What Is Cholecystitis? What Causes Cholecystitis?

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Main Category: GastroIntestinal / Gastroenterology
Article Date: 24 Nov 2009 - 11:00 PDT

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Cholecystitis is inflammation of the gallbladder. The gallbladder is a small, pear-shaped organ connected to the liver, on the right side of the abdomen, which stores bile and releases it into the small intestine to help in the digestion of fat.

95% of cholecystitis cases are caused by gallstones which are formed by cholesterol and bilirubin (pigment) in bile, also referred to as biliary sludge. The other cases are generally caused by trauma, treatment in hospital, or treatment for illnesses related to bile or the liver.

According to Medilexicon's medical dictionary:

• cholecystitis is "Inflammation of the gallbladder."


• acute cholecystitis is "inflammation and/or hemorrhagic necrosis, with variable infection, ulceration, and neutrophilic infiltration of the gallbladder wall; usually resulting from impaction of a stone in the cystic duct."

What are the signs and symptoms of cholecystitis?

A symptom is something the patient feels and reports, while a sign is something other people, including a doctor or a nurse may detect. For example, pain may be a symptom while a rash may be a sign.

• Pain on the right-hand side of the upper abdomen. In cases of acute cholecystitis the pain comes on suddenly, does not go away, and is intense. If left untreated it will usually get worse, and feel more intense when breathing in deeply. The pain may radiate from the abdomen to the right shoulder or back.

Other symptoms may include


• A slight fever
• Chills
• Abdominal bloating
• Tenderness on the upper-right hand side of the abdomen
• Very little or no appetite
• Nausea
• Vomiting
• Sweating

After a meal, especially one high in fat, symptoms will worsen.

What are the causes of cholecystitis?

The gallbladder holds bile - a fluid that is released after we eat, especially if the meal was high in fat - which aids digestion. The bile travels out of the gallbladder through the cystic duct - a small tube - to the common bile duct (another tube), and then into the small intestine.

If cholecystitis occurs suddenly it is called acute cholecystitis. If it develops slowly over time it is called chronic cholecystitis.

• Gallstones - in the majority of cases acute cholecystitis is caused by gallstones or biliary sludge getting trapped at the gallbladder's opening.


• Injury - trauma to the abdomen, or surgery, can result in cholecystitis.


• Infection - if the infection is located within the bile, the gallbladder can become inflamed.


• Tumor - a tumor may stop the bile from draining out of the gallbladder properly, resulting in an accumulation of bile, which can lead to cholecystitis.

What are the risk factors for cholecystitis?

A risk factor is a condition, situation or environment which raises the risk of developing a disease or condition. For example, obese people have a higher risk of developing Diabetes Type II. Therefore, obesity is a risk factor for Diabetes Type II.

The following conditions or situations may increase the risk of developing gallstones:

• A family history of gallstones on the mother's side of the family
• Crohn's disease
• Diabetes
• Hyperlipidemia
• Losing weight rapidly
• Obesity
• Older age
• Pregnancy
• Long labor - if the pregnant mother has a very long labor there can be damage to the gallbladder, which raises the risk of developing cholecystitis during the weeks after giving birth.

How is cholecystitis diagnosed?

Patients who see their GP (general practitioner, primary care physician) first, will most likely be asked whether they have a history of cholecystitis, because most patients have had it before. The patient will be physically examined to see how tender the gallbladder is.

The following tests may also be ordered:

• Blood test - a higher than normal white blood cell count may indicate that there is an infection. Higher levels of bilirubin, alkaline phosphatase and serum aninotransferase may also help the doctor make a diagnosis.


• Computerized tomography (CT) or ultrasound scans - these will allow the doctor to see an image of the gallbladder, and possible signs of cholecystitis.


• HIDA (Hepatobiliary iminodiacetic acid) scan - also known as a cholescintigraphy, hepatobiliary scintigraphy or hepatobiliary scan. This scan creates pictures of the liver, gallbladder, biliary tract and small intestine. The doctor is then able to track the production and flow of bile from the liver to the small intestine and determine whether, and if so, where there is a blockage.

What is the treatment for cholecystitis?

A patient with cholecystitis will be hospitalized. For a specific period the individual will probably not be allowed to consume any solid or liquid foods and may be given liquids intravenously. Pain medications and antibiotics may also be administered.

Surgery - cholecystitis generally recurs (comes back). Eventually doctors may recommend surgically removing the gallbladder.

Patients with complications, such as gangrene or perforation of the gallbladder will need immediate surgery to remove the gallbladder. If the patient has an infection a tube may be inserted through the skin into the gallbladder to drain the infection.

Patients who do not have complications may undergo a cholecystectomy or laparoscopic cholecystectomy, in which long thin instruments go into the skin, one of them with a tiny video camera - there are usually four skin incisions. The surgeon can see what the tools are doing on a monitor.

After the gallbladder is surgically removed, bile flows directly into the small intestine from the liver. Generally, the patient's overall health and digestive system are not affected by gallbladder removal. In some cases the there may be more episodes of diarrhea.

What are the possible complications of cholecystitis?

Untreated acute cholecystitis can lead to:

• A fistula (a tube/channel is formed between the gallbladder and duodenum)


• Biliary peritonitis


• Gallbladder distention - if the gallbladder is inflamed because of bile accumulation, it may stretch and swell, causing pain. There is then a much greater risk of perforation (a tear) in the gallbladder, as well as infection and tissue death.


• Perforation of the gallbladder


• Pericholecystic abscess


• Tissue death - gallbladder tissue can die (gangrene), which can result in perforation, or the bursting of the bladder.

Prevention of cholecystitis

The following measures can reduce your risk of developing gallstones, which in turn reduce your risk of developing cholecystitis:

• Eating times - try to stick to a regular breakfast, lunch and dinner times. Don't skip meals.


• Exercise - the less physically active you generally are, the higher is your risk of developing gallstones. Try to do exercise five days per week for at least 30 minutes each time.


• Slow weight loss - if you are overweight and want to lose some pounds, don't do so rapidly. Rapid weight loss raises the risk of developing gallstones. Healthy weight loss is generally around 1 to 2 pounds (0.5 to 1 kilograms) of bodyweight per week.


• Bodyweight - the nearer you are to your ideal bodyweight, the lower the risk will be of developing gallstones. Obese people are significantly more likely to have gallstones than people whose bodyweight is ideal for their age, height and body frame.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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