Acute Cholecystitis: I'm Having a Gallbladder Attack

These slides depict the stages of an acute gallbladder attack or acute cholecystitis. The first shows the grayish appearance of an edematous gallbladder. The gallbladder wall has swollen and retained water and is edematous. There is an obstruction of the cystic duct and the gallbladder begins to swell. It no longer has the "robin egg blue" appearance of a normal gallbladder.

 

As the acute cholecystitis progresses, the gallbladder begins to become necrotic and gets a speckled appearance as the wall begins to die.

Finally, the gallbladder undergoes gangrenous change and the wall becomes very dark green or black. This is the stage when perforation occurs.

 

Gallbladder Problems

Fair, fat, forty, female; all adjectives to describe that person most at risk of developing symptomatic gallstones. Gallstones can occur at anytime from childhood to late in life but may not become symptomatic right away. Small children have rarely developed sympotmatic gallstones that have had to be surgically removed. Adolescents will at time have recurrent attacks of upper abdominal pain that are related to gallstones. Ususally these children have a family history of gallstones. Gallstones can result from rapid weight loss and may form during pregnancy. The stones form as bile salts form precipitates within the stagnant gallbladder. They may become symptomatic when they are 1 mm in diameter or remain silent until the person is in their 90s and has a 4 cm gallstone. The smaller the stone, the more apt they may be to migrate into the common bile duct to produce jaundice or pancreatitis.

In medical school, "doctors-to-be" are taught that symptomatic gallstones cause severe attacks of right upper quadrant pain. This is one subset of the patients that eventually will need an operation to remove the gallbladder and the stones. Some doctors only remember this set of patients and do not consider the pain in the upper back between the shoulder blades or the chest pain that mimics a heart attack. If you have chest pain, it is far better to have your heart checked out first before ascribing the pain to gallstones. Gallstones can cause lessor degrees of discomfort including bloating, belching and indigestion. Fortunately one of the worst complicatons of gallstones is fairly rare. Pancreatitis is the most feared complication of gallstones and presents with pain in the mid abdomen that radiates into the back. It is also the one complication of this condition that is potentially lethal.