Cholecystitis

Cholecystitis refers to severe abdominal pain associated with gallbladder inflammation or gallstones. Acute Cholecystitis can manifest as sharp cramping pain in the right upper quadrant of the abdomen. This pain can spread to the back or below the right shoulder blade. It usually appears after a fatty meal. Cholecystitis might also lead to nausea and vomiting and often jaundice. The person suffering Cholecystitis might notice clay colored stools and fever. Diagnostic tests that are prescribed to detect this condition are Liver function test, abdominal ultrasound and Endoscopy.

In many cases, Cholecystitis can clear on its own, with the right low fat diet and antibiotics. But in other cases, Cholecystectomy may be done to remove the gallbladder. Acute Cholecystitis needs to be treated urgently lest it lead to complications such as a perforated gallbladder or gangrenous Cholecystitis where the gallbladder tissue dies. On the other hand, cholangitis involves infection of the bile ducts either due to biliary obstruction or bacterial infection.

Cholecystectomy

Cholecystectomy or Gallbladder removal surgery is now commonly carried out by laparoscopic method. This has greatly reduced recovery time over the traditional open surgery. Laparoscopic Cholecystectomy is performed with special tools inserted through small incisions made on the abdomen. A tiny video camera is also inserted to aid the process. Typically Cholecystectomy is resorted in cases where the patient suffers gallstones in the gallbladder or bile duct. Severe Pancreatitis or Cholecystitis (Severe pain coupled with rigidity in the upper right abdomen owing to the infection or inflammation of the gallbladder) are other reasons for resorting to a Cholecystectomy. Some patients and conditions are not suitable for a laparoscopic Cholecystectomy and in these cases, the surgeon opts for the open incision method. Cholecystotomy is a surgical procedure where the gallbladder is opened for removal of the gallstones and the excess bile is drained - but the gallbladder itself is not removed. The actual surgical incision into the gallbladder is called as Cholelithotomy.

Cholecystectomy complications

With laparoscopic Cholecystectomy, a patient can leave the hospital within a couple of days. While this is a relatively simple procedure, the possible complications include blood clots, bile leakage, injury to bile duct and infection. Sometimes, a gallstone might still remain within the bile duct and might get pushed into the central bile duct. In case of injury to bile duct, complex corrective surgery has to be done. For gallstones still remaining in the bile duct, an endoscopic retrograde cholangiopancreatography (ERCP) is conducted. After laparoscopic cholecystectomy, patients might experience bloating and diarrhea. Some patients notice indigestion and abdominal pain. Jaundice might be noticed in a few.

Diet after gallbladder removal

After gallbladder removal surgery, many a patient suffers diarrhea for a few months till the bile flow is regulated. Remember that there is no gallbladder to store the bile and release it when necessary. Now, in the absence of a gallbladder, the bile flows directly into the small intestine. Here it is used for the digestion of fats. But some of it might flow into the large intestine causing irritation and resulting in diarrhea. Unregulated bile supply might lead to improper digestion of fat. It is not surprising to note that the fat content of the stool is higher in those who have had gallbladder surgery. A low fat diet must be followed after gall bladder removal. Fluids and high fiber diet help in preventing constipation or diarrhea post gall bladder surgery. The patient may experience burping and feeling of fullness coupled with gas.

• Eating smaller meals at more frequent intervals helps.
  
• Add new foods slowly and watch out for any symptoms.
  
• Pack in lean protein, poultry, fish and low-fat dairy into your meals.
  
• Caffeine tends to worsen abdominal gas and diarrhea in some patients after Cholecystectomy.
  
• Limit your intake of sweets, cake, cookies and chocolate bars. They might result in intestinal distress.
  

Opt for whole grains and generous servings of fruits and vegetables.Ensure that low fat dairy products are used post gall bladder surgery. Avoid convenience foods and fast foods, as they tend to pack in hidden fats. Limit the use of oil to about 2-3 tsp. a day.

Typhoid

Typhoid is caused by bacterium Salmonella Typhi and is spread by drinking contaminated water. Those suffering from typhoid carry this bacteria in their intestinal tract and blood. Even after recovery from the typhoid fever, the bacteria continue to reside leading to spread of the disease.

Eating food handled by a carrier leads to the spread of typhoid. Typically typhoid fever goes as high as 103° to 104° F. The patient suffers stomach pain, headache, gastroenteritis, weakness and loss of appetite. It can also result in rose-colored rashes, known as 'rose spots' in the abdomen. Some might notice epistaxis (bleeding from the nose) and swelling in the abdomen. As the disease progresses, there might be delirium and agitation. If typhoid fever continues into the third week, there might be life-threatening complications such as intestinal hemorrhage, Cholecystitis (inflammation of the Gallbladder) and intestinal perforation. Intestinal leakage could lead to intense irritation and inflammation of the abdominal cavity - a condition known as Peritonitis which can be fatal.

Other Complications:

• There might be a decrease in WBC count and blood culture tests may show positive for Salmonella typhi or paratyphi.
  
• The spleen and liver might become enlarged.
  
• Anemia owing to intestinal bleeding
  
• Lowered body defenses could not fight against bacterial infections like Streptococcus Pneumoniae
  
• Infection may spread to heart or brain causing Meningitis and even coma.
  

If typhoid is diagnosed early, antibiotics for about 7 - 14 days are prescribed. The patient must be given plenty of fluids and small meals. Plenty of bed rest is needed to recoup from a bout of typhoid.