickens him. The bile juice is needed to digest fats in the intestine.

Classification of gallbladder inflammations

Doctors also speak of cholecystitis in a gall bladder infection (gr chole = bile, kystis = bladder). If gallbladder inflammation is the result of gallstone disease (90 to 95 percent of cases), it is also called calculous cholecystitis. If it comes without stones to gallbladder inflammation doctors speak of an akalkulösen cholecystitis. In addition, experts distinguish an acute from a chronic gall bladder infection.

Cholecystitis frequency

According to a report by the Federal Statistical Office, in 2012 there were 15,126 patients with gallbladder inflammation (main diagnosis) in German hospitals. In most cases, patients were over 55 years old. Most commonly affected were people between the ages of 70 and 75 (1,945 gall bladder infections). The German Medical Journal even speaks of a total of over 64,000 inpatients with gallbladder inflammation.

According to various studies, chronic cholecystitis is about three to eight times more common than an acute one. Precise information on the incidence of gallbladder inflammation can not be provided because most patients either do not visit the doctor or are not hospitalized.

Stone gallbladder inflammation is more common in women than in men. This is mainly due to the fact that gallstones are the main cause of cholecystitis in women about twice as often as in men. Much less often does the gallbladder wall become inflamed even without gallstones. Cholecystitis, for example, is the result of artificial nutrition in intensive care patients. Men with non-stone gall bladder infection are more affected than women.

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Gallbladder inflammation: symptoms

The typical gallbladder inflammation symptoms are pain that begin in the upper abdominal region above the stomach and gradually migrate into the right upper abdomen. At first they usually appear in spasmodic waves (biliary colic). In the further course, however, sufferers experience pain in the right abdomen in almost all gall bladder infections throughout (over at least six hours). If the doctor presses on this spot, the pain intensifies. They may also radiate into the back, right shoulder, or between the shoulder blades. Usually, the signs of gallbladder inflammation persist for four to five hours.

Some patients also complain of loss of appetite, nausea and vomiting. In addition, many suffer from (mild) fever and palpitations (tachycardia). If, in addition to gallbladder inflammation, an inflammatory disease of the biliary tract (cholangitis) occurs, yellowing of the conjunctiva (scleral icterus) and, in the advanced stage, also of the skin (jaundice = jaundice) may occur. The yellowing is caused by the blood pigment bilirubin. The bilirubin first stains the conjunctiva of the eyes and finally into the skin tissue.

Gallbladder inflammation in children

If the gall bladder is inflamed in children, similar symptoms occur. However, gallbladder inflammations lead to jaundice and white to grayish bowel movements (acholes) in infants much faster than in adults. The children are easily irritated and "whining" and often shout. Many parents also report an appetite loss of their child. Gallbladder inflammation symptoms such as nausea and vomiting often affect older children and adolescents. At the onset of cholecystitis, children often experience an uncomfortable feeling of pressure rather than an upper abdominal pain, which only develops into spasmodic pain over time.

Gallbladder inflammation in the elderly

In older people, the signs are often weak when the gallbladder is inflamed. Symptoms such as pain or fever are usually absent. Many feel only a slight pain when pressure on the right upper abdomen. Some sufferers feel only beaten off and tired. This is particularly the case if they additionally suffer from the diabetes diabetes. Even with chronic gallbladder inflammation the symptoms are weaker. Affected suffer mostly only a slight pressure and flatulence. In contrast, acute cholecystitis (without stones) leads relatively quickly to a serious clinical picture (high-fever sepsis).

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Gallbladder inflammation: causes and risk factors

About 90 percent of gall bladder infections precede gallstones. These stones move the gallbladder outlet (cholecystolithiasis), the bile duct (choledocholithasis) or the junction of the small intestine. Due to this so-called obstruction, the bile can no longer run off and accumulates in the gallbladder. This is stretched excessively. As a result, the gallbladder wall is compressed. The blood can no longer flow freely through the vessels in the gallbladder wall and the lymph drainage is also disturbed. In the gallbladder mucosa there is a lack of nutrients and oxygen. The cells of the gallbladder partially die off and lead via released pollutants to gallbladder inflammation.

The bile itself also damages the gallbladder wall with its bile acids and the substance lysolecithin. On the one hand, cells are destroyed and trigger gallbladder inflammation. On the other hand, special proteins, so-called prostaglandins, are released by the aggressive substances. In particular, the prostaglandins E and F promote gallbladder inflammation. In addition, the gallbladder wall secretes more fluid under prostaglandin influence. As a result, the gallbladder will be stretched even further and the mechanism of undersupply further intensified.

Risk factor gallstones

Most gallbladder disease causes gallbladder inflammation, as the bile can not drain properly. Therefore, the risk factors for gallstones also increase the risk of calculous cholecystitis. These risk factors include the so-called "6 f":

  • female (female gender)
  • fat (overweight, obesity)
  • fourty (forty years old, generally with increasing age)
  • fertile
  • fair (fair-skinned)
  • family (family disposition)

In addition, fast weight loss can also lead to gallstones. Certain medications, especially hormone supplements for women, increase the risk of gallstones and thus gall bladder infections. The same applies to pregnant women: An increased occurrence of the messenger progesterone promotes the development of gallbladder inflammation by stones.

Akalkulöse gallbladder inflammation

The exact formation of gallbladder inflammation not caused by gallstones is not very clear. However, researchers also assume a stasis here or the fate of viscous (concentrated) bile in the gallbladder. Concentrated bile is very aggressive and attacks the mucous membrane of the gallbladder, if it does not deflate regularly (bile stasis). The messenger cholecystokinin (CCK) provides in healthy people for just this emptying of bile into the intestine.

Disturbed gallbladder emptying

Severe accidents, serious burns or febrile illnesses such as bacterial toxemia (sepsis) dry out the body and make the bile more viscous. If the patient does not eat any food (for example, because he is in an artificial coma), the messenger substance CCK is not released. The aggressive, tenacious, concentrated bile remains in the gallbladder and eventually leads to gallbladder inflammation. Even long fasting prevents the release of CCK and thus the gall bladder emptying. The same applies if a patient is fed artificially via the vein (parenteral) over a long period of time (three months).

Disturbed oxygenation and other risk factors

In addition, a reduced blood and thus oxygen supply can ignite the gallbladder. This is the case for example after heart attacks. Sickle cell anemia can also lead to gallbladder inflammation. The misshapen red blood cells clog the blood capillaries of the gallbladder wall. In diabetics, the vessels are damaged by deposits. In addition, infections with Salmonella, the hepatitis A virus or the HI virus ("AIDS") increase the risk of gallbladder inflammation. In HIV patients, especially the cytomegalovirus, crypto- and microsporidia (parasites) play a crucial role. Due to an increased risk of infection, immunocompromised people are generally at risk of developing gallbladder inflammation.

bacteria

The bile is usually germ-free. However, if gallbladder inflammation occurs after a gall bladder infection, pathogens often rise from the intestine and invade the gallbladder wall. The most common germs are the bacteria Escherichia coli, Klebsiella and Enterobacteria. They migrate either through the bile duct or the lymph channels into the gallbladder. Bacterial infections are the leading cause of serious complications of gallbladder inflammation. Bacterial gall bladder infections primarily affect the immune deficient (immunosuppressed) and severely (pre-) diseased patients (for example in the case of sepsis). But they can also occur after abdominal surgery or a reflection of the pancreatic and biliary ducts (ERCP = endoscopic retrograde cholangiopancreatography).

A special form of gallbladder inflammation is emphysematous cholecystitis. Here it comes to an infection with the gas-forming bacteria E. coli and clostridia. Although very rare (about one percent of all acute cholecystitis), this form of gallbladder inflammation is highly dangerous. It is associated with a significantly increased risk of serious complications. In addition to bacteria, parasites such as amoebae or water-borne worms can cause akalkulöse gallbladder inflammation.

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Gallbladder inflammation: diagnosis and examination

If you have a suspicion of gallbladder inflammation, you should always see a doctor. For mild symptoms, a family doctor or a specialist in internal medicine (internist) can help. However, severe pain and high fever associated with acute cholecystitis require hospitalization. Once you have visited your doctor, he will immediately refer you to a clinic.

Medical history (anamnesis)

The history (history) is as crucial as any disease. It provides the doctor with first indications of the correct diagnosis. He first asks for possible symptoms of gallbladder inflammation. The doctor may ask the following questions:

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