Gall bladder disease symptoms or chronic cholecystitis

PROLONG FASTING AND OLDER AGE WITH GALL STONES

CAN PRECIPITATE GALL BLADDER DISEASE SYMPTOMS

CHRONIC CHOLECYSTITIS   is invariably associated with gall stones.It may develop after repeated episodes of acute cholecystitis but more often develop insidiously without any precedind clinically evident acute attacks .The gall bladder wall becomes thickened by fibrosis and relatively indistensible .The gall bladder wall is infiltrated with chronic inflammatory cells ,lymphocytes ,plasma cells and macrophages.Glandular outpouchings are formed by the lining of the mucosa and are known as Aschoff - Rokitansky sinuses. If obstructive jaundice occurs ,it is due to a stone impacted in the common bile duct.

The gall bladder does not usually distend ,as the wall is relatively rigid due to fibrosis consequent on the associated chronic cholecystitis.Mucocele ,this ocurrs when a stone impacts in the neck of the gall bladder in the absence of infection in the bile.The bile is absorbed from the gall bladder,and  mucus is secretedinto it from the mucus secreting cells of the epithelium.The lack of inflammation in the wall allowsthe gall bladder to distend to several times its normal size.The gall bladder is usually palpable below the costal margin.The wall of a mucocele is usually very thin and is easily ruptured at surgery.cholestrolosis ,this is a condition where  lipid laden macrophages accumulate in the gall bladder mucosa to produce yellowish flecks in a reddish mucosa ,appearing  like the surface of a strawberry - hence the alternative name " strawberry  gall bladder " .This is often a symptomless condition but may accompany or pedispose to cholestrole stones.

SYMPTOMS AND SIGNS  

May be asymptomatic for years,may progress  to symptomatic gall bladder disease or to acute cholecystitis ,or present with complications.PAIN in right hypochondrium ,radiate between shoulder blades is frequent .it can occur after eating but not so closely related as peptic ulcer.It begins gradually 15 - 30 minutes after meal and last for 30 -90 minutes ,its duration is several hours ,but it must be less than 12 hours.severity is varying from mild to excruciating .it can precipitated by taking fatty foods,and relieved by analgesic drugs ,associated with nausea and vomiting .

FLATULENT DYSPEPSIA it is a feeling of fullness after food associated wih belching and heartburn.It is brought on by a large or a fatty meal.

TENDERNESS present in  the right hypochondrium ,just below the tip of 9th rib where edge of rectus abdominus muscle crosses the costal margin ( gall blader  point ) .

MURPHY's SIGN  may be positive .This is elicited  by asking the patient to breathe in whilst gently pressing the gall bladder point with your thumb pointing towards feet , Patient will experience pain and catch her breath just before the zenith of inspiration.

DIAGNOSTIC INVESTIGATIONS

PLAIN X-RAY ABDOMEN show radio opaque gall stones.


ORAL CHOLECYSTOGRAPHY ( OCG ) presence of gall stones can be detected ( filling defects )

ULTRASONOGRAPHY demonstrates gall stones , as well as biliary calculi and dilatation of biliary tree.

CT SCAN useful for patients in whom U/S is difficult e,g. obese or those with excessive bowel gas.

PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY ( PTC ) or PEROPERATIVE 
CHOLANGIOGRAPHY to detect associated duct stones....... read more