Do I Have a stomachache, Doc?

Perhaps you suffer from severe, chronic pain in the middle of your abdomen! You should not dismiss it as ‘just a stomachache’. I suggest you to go to the doctor as soon as possible: it may be a stomachache, or it may be something worse: cholecystitis.

In this article, I will talk about gallbladder inflammation, also known as cholecystitis. Both cholecystitis and regular stomachaches can give you severe pain in the middle and right abdomen.

Let’s give an example:

“A man, 44 years old, often felt a severe pain in his middle abdomen. He had thought that he had a stomachache since 20 years ago. He had gone to doctor and get a negative result of USG (Ultrasonography) examination. When he went back to doctor again in the next time, the laparoscope found a gallbladder inflammation.”

 

Cholecystitis (from cholecyst: gallbladder; itis : inflammation) is an inflammation in gallbladder (vesica biliaris). It occurs when there is an obstruction in the cystic duct.

Let me discuss the anatomy of the gallbladder, before I continue to cholecystitis. The gallbladder is under and behind the liver (a.k.a the hepar). Liver cells flow the bile to the gallbladder, and increases in concentration over time. After that, it flows into the duodenum (a part of a small intestine). All of these ducts called hepatic biliaris duct (hepatic : all about hepar; biliaris : all about bile).

The hepatic biliaris duct consists of:

1. Hepatic Duct
   • This duct is from hepar and with cystic duct (on the right side), both of them build choledochus duct.
2. Choledochus Duct
   • Choledochus duct with pancreatic duct together go to small ampulla.
3. Vesica Biliaris(gall bladder)
   • Is a bladder, like a pear-shape, and behind the hepar.
   • Vesica biliaris in able to contain 30-50 mL of bile. Here, the bile is used for the fat emulsion.
   • Vesica biliaris can contract to flow the bile to duodenum.
4. Cystic Duct
   • This duct connects the vesica biliaris and pancreatic duct to create the choledochus duct.
   • This is in a S-shape.

 

http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/19261.jpg.

The Hepatic Billiary Duct

Cholecystitis usually strikes due to gall bladder stones (cholelithiasis, chole : gallbladder; lithiasis : stones genesis). These stones will increase in number and can obstruct the cystic duct. This obstruction can make a gall bladder inflammation.

 

http://en.wikipedia.org/wiki/Image:Gallstones.jpg.

The Gallstones

 

Cholecystitis can be divided to two parts :

1. Acute Cholectstitis

· The symptoms are a severe pain in upper right abdomen or epigastrium (the middle abdomen) and can spread to right shoulder and right back. Pain is usually felt in the midnight.

·The pain can be more severe for 30-60 minutes and after 3 hours pain move to right abdomen.

· It occurs if you often consume the fatty food in the night

· If the condition grows more severe, it can jaundice.

2.Chronic Cholecystitis

·The inflammation in this condition usually is related to acute cholcystitis, but it can also unconnected to any previous problem.

· The symptoms are same as the acute cholystitis.

Cholecystitis is detected by USG, intravenous cholangiography, oral cholecystography, abdomen X-ray, CT Scan, MRI, and ERCP. In Indonesia, medical staff usually uses the USG to diagnose and routine examination of gallstones disorder because it costs less than CT Scans and MRI’s. But, the USG has limitations: it depends on the operator skills & obese patients, and gas in the intestine can distort readings.

The surgical treatment must be done as soon as possible for acute cholecystitis. But, if the condition is in the highest risk condition, the patient must be given antibiotic treatments first.

After we have become aware of the possibility of cholcystitis , I think we can’t dismiss severe pain in middle abdomen as ‘unimportant’. So, if you are suffering such pain, immediately go to your doctor for a complete examination!

 

 

Written by : Catherine Maname Uli

Edited by : Mr. Alvin, teacher of EF Pluit

References :

1. Jangan Remehkan Rasa Sakit Seperti Maag. 2006. Available from the URL : http://depkes.go.id/index.php?option=news&task=viewarticle&sid=2157.

2. Kamus Kedokteran Dorland Edisi 29. 2005. Jakarta : EGC.

3. Richard S. Snell. 2006. Anatomi Klinik untuk Mahasiswa Kedokteran. Jakarta : EGC.

4.Cholecystitis. Available from the URL : http://en.wikipedia.org/wiki/Cholecystitis.

5.Noer, H.M Sjaifoellah. 2007. Buku Ajar Ilmu Penyakit Hati. Jakarta : FKUI.