Cholecystitis

Cholecystitis (pronounced ko-luh-sis-TIE-tis) is inflammation of the gallbladder, a small, pear-shaped organ located under the liver. Its primary function is to store and concentrate bile, a digestive fluid produced by the liver. When the gallbladder becomes inflamed, it can cause significant pain and may lead to serious complications if not treated. 

There are two main types of cholecystitis: 

  • Acute cholecystitis: A sudden, severe inflammation that typically develops over hours.

  • Chronic cholecystitis: Inflammation that occurs repeatedly over a longer period, often following several acute attacks. 

Common causes

In most cases, cholecystitis is caused by a blockage in the bile ducts that prevents bile from leaving the gallbladder. 

  • Gallstones: The most frequent cause of both acute and chronic cholecystitis. A gallstone can get stuck in the cystic duct, the tube that drains bile from the gallbladder. This causes bile to back up, leading to pressure, irritation, and inflammation.

  • Acalculous cholecystitis: A less common but more severe form that occurs without gallstones. It typically affects people who are already very ill, such as those with severe burns, major trauma, or a compromised immune system.

  • Tumors: A growth in the pancreas or liver can block the bile ducts and cause inflammation.

  • Serious illness: In very ill patients, serious conditions can damage blood vessels, reducing blood flow to the gallbladder and triggering inflammation.

  • Infections: Some infections, including HIV, can cause the gallbladder to swell and become irritated.

  • Gallbladder sludge: A thick buildup of microscopic particles can block the bile ducts and cause inflammation. This is more common in pregnant women or people who have experienced rapid weight loss. 

Signs and symptoms

The symptoms of cholecystitis often develop after a meal, especially one that is high in fat. 

  • Severe abdominal pain: The most prominent symptom is a sudden, sharp, and constant pain in the upper right side of the abdomen. The pain may spread to the back or right shoulder blade and is often made worse by taking a deep breath.

  • Fever and chills: These are common, especially with acute cholecystitis, and may signal an infection.

  • Nausea and vomiting: These digestive issues often accompany the pain.

  • Abdominal tenderness: The upper right part of the abdomen is usually tender to the touch.

  • Bloating: A feeling of fullness in the belly is common.

  • Jaundice: A yellowing of the skin and eyes can occur if a gallstone blocks the common bile duct.

  • Clay-colored stools: This can also be a sign of a blockage in the bile ducts. 

Diagnosis

Because the symptoms can be similar to other digestive problems, a doctor will use several methods to confirm a diagnosis.

  1. Physical exam and medical history: The doctor will check for abdominal tenderness and ask about your symptoms and risk factors.

  2. Blood tests: A blood test can check for signs of infection (elevated white blood cell count) and other issues affecting the liver or pancreas.

  3. Abdominal ultrasound: This is the most common imaging test used to visualize the gallbladder and check for gallstones, thickened gallbladder walls, or other signs of inflammation.

  4. Hepatobiliary (HIDA) scan: This nuclear imaging test tracks the flow of bile from the liver to the small intestine. It can show if a blockage is preventing bile from leaving the gallbladder. 

Treatment

Treatment for cholecystitis almost always requires hospitalization, especially for acute cases, to monitor and control the inflammation and pain. 

  • Initial hospital treatment: You will likely be put on a fast to rest the gallbladder. Intravenous (IV) fluids will be given to prevent dehydration, along with pain medication and antibiotics to treat any infection.

  • Surgical removal of the gallbladder (cholecystectomy): For most people with cholecystitis, surgical removal of the gallbladder is the standard treatment and prevents future attacks. The gallbladder is not a necessary organ, and bile will simply flow from the liver directly to the small intestine after it is removed.

    • Laparoscopic surgery: This minimally invasive procedure uses small incisions, resulting in a quicker recovery time.

    • Open surgery: In some cases, such as during complications, a larger incision may be necessary.

  • Non-surgical procedures: For patients who cannot undergo surgery, a drain can sometimes be placed into the gallbladder to remove the infected bile. In cases where a gallstone is stuck in the common bile duct, a procedure called an ERCP may be used to remove the stone.

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