What is cholecystitis?
Cholecystitis is the inflammation of the gallbladder, which is a pear-shaped organ situated under the liver. The gallbladder serves as the storage organ for bile until it is needed for the digestion of fatty foods in the duodenum or the first segment of the small intestine.
Most cases of cholecystitis are caused by gallstones. Other causes of cholecystitis include infections, tumors, bile duct problems, and serious illnesses. Gallbladder inflammation is also more common in women than in men. People with acute cholecystitis are often admitted to a hospital for prompt treatment and monitoring. Although the inflammation may be relieved with medications, surgery to remove the gallbladder is often recommended by doctors to prevent further complications.
Signs and Symptoms of Cholecystitis
The signs and symptoms of cholecystitis usually occur after consuming a large or fatty meal, and may include:
- Abdominal tenderness
- Slight fever
- Severe pain at the center or upper right corner of the abdomen
- Pain that radiates to the back and right shoulder
Make a doctor's appointment if you have worrisome symptoms. However, if you develop severe abdominal pain, seek medical attention right away.
Cholecystitis can be caused by the following:
- Gallstones: Most cases of cholecystitis are caused by gallstones that form in the gallbladder. Gallstones can obstruct the tube, where bile flows through when it exits the gallbladder. When there is an obstruction, bile builds up and cause inflammation. The main risk factor for developing cholecystitis is having gallstones.
- Blockage of the bile duct: Cholecystitis may also occur if there is an obstruction between the gallbladder and the common bile duct. Blockages can also be due to scarring or inflammation of the bile ducts.
- Tumor: The presence of a tumor may prevent bile from properly exiting the gallbladder, causing bile to build up and cause gallbladder inflammation.
- Infection: Certain infections, including AIDS, can trigger cholecystitis.
- Blood Vessel Problem: Severe illnesses can cause blood vessel problems that reduce the flow of blood to the gallbladder, leading to inflammation.
If acute cholecystitis is left untreated, it can cause the following complications:
- A fistula: A fistula is a tube that can develop if large stones erode the gallbladder wall. This can create an abnormal connection between the gallbladder and duodenum, which stones may easily pass through.
- Gallbladder distention: If bile accumulation causes cholecystitis, the gallbladder may swell, stretch, and cause pain. There is also an increased risk of developing a tear or perforation in the gallbladder, including infections and tissue death.
- Tissue death: When gallbladder tissues die, gangrene develops and cause a perforation or gallbladder rupture. If it is left untreated, around 10 percent of patients who have acute cholecystitis will develop localized perforation. Moreover, 1 percent of these patients will develop free perforation as well as peritonitis.
The following tests and procedures may be used to help diagnose cholecystitis:
- Blood tests: Blood tests may be performed to look for any signs of infection or gallbladder issues.
- Imaging tests: These tests may include an endoscopic ultrasound, abdominal ultrasound, or a computerized tomography (CT) scan. These imaging scans are used to create images of the gallbladder and identify signs of gallbladder inflammation, bile duct stones, or gallstones.
- Hepatobiliary iminodiacetic acid (HIDA) scan: This type of imaging test helps doctors track the flow and production of bile from the liver to the small intestine. It can also show blockages. This imaging procedure involves radioactive dye injection into the body to highlight certain organs on the scan.
Hospital admission is often required when it comes to treating cholecystitis. Aside from medications that can help control the inflammation, the surgical removal of the gallbladder is also a treatment option.
Treatments administered in the hospital may include:
- IV fluids: Medications are often given through an IV line aside from preventing dehydration.
- Antibiotics: Antibiotics are given to help fight the infection. If the gallbladder is infected, doctors will likely give antibiotics.
- Pain relievers: These can help control pain until the inflammation in your gallbladder is relieved.
- Stone removal procedure: Bile duct stones can be removed through a procedure called endoscopic retrograde cholangiopancreatography (ERCP). However, most patients with cholecystitis eventually need cholecystectomy or the surgical removal of the gallbladder.
Cholecystectomy is often a minimally invasive procedure that involves small abdominal incisions. However, in rare cases, a long abdominal incision or open procedure can also be performed.
Surgery to remove the gallbladder also depends on the patient’s symptoms and risk factors. Patients who are at low surgical risk may undergo surgery within two days of hospital admission. When the gallbladder is removed, there is no longer a storage organ to hold bile, so after its removal, bile directly flows from the liver into the small intestine. People do not need a gallbladder to live a normal life.
The risk of developing gallstones and cholecystitis can be reduced by the following measures:
- Avoid consuming saturated fats
- Eat breakfast and avoid skipping meals
- Exercise for at least 30 minutes, 5 days a week
- Maintain a healthy weight (being overweight or obese increases the risk of gallbladder problems)
- Gradually lose weight to avoid developing gallstones
- Follow a healthy weight loss of around 0.5 to 1 kg or 1 to 2 lbs. of body weight each week
When to See a Doctor
It's time to see a doctor if you have worrisome symptoms. You will likely see a primary care physician, but when the doctor suspects that you have cholecystitis, you may be referred to a specialist called a gastroenterologist, who specializes in the digestive system. Your primary care provider may also send you to a hospital if you have acute and severe symptoms.
Before your scheduled appointment, make sure to ask about pre-appointment restrictions, such as diet restrictions. Write down important personal information as well as your symptoms and questions to ask your doctor. You should also prepare a list of all your medications, including herbal supplements or vitamins that you are taking. Do not forget to bring relevant medical records if you have any.
To avoid forgetting the information you get from your doctor, you can ask someone (a friend or a family member) to accompany you during your doctor's appointment.