liver and gallbladder disorders
Cholecystitis
Treatment of Cholecystitis
Surgery to remove gallbladder (cholecystectomy) People with acute or chronic cholecystitis need to be hospitalized. They are not allowed to eat or drink and are given fluids and electrolytes intravenously. A doctor may pass a tube through the nose and into the stomach, so that suctioning can be used to keep the stomach empty and reduce fluid accumulating in the intestine if the intestine is blocked and to allow the gallbladder to rest. Usually, people are given antibiotics intravenously (because infection is possible) and pain relievers. The gallbladder is usually removed within 24 to 48 hours after symptoms start if: Acute cholecystitis is confirmed and the risk of surgery is small. People are older or have diabetes because in such people, cholecystitis is more likely to result in infections. A complication such as an abscess, Gas Gangrene , or perforated gallbladder is suspected. People have Acalculous cholecystitis . If necessary, surgery can be delayed for 6 weeks or more while the attack subsides. If people have a disorder that makes surgery too risky (such as a serious heart, lung, kidney, or liver disorder), surgery is delayed until appropriate treatment can control the disorder as well as possible. If surgery needs to be delayed or avoided completely, the gallbladder may need to be drained to help treat and prevent spread of the infection. Drainage can be done by placing a tube through the abdominal wall into the gallbladder, allowing fluid to drain outside the body. Alternatively, a drainage tube can be placed from inside the body during Endoscopy guided by In chronic cholecystitis, the gallbladder is usually removed after the current attack subsides. Surgical removal of the gallbladder (cholecystectomy) is usually done using a flexible viewing tube called a laparoscope. After small incisions are made in the abdomen, the laparoscope and surgical instruments are inserted through the incisions. Doctors then use the instruments to remove the gallbladder. The laparoscope contains a tiny camera, which enables surgeons to see what they are doing inside the body. A few people have new or recurring episodes of pain that feel like gallbladder attacks even though the gallbladder (and the stones) have been removed. Diarrhea can also develop. Doctors sometimes call this postcholecystectomy syndrome. The cause of this syndrome is not known, but in a few people, it may be malfunction of the sphincter of Oddi (a ring-shaped muscle between the common bile and pancreatic ducts and the small intestine). Malfunction of this muscle can slow the flow of bile and pancreatic secretions from the ducts and thus increase pressure in the ducts, causing pain. Pain may also result from small gallstones that remain in the ducts after the gallbladder is removed. More commonly, the cause is another, unrelated problem, such as Irritable Bowel Syndrome (IBS) or even Endoscopic retrograde cholangiopancreatography (ERCP) or cholescintigraphy (see Imaging Tests of the Liver and Gallbladder ) may be necessary to determine whether the cause of pain is increased pressure. For ERCP, a flexible viewing tube (endoscope) is inserted through the mouth and into the intestine, and a device to measure pressure is inserted through the tube. If pressure is increased, surgical instruments are inserted through the tube and used to cut and thus widen the sphincter of Oddi. This procedure (called endoscopic sphincterotomy) can relieve symptoms when the pain is caused by malfunction of the sphincter. 