With cholecystitis, there is constant pain in the right upper abdomen. Inflammation extends through the wall of the gallbladder, and the right upper abdomen becomes particularly tender when it is pressed or even tapped. Unlike with biliary colic, however, it is painful to move around. Individuals with cholecystitis usually lie still. There is fever , and the white blood cell count is elevated, both signs of inflammation. Cholecystitis usually is treated with antibiotics, and most episodes will resolve over several days. Even without antibiotics, cholecystitis often resolves. As with biliary colic, movement of the gallstone out of the cystic duct and back into the gallbladder relieves the obstruction and allows the inflammation to resolve.
One of the difficulties in diagnosing NASH as the cause of severe scaring or cirrhosis is that as the scaring progresses to cirrhosis, the fat disappears. This results in a condition that is referred to as cryptogenic cirrhosis , cirrhosis in which there is no clear cause. (Specifically, in cryptogenic cirrhosis the two most common causes of cirrhosis - alcohol and viral hepatitis - are not involved.) Cryptogenic cirrhosis has puzzled physicians for many years as to its cause. However, it now appears that half of cryptogenic cirrhosis occurs in patients with obesity and/or diabetes and probably is due to NASH.
While alcoholism and viral hepatitis were traditionally thought to be the major causes of liver failure, it is actually the consequences of obesity and metabolic syndrome that have now surpassed these older risk factors. A condition called fatty liver has reached epidemic proportions, by some estimates affecting from 10-20 percent of the population. A recent study showed that up to 45 percent of Hispanics have some form of liver compromise. Unheard-of in pediatric patients until recently, fatty liver is even beginning to make inroads among our kids.