Gallbladder inflammation is the inflammation of the gallbladder wall. In most cases (90 to 95 percent), gallstones are the cause of the inflammation.
Gallbladder inflammation can be acute or chronic.
In acute gallbladder inflammation, the patient experiences colicky pain in the right upper abdomen. It develops into persistent pain and can be accompanied by fever and nausea.
In chronic gallbladder inflammation, the gallbladder wall is repeatedly irritated by gallstones or bile. Persistent dull or intermittent pain and digestive problems can occur.
Chronic gallbladder inflammation increases the risk of gallbladder cancer.
The gallbladder is located in the gallbladder fossa on the lower edge of the liver in the right upper abdomen. The main function of the gallbladder is to collect the bile produced in the liver. When food is ingested, it releases the bile through the common bile duct into the duodenum. There, the bile emulsifies the food pulp and plays a key role in the digestion of fats.
The gallbladder is equipped with several sphincter muscles that regulate the outflow of bile through contractions.
Gallbladder inflammation is usually caused by gallstones . They disrupt the flow of bile and cause the gallbladder to overfill.
This overfilling initially leads to cramp-like pain, known as colic. As the disease progresses, bacteria from the intestine can enter the gallbladder via the bile duct and infect it.
Gallstones form when
- the composition of the bile and thus the solubility of cholesterol, among other things, changes,
- the motility (mobility) of the gallbladder is disturbed or
- bacteria lead to crystallization of the bile.
Accordingly, a distinction is made between different types of gallstones. In most cases, these are cholesterol and mixed gallstones. Pigment gallstones, which consist mainly of bilirubin, are less common.
Risk factors for the development of gallstones are
- Physical inactivity,
- poor diet (too high in calories and too low in fiber) and
- obesity.
Oestrogen-based hormone therapy also appears to increase the risk of gallstones.
Other risk factors are
- an age of around 40 years,
- female gender,
- pregnancy,
- metabolic disorders,
- rapid weight loss and
- familial accumulation.
The location of the gallbladder below the liver © Henrie / Fotolia
In rare cases, gallbladder inflammation is caused by
- operations,
- Inflammation of other internal organs,
- burns or
- accidents
triggered.
Gallbladder inflammation is mainly manifested by severe cramp-like pain in the right upper abdomen. The pain can also radiate towards the back in the shape of a belt.
- Nausea and nausea, occasionally also vomiting,
- a slight yellowing of the skin and
- indigestion
are further symptoms of gallbladder inflammation.
If bacteria infect the accumulated bile secretions, the above-mentioned symptoms are joined by
- Fever,
- chills,
- pressure pain and
- a tense abdominal wall in the right upper abdomen
occur.
Various examinations are used to diagnose cholecystitis:
- Physical examination,
- blood tests and
- imaging procedures.
Typical signs of gallbladder inflammation are
- local signs of inflammation: A pressure-painful ultrasound examination and tensing of the abdominal muscles during palpation of the abdomen - the so-called defensive tension,
- general signs of inflammation: See below under laboratory analysis,
- a thickening of the gallbladder wall and
- in most cases, the detection of gallstones.
Laboratory analysis
The blood test is an important examination in the investigation of gallbladder inflammation.
In the case of gallbladder inflammation
- the number of white blood cells is increased,
- the erythrocyte sedimentation rate is accelerated and
- the concentration of C-reactive protein (CRP) increases.
The liver values may also be above the normal range.
Imaging procedures
During an ultrasound examination (sonography), the gallbladder is examined using a transducer. With the help of this procedure, the doctor can
- an enlarged gallbladder,
- a swelling of the gallbladder wall and
- subsequently a so-called three-layering of the gallbladder wall
of the gallbladder wall. The gallstones causing the inflammation can also be visualized using ultrasound. Typical of gallbladder inflammation is the localized pain that occurs when the doctor applies pressure with the transducer. This phenomenon is also known in medicine as Murphy's sign.
Sometimes the result of an ultrasound examination is not clear. In this case, magnetic resonance imaging(MRI) or computer tomography(CT) can also be used.
The patient is given a contrast agent beforehand, which allows the doctor to better recognize the gallbladder wall and its surroundings. This may provide him with indications of inflammation.
Gallbladder inflammation should always be treated at an early stage. If treatment is delayed, life-threatening complications can develop, such as a rupture of the gallbladder. This causes infected bile to spread throughout the abdominal cavity. This can result in peritonitis.
After diagnosis, treatment with antibiotics should be started immediately to combat the bacterial infection. In addition, symptomatic treatment with painkillers and antispasmodics is given.
Surgical treatment of gallbladder inflammation
Surgical removal of the gallbladder(cholecystectomy) and the stones it contains is then recommended and necessary. Otherwise, new symptoms and inflammation can be expected.
The operation can be performed immediately in the acute inflammation stage. Alternatively, it can be performed at least 6 weeks after the inflammation has subsided.
Surgical removal of the gallbladder is usually possible using minimally invasive laparoscopy. The surgeon makes 3-4 small 0.5-2 cm incisions in the patient under general anesthesia. A tiny camera, a light source and the necessary instruments are inserted through the incisions. The operation then takes place with a view of a monitor on which the image from the camera is transmitted from inside the body.
Most patients can leave the hospital the day after the operation.
Only rarely does the abdominal cavity have to be opened with a large incision to remove the gallbladder in the case of more severe inflammation.
If gallstones are stuck in the common bile duct, they can be removed endoscopically using ERCP (endoscopic retrograde cholangiopancreatography).
Complications of incorrect treatment
Dissolution or fragmentation(extracorporeal shock wave lithotripsy) of the gallstones is not recommended. Such attempts can cause serious complications. Remains of the gallstones can enter the common bile duct and block it.
Stones can also get stuck in the area of the papilla. The papilla is the common opening of the common bile duct and the pancreatic duct into the duodenum. This can lead to a life-threatening inflammation of the pancreas(pancreatitis).
In the vast majority of cases, gallbladder inflammation is caused by gallstones. Prevention therefore primarily involves measures against gallstones.
A balanced, needs-based diet plays an important role. The following also appear to have a preventive effect
- Fruit,
- vegetables,
- legumes,
- olive oil,
- wholemeal products,
- salad,
- nuts and
- unsaturated fats.
The same applies to an adequate intake of vitamin C and magnesium. Regular physical activity also helps to maintain a normal body weight.
In contrast, saturated fatty acids, sweets and energy drinks increase the risk. In certain situations, for example
medication can help to reduce the risk. However, there is no general recommendation for drug-based prevention.
