If you have gallstones and experience right upper abdominal pain after eating greasy food, be careful of acute cholecystitis!

Author: Guo Shubin, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Mi Yuhong, Chief Physician, Beijing Anzhen Hospital, Capital Medical University

Pavlov proposed a theory on the types of higher nervous activity at the Kortus Institute.

Pavlov believed that humans have two signal systems. When children eat candy, they will secrete saliva as soon as they see the candy. When they understand language, they will also drool as soon as they hear adults talk about candy. This is a unique function of human beings.

Just like Pavlov's theory, we secrete saliva when we see food. After eating food, various nerve fluids in the body will begin to be secreted, especially when the food passes through the gastrointestinal tract, the gallbladder will secrete bile and the pancreas will secrete pancreatic juice to digest the food. This is the result of long-term human evolution.

So as long as you eat, the gallbladder will contract and excrete bile during the contraction process.

1. What is the relationship between overeating greasy food and acute cholecystitis?

When you eat greasy food or eat too much, the gallbladder will contract quickly, secrete a lot of bile, and increase the tension of the gallbladder, which will lead to cholecystitis. If there are stones or sand-like things in the bile at the same time, the fine bile sand and mucus will be wrapped together, just like stones, and will block the bile duct, causing obvious pain.

The exit of the gallbladder is called the sphincter of Oddi. Under normal circumstances, it opens and closes regularly. When you eat too much, the opening and closing functions become abnormal, and duodenal fluid and bile flow inward, increasing the pressure in the gallbladder. If the duodenal fluid and bile contain some bacteria, it will cause inflammation of the biliary system.

2. Will acute cholecystitis cause biliary colic?

The clinical manifestations of acute cholecystitis are different for each person.

The most common symptom of simple cholecystitis is right upper abdominal pain accompanied by radiating pain in the right shoulder and back. The gallbladder wall is normally very smooth, but after inflammation, it will ooze and thicken, stimulating the somatic nerves, resulting in typical pain in the right upper abdomen, which is generally stabbing or dull.

Figure 1 Original copyright image, no permission to reprint

In addition to inflammation of the gallbladder, if there are stones or roundworms, the diameter of the Oddi sphincter at the gallbladder outlet is 9 mm. If the stones are slightly smaller or larger than this, they may become incarcerated. If they are incarcerated at the gallbladder outlet, they will cause severe biliary colic. If the stones are free in the gallbladder, they generally will not cause clear biliary colic.

Figure 2 Original copyright image, no permission to reprint

The gallbladder is an organ that helps digestion. When it hurts, it is usually accompanied by clear digestive system symptoms, such as bloating, nausea, and vomiting.

In severe cholecystitis, such as that caused by bile duct stones, the sudden symptoms may not be pain in the upper right abdomen, but intestinal obstruction, manifested as abdominal pain, vomiting, and no flatulence or defecation.

Therefore, the clinical manifestations of cholecystitis vary greatly, but basically there is a clear history of gallstones. In general, cholecystitis is generally characterized by pain, and the location of the pain is relatively characteristic, accompanied by some symptoms of indigestion.

3. How to treat acute cholecystitis?

Acute cholecystitis must first be determined whether it is caused by bacterial infection or gallstones.

If it is caused by bacterial infection, you should first fast for food and water, because eating will promote gallbladder secretion and excretion, which will cause pain.

Antibiotic treatment is required after fasting and drinking water fasting. After symptomatic treatment with antibiotics, cholecystitis can usually be controlled quickly, unless the immune function is poor.

If it is caused by stones and becomes incarcerated, it will cause severe biliary colic. In the past, stones were removed by surgery, but now it is basically done by endoscopic retrograde pancreaticocholangiopancreatography. The endoscope is inserted through the mouth to the site of the gallbladder exit, the corresponding papillary muscles are cut, and the stones are taken out.

Once a critical situation such as suppurative obstructive cholangitis occurs, the first thing to do is to solve the drainage problem of the abscess. Only by solving the drainage problem can the bacteria-rich bile be prevented from further entering the blood, and infectious shock and death of the patient can be avoided. In the past, laparotomy was generally performed directly to remove the stones in the bile duct to relieve the obstruction. Now, endoscopic stone removal is basically used without laparotomy. Another method is percutaneous liver puncture, where the puncture needle is directly inserted into the dilated bile duct, and the suppurative bile is drained out with a tube. After the condition improves, papillary muscle incision is performed to remove the stones.

If you experience the above symptoms, especially if you already have gallstones, you should consider the possibility of an acute attack of cholecystitis and seek medical attention promptly.