Cholecystitis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 24, 2016
StartDiseasesCholecystitis

Cholecystitis occurs when the gallbladder becomes inflamed. The gallbladder releases a fluid that aids in digestion. Occasionally, the flow of this fluid can become obstructed, which can cause severe pain, inflammation, and even infection. If left untreated, cholecystitis which is also known as gallbladder inflammation can lead to potentially life-threatening complications, including a ruptured gallbladder.

Contents

Definition & Facts

The gallbladder is a small organ that is shaped similar to a pear and situated beneath the liver on the right side of the abdomen. The gallbladder produces and releases bile into the small intestine, which helps the body digest fat. When the gallbladder becomes blocked or does not function properly, an individual can develop cholecystitis.

Gallbladder inflammation is extremely common in the United States. The condition most often occurs in middle age and is more prevalent in women than men. Other risk factors for developing cholecystitis include having a prior medical history of gallstones and being overweight or diabetic. Cholecystitis can be either acute, meaning it develops suddenly, or chronic, meaning that is longstanding.

Symptoms & Complaints

The most common symptom of an inflamed gallbladder is pain and tenderness in the upper right quadrant of the abdomen. In some instances, the pain will radiate through to the back or the shoulder blades. Other possible symptoms include:

The symptoms of cholecystitis are often worse after eating a large, fatty meal and may persist for several hours. Symptoms may present slightly differently in the elderly. Older adults may only complain of abdominal tenderness and may not experience the typical pain and fever associated with cholecystitis. Anyone experiencing abdominal pain that is so severe that it is impossible to get comfortable or sit still should go to the nearest emergency department for immediate medical attention.

Causes

A number of different factors can lead to cholecystitis. The most common causes are an obstruction of the bile duct. Gallstones, also referred to as cholelithiasis, are the most frequent cause of a biliary obstruction. Gallstones are collections of hard particles resulting from an imbalance in the substances that make up the bile, such as bile salts and cholesterol. Tumors, infections, and traumatic injuries can also lead to a possible blockage.

Biliary obstructions resulting in acute cholecystitis can cause the bile to back up inside the gallbladder. This can lead to infection and, in rare instances, even cause the gallbladder to rupture. A rare form of gallbladder inflammation, called acute acalculous cholecystitis, does not involve gallstones and typically occurs as a complication of another severe illness, such as HIV or diabetes.

Chronic cholecystitis is normally the result of repeated instances of acute cholecystitis. The repeated episodes of inflammation cause the walls of the gallbladder to thicken so that there is a decrease in gallbladder function. 

Diagnosis & Tests

The abdominal pain and other symptoms of cholecystitis can mimic other conditions. In addition to the patient’s history of symptoms and a physical examination to assess for abdominal tenderness, the doctor will use a variety of laboratory tests and imaging procedures to confirm the diagnosis and rule out other causes of the symptoms. Blood tests are useful in identifying possible infections and measuring liver function.

An abdominal ultrasound is the most frequently used imaging test in diagnosing cholecystitis. An ultrasound is a painless test that uses sound waves to create a picture of the internal organs. Although less common, a CT scan may also be used to provide a visual image of the gallbladder and the surrounding structures. These imaging tests can verify if gallstones are present in the bile ducts, if the gallbladder wall shows evidence of thickening, and to evaluate the shape and size of the gallbladder.

A hepatobiliary iminodiacetic acid test, also known as a HIDA scan, can measure gallbladder function and track the flow of bile from the liver to the small intestine. The test involves injecting a small amount of radioactive contrast dye into the body that will bind with the bile-producing cells. The bile can then be followed as it moves through the bile ducts to the small intestine. 

Treatment & Therapy

The majority of patients experiencing cholecystitis require a hospital stay to stabilize the inflammation and treat potential infections. This is usually followed by surgery to remove the gallbladder. Once hospitalized, the first step is to reduce the stress on the gallbladder through fasting. IV fluids may be required to prevent dehydration. Antibiotics may be prescribed if the gallbladder also shows signs of infection. Most patients also receive pain medications until the acute inflammation has started to subside.

Cholecystitis has a high rate of recurrence, so most patients eventually have their gallbladder surgically removed. The majority of gallbladder surgeries are performed laparoscopically. The procedure involves making four small incisions in the abdomen. A small video camera attached to a flexible tube is inserted through one opening, and the tools used to remove the diseased gallbladder are inserted through the other incisions. The surgeon uses a video monitor to visualize the gallbladder and the surrounding structures and to guide the instruments.

The open method of removing the gallbladder, which required a long incision in the abdomen, is rarely used today. Once the gallbladder is removed, the bile is allowed to flow freely from the liver to the small intestine. The gallbladder is not required for digestion, and patients are able to lead perfectly normal lives following a short recovery period.

Prevention & Prophylaxis

There are a number of steps that can decrease the risk of developing gallstones, which are the leading cause of cholecystitis:

  • Obesity increases the risk of gallstones. Individuals should try to maintain a healthy weight by monitoring calorie intake and increasing physical exercise.
  • It is recommended to avoid rapid loss that can contribute to gallstone formation. Healthy weight loss is approximately one to two pounds a week.
  • A high-fat, low-fiber diet can increase the risk of developing gallstones; therefore a low-fat diet and high fiber diet may reduce the risk of gallstones and cholecystitis. Prevention includes making healthy food choices such as plenty of fresh vegetables, fruits, and whole grains.