Is it possible to have a gallbladder infection without gallstones?
The gallbladder is a small but vital organ that looks like a pear. It is located just under the liver, on the right side of the abdomen. The main purpose of this organ is to store and release bile into the small intestine when necessary. The liver produces this bile fluid, and it helps to digest the fats in the food you consume. The gallbladder plays a crucial role in digestion, but it is at risk of certain conditions that can affect its regular function. Acalculous cholecystitis is one such gallbladder condition, a severe inflammatory disease that needs prompt medical attention.
Many think only gallstones lead to gallbladder inflammation, which is called calculous cholecystitis and accounts for nearly 95% of the cases. But it is possible to have a gallbladder infection even without gallstones, which is called acalculous cholecystitis. Acalculous means that gallstones are not the cause, and cholecystitis means gallbladder inflammation. Even though it is less common, it can be life-threatening.
Symptoms of acalculous cholecystitis
This condition can lead to a range of symptoms, making diagnosis challenging at times. Acknowledging these symptoms is the key to timely and effective medical treatment. One should look out for these symptoms:
- Abdominal pain, especially in the right upper side, which might become worse with deep breathing
- Abdominal pain or cramping after eating, especially after consuming fatty foods
- Nausea
- Vomiting
- Bloating
- Intolerant to certain foods
- Belching (burping or eructation)
- Fever
Patients may experience sudden and severe pain in the right upper abdomen in the case of acute acalculous cholecystitis. At times, this pain may radiate up to the shoulder blades.
Causes of acalculous cholecystitis
Accumulation of bile salts is one of the causes. This happens when the bile fluid moves more slowly through the biliary system, including the gallbladder and bile ducts, which increases pressure within the gallbladder. This condition can lead to:
- Problems with blood flow
- Pressure ulcers
- Necrosis (death of tissue)
- Gallbladder perforation
Other causes and risk factors of acalculous cholecystitis
- Prolonged fasting
- Rapid weight loss
- Total parenteral nutrition (intravenous feeding)
- Staying in intensive care or recovering from any major surgery
- Stroke
- Heart attack
- Sepsis (improper response of your body to an infection)
- Severe burns or injuries
Acalculous cholecystitis is observed in both men and women, but it is more common in men who have had major surgery or are critically ill. Having a weak immune system, especially due to HIV, can increase the likelihood of developing acalculous cholecystitis.
Diagnosis of acalculous cholecystitis
Doctors may use the HIDA (cholescintigraphy nuclear scan) technique to diagnose this condition. This is an imaging test which helps the doctor observe the functioning of the biliary system on a scanner. The procedure involves injecting a radioactive substance into a vein in your arm, and it travels into the liver, combines with the bile fluid, and enters the gallbladder and then the bile ducts.
Another test is to stimulate gallbladder contraction by administering the cholecystokinin (CCK) hormone. This test helps to evaluate gallbladder function and emptying.
Doctors may suggest a CT scan or an abdominal ultrasound to check for inflammation in the gallbladder walls.
Blood tests are also done. Elevated white blood cell counts indicate the signs of acalculous cholecystitis.
Treatment of acalculous cholecystitis
Different types of treatment approaches are available, but choosing the best option depends on various factors like overall condition, severity, and the presence of any underlying complications.
Close monitoring in the intensive care unit (ICU) with supportive care.
Administering a broad spectrum of antibiotics to treat potential bacterial infections.
If patients are on total parenteral nutrition (TPN), it is better to discontinue.
Percutaneous cholecystostomy—A minimally invasive procedure to drain infected bile and relieve obstruction by inserting a catheter into the gallbladder.
Endoscopic transpapillary gallbladder drainage (ETGBD)—A minimally invasive procedure to drain the gallbladder by placing a stent.
Cholecystectomy—a surgical procedure to remove the gallbladder. It can be performed either as a laparoscopic surgery or as an open surgery, depending on the patient’s condition.
Acalculous cholecystitis is a life-threatening condition which needs to be addressed immediately. Prompt treatment might prevent progression and complications. Recovery after treatment might take a few months, especially in the case of cholecystectomy. If you are facing any gallbladder problems, consult Dr. Venugopal Pareek, one of the best laparoscopic surgeons in Hyderabad and an expert in treating various gallbladder problems. With his expertise and a multidisciplinary team, he can provide the best patient care. Call +91 91777 77715 to book your consultation with the doctor.
