Cholecystitis acute, treatment

Acute cholecystitis management has been based conservatively on antibiotic treatment plus relief of pain before planned open cholecystectomy. However, it has become increasingly evident that early laparoscopic cholecystectomy is safe and shortens hospital stay. 

Gallbladder inflammation (cholecystitis) usually presents with acute abdominal pain (colic) with radiation to the right shoulder. The normal composition of bile is about 5% cholesterol, 15% phosphatidylcholine, and 80% bile salt in a micellar liquid form. Increased cholesterol from high-fat diets or genetic conditions can upset the delicate micellar balance, leading to supersaturated cholesterol or cholesterol precipitates that cause gallstone formation. Removal of the gallbladder is a common treatment for this painful condition. 

Serious untoward effects are rarely caused by erythromycin. Among the allergic reactions observed are fever, eosinophilia, and skin eruptions, which may occur alone or in combination each disappears shortly after therapy is stopped. Cholestatic hepatitis is the most striking side effect. It is caused primarily by erythromycin estolate and rarely by the ethylsuccinate or the stearate. The illness starts after about 10 to 20 days of treatment and is characterized initially by nausea, vomiting, and abdominal cramps. The pain often mimics that of acute cholecystitis. These symptoms are followed shortly thereafter by jaundice, which may be accompanied by fever, leukocytosis, eosinophilia, and elevated transaminases in plasma. Biopsy of the liver reveals cholestasis, periportal infiltration by neutrophils, lymphocytes, and eosinophils, and occasionally, necrosis of neighboring parenchymal cells. Findings usually resolve... 

Luhtnaim A, Buter A, Abela J-E. Haemobilia causing cholangitis in a patient on dual anti-platelet treatment suffering from acute acalculous cholecystitis. Int J Surg Case Rep 2013 4(4) 368-70. 

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