Overview

Gall bladder infection, medically known as acute cholecystitis, is a condition where the gall bladder becomes inflamed, often due to a blockage caused by gallstones. The gall bladder is a small organ located beneath the liver that stores bile, a digestive fluid essential for fat digestion. When bile flow is obstructed, bacteria can multiply within the gall bladder, leading to infection and inflammation. Gall bladder infection is a serious medical condition that requires prompt treatment to prevent complications like gall bladder rupture, abscess formation, or widespread infection (sepsis).

Causes

The most common cause of gall bladder infection is gallstones, but other factors can also contribute to the development of this condition:

• Gallstones (Cholelithiasis): Gallstones block the cystic duct, leading to bile buildup, irritation, and infection.
• Bacterial Infection: Common bacteria such as Escherichia coli, Klebsiella, and Enterococcus species can proliferate in stagnant bile, causing infection.
• Bile Sludge: Thickened bile or sludge can obstruct bile flow, leading to cholecystitis without visible gallstones.
• Tumors: Tumors in the bile ducts or pancreas can block bile drainage, increasing infection risk.
• Vascular Insufficiency: Reduced blood supply to the gall bladder, especially in critically ill patients, can cause gall bladder inflammation (acalculous cholecystitis).
• Severe Illness or Trauma: Major surgery, burns, or severe infections can predispose individuals to gall bladder infections without gallstones.

Symptoms

Gall bladder infection typically presents with acute symptoms, which can escalate rapidly if left untreated:

• Severe Abdominal Pain: Sharp or cramping pain in the right upper abdomen, which may radiate to the right shoulder or back.
• Fever and Chills: A sign of systemic infection and inflammation.
• Nausea and Vomiting: Common due to digestive upset and inflammation.
• Tenderness in the Abdomen: Pain intensifies upon touching the upper right abdomen, especially under the ribs.
• Loss of Appetite: Reduced desire to eat due to ongoing pain and nausea.
• Jaundice: Yellowing of the skin and eyes may occur if bile ducts are obstructed.
• Dark Urine and Pale Stools: Signs of impaired bile flow.

Diagnosis

Diagnosis of gall bladder infection involves a combination of physical examination, laboratory tests, and imaging studies:

• Physical Examination: The doctor checks for abdominal tenderness, especially a positive Murphy’s sign (pain on deep palpation of the right upper quadrant).
• Blood Tests: Elevated white blood cell count (WBC), increased liver enzymes, and inflammatory markers indicate infection and biliary obstruction.
• Ultrasound: The most common imaging test, showing gallstones, gall bladder wall thickening, or fluid collection around the gall bladder.
• CT Scan: Provides more detailed images, helpful if complications like abscess or perforation are suspected.
• HIDA Scan (Cholescintigraphy): A nuclear medicine test that evaluates gall bladder function and identifies obstruction.
• MRCP (Magnetic Resonance Cholangiopancreatography): MRI-based imaging to visualize bile ducts and gall bladder, used in complex cases.

Treatment

Treatment of gall bladder infection depends on severity but generally involves a combination of medical management and surgery:

• Hospitalization: Most patients require admission for observation, hydration, and close monitoring.
• Antibiotic Therapy: Broad-spectrum intravenous antibiotics are started to control bacterial infection.
• Pain Control: Analgesics help manage abdominal pain and discomfort.
• NPO (Nothing by Mouth): Patients are kept fasting to rest the digestive system and prevent gall bladder stimulation.
• Cholecystectomy (Gall Bladder Removal):
  • Laparoscopic Cholecystectomy: Minimally invasive surgery preferred for most patients after stabilization.
  • Emergency Surgery: Required if there is gall bladder perforation, abscess, or spreading infection.
  • Delayed Surgery: In critically ill patients, surgery may be postponed until the infection is controlled.
• Percutaneous Cholecystostomy: A drainage procedure for high-risk patients who cannot undergo surgery immediately.

Prognosis

The prognosis for gall bladder infection depends on timely diagnosis and treatment:

• Good Prognosis with Early Treatment: Most patients recover completely after appropriate antibiotic therapy and cholecystectomy.
• Risk of Recurrence: Without surgery, the risk of recurrent infections remains high.
• Complications: Delayed treatment may lead to serious complications like gall bladder gangrene, perforation, abscess formation, or sepsis, increasing morbidity and mortality.
• Full Recovery: After gall bladder removal, patients typically experience full recovery and can resume normal diet and activities after a brief recovery period.
• Long-Term Outlook: Life without a gall bladder is generally normal, though some people may experience mild digestive adjustments post-surgery.

In summary, gall bladder infection is a treatable condition with excellent outcomes if managed promptly. Early medical attention and surgical intervention are key to preventing serious complications.