Cholecystitis Cholangitis and Common Bile Duct Obstruction

Gallbladder disease generally presents as biliary colic, a "benign" condition in which gallstones cause colicky right upper quadrant pain that is easily treated with mild analgesics. Cholelithiasis is most common in obese women in their fourth decade.

However, it is important not to miss patients who have cholecystitis (inflammation of the gallbladder), common bile duct obstruction, or cholangitis (inflammation of the biliary duct system), for which hospital admission and specific treatments are required. Approximately 10% of cholecystitis occurs in the absence of documented gallstones.

Causes

• The most common cause of blocked bile ducts is gallstones. Stones form inside the gallbladder and may block the common bile duct means a large drainpipe at the base of the liver. If the duct blocked, then waste may collect in the bile duct system and in the bloodstream. If bacteria above the blockage occur, then it may cause a severe infection known as ascending cholangitis.
• Common causes of blockages bile ducts such as includes cancers of the bile duct and strictures.
• Most common cause of acute cholangitis is Choledocholithiasis.
• Causes of cholangitis such as including endoscopic manipulation of the CBD, Sclerosing cholangitis, AIDS cholangiopathy.

Symptoms

• Acute onset of colicky severe right upper quadrant or epigastric pain
• Nausea and vomiting +++
• Fever is variably present with cholecystitis and cholangitis.

Signs

• Right upper quadrant tenderness ++++
• Localized peritonitis
• Murphy's sign (arrest of respiration with palpation of the right upper quadrant)
• Low grade fever and tachycardia are variably present in cholecystitis.

Treatment

• For the treatment of bile duct or gallstone blockage, that may occur by infection. Surgeon may remove stones in the bile duct using endoscopic retrograde cholangiopancreatography. In some cases the endoscope may be used to remove the stone using wire loops.
• Extracorpeal shock wave lithotripsy (ESWL) is another nonsurgical treatment to manage gallstones. In which no general anesthesia is required and you can managed the patient on an outpatient basis. In which method, it employs high-energy sound waves that produce shock waves and then shock waves are transmitted through water and tissue. This method have the ability to generate compressive and tensile waves. By using this method, You can disintegration and fragmentation the gallstones by producing strong forces enough to fracture the stones.