Chronic cholecystitis means chronic inflammation of the gall bladder

  • Chronic calcular cholecysitits due to stones in gall bladder most common form
  • Chronic non calcular cholecysitis due to other causes than stone in gall bladder less common

Chronic inflammation of the gall bladder due to the presence of stones inside it which has the following criteria
Early changes like
  • The gall bladder wall become opacity
  • Fibrosis of the liver around the gall bladder bed 
  • The cystic lymph node  become enlarged
  • Gall bladder does not empty completely
Late changes
  • The gall bladder wall become thickened fibrosed 
  • Adhesion of the gall bladder to stomach duodenum or colon
  • Mucocele of the gall bladder 
Symptoms of chronic calcular cholecystitis

Type of patient:  Remember 5 F Fatty , Filthy, Fertile ,Female, above age of Foruty
  • Pain dull aching pain often occurs in the right hypochondrium sometimes in the epigastric region the pain may radiate to the right shoulder tip and infrascapular region or right upper back or between the scapulae become more severe in first hour and may last for 5 hours 
  • Recurrent attack of biliary colic
  • The pain is severe and come suddenly typically during the night or after eating heavy fatty meal
  • The pain is often associated with nausae and vomiting
  • The pain is episodic the patients suffers from discrete attack of pain between which they feel well
  • Atypical presentation of gall stone disease is common associated with meals as follow
  • Mild attack of pain after meals the pain may feel in the back or the upper or lower right quadrant
  • Bloating and bleching flatulence abdominal distension heart burn and constipation are common
  • Reflex symptoms called cardiac symptoms in the form of precordial pain palpitations and dyspnea these symptoms similar to angina attack and so called pseudoanginal attack or cholecytic heart after cholecystectomy or removal of gall bladder these symptoms disappear and the heart return normal
  • The inflammed gall bladder acts as septic focus and may causes headache malaise rheumatic like pain in the neck back and joints
  • Such these symptoms disappear after removal of gall bladder
  • When the pain lasts more than 24 hours an impacted stone in the cystic duct or acute cholecystitis should be suspected 
Signs of chronic calcualr cholecystitis
  • Tenderness is always present at the tip of the ninth costal cartilage
  • Murphy,s sign if continuous gentle pressure is exerted over the right hypochondrium while the patient take a deep breath there will be a catch of breath before the end of inspiration
  • Boas,s sign area of hyperaesthesia between the 9th and 11 th ribs on the right side may be present
  • Palpable gall bladder (mucocele) is rare
Chronic  or acute acalcular or non calcular cholecystitis
Chronic inflammation of the gall bladder due to other causes rather than stone in gall bladder these causes are
  • Bacterial infection Typhoid gall bladder Salmonella typhi can infected the gall bladder leading to acute or chronic cholecystitis 
  • Biliary dyskinesia which due to achalasia or dilatation of the sphincter of Oddi leading to marked dilatation of the fall bladder
  • The cholecystoses which include the following conditions
  • Cholesterosis or called also Strawberry gall bladder this is due to an error in cholesterol metabolism which causes deposition of cholesterol crystals in the mucosa of the gall bladder which become red and studded with yellow specks of cholesterol esters giving strawberry appearance  later on forming lipoid polpi called cholesterol polyposis of the gall bladder and ending in cholesterol stone formation
  • Cholecystic Glandularis Proliferans which include a varieties of conditions affecting the gall bladder by polyps adenomyomatosis intramural or diverticular stones which can be complicated by an intra or extra mural abscess and fistula formation-
Abdominal ultrasound simple good for diagnosis which showing the stone inside gall bladder and thickening in the wall of the gall bladder any any other abnormalities

CT scanning
Abdominal CT scanning is very helpful and
Cholecystokinin cholecystogtaphy
To diagnosis acalculous cholecystitis and biliary dyskinesia
Plain X rays
Remember that about 90 % of gall bladder stone are radiolucent so not appear on X rays
Oral cholecystography
  But rare used nowadays and it is replaced by ultrasound

MRI scanning
very good and also for associated other lesions and abnormalities

For more investigations details see here 

Treatment of acute or chronic cholecystitis
 Medical and conservative treatment
  • Avoid fatty meals and heavy bulky or large food
  • Antibiotic and biliary antiseptic
  • Antispasmodics as belladonna khelline
  • Cholagogues as olive oil 3-5 ml before meals to avoid stasis of bile
  • These measures may indicated for patient unfit for operation
  • Indicated also in chronic non calcular cholecystitis and biliary dyskineasia but if no improvement for 4-6 months so removal of gall bladder (cholecystectomy )will be indicated
Surgical treatment
It is treatment of choice can be done either by
  • Open cholecystecomy through a right paramedian or subcostal kocher incision most common used
  •   Laparoscopic guided cholecystecomy
See more 
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