Cholecystitis is an inflammation of the gallbladder. It normally happens because a gallstone gets stuck at the opening of the gallbladder. It can lead to fever, pain, nausea, and severe complications.
Untreated, it can result in perforation of the gallbladder, tissue death and gangrene, fibrosis and shrinking of the gallbladder, or secondary bacterial infections.
Ninety-five percent of cholecystitis cases involve gallstones. These may be formed from cholesterol, bilirubin, or "pigment," or a mix of the two. It can also be triggered by biliary sludge, when bile collects in the biliary ducts.
Other causes include trauma, critical illness, immunodeficiency, or certain medications. Some chronic medical conditions, like kidney failure, coronary heart disease, or certain types of cancer also increase the risk of cholecystitis.
In the United States, there were 215,995 hospital admissions for cholecystitis in 2012, and the average hospital stay was 3.9 days.
Acute cholecystitis starts suddenly. Chronic cholecystitis develops slowly over time.
Contents of this article:
Signs and symptoms
Gallstones in the gall bladder can lead to cholecystitis.
Signs and symptoms of cholecystitis include right upper quadrant pain, fever, and a high white blood cell count.
Pain generally occurs around the gallbladder, in the right upper quadrant of the abdomen.
In cases of acute cholecystitis, the pain starts suddenly, it does not go away, and it is intense. Left untreated, it will usually get worse, and breathing in deeply will make it feel more intense. The pain may radiate from the abdomen to the right shoulder or back.
Other symptoms may include:
- Abdominal bloating
- Tenderness on the upper-right hand side of the abdomen
- Little or no appetite
A slight fever and chills may be present with acute cholecystitis.
After a meal, especially one that is high in fat, symptoms will worsen. A blood test may reveal a high white blood cell count.
Causes and risk factors
The gallbladder is a small, pear-shaped organ connected to the liver, on the right side of the abdomen. It stores bile and releases it into the small intestine to help in the digestion of fat.
The gallbladder holds bile, a fluid that is released after we eat, especially after a meal that is high in fat, and this bile aids digestion. The bile travels out of the gallbladder through the cystic duct, a small tube that leads to the common bile duct, and from there into the small intestine.
The main cause of cholecystitis is gallstones or biliary sludge getting trapped at the gallbladder's opening. This is sometimes called a pseudolith, or "fake stone."
Other causes include:
- Injury to the abdomen from burns, sepsis or trauma, or because of surgery
- Immune deficiency
- Prolonged fasting
An Infection in the bile can lead to an inflammation in the gallbladder.
A tumor may stop the bile from draining out of the gallbladder properly, resulting in an accumulation of bile. This can lead to cholecystitis.
The following factors may increase the risk of developing gallstones:
- A family history of gallstones on the mother's side of the family
- Crohn's disease
- Coronary artery disease
- End-stage kidney disease
- Losing weight rapidly
- Older age
Long labor during childbirth can damage the gallbladder, raising the risk of cholecystitis during the following weeks.
Diagnosis and treatment
A doctor will normally ask if a patient has a history of cholecystitis, because it often recurs. A physical examination will reveal how tender the gallbladder is.
Cholecystitis can cause abdominal pain.
The following tests may also be ordered:
- Ultrasound: This can highlight any gallstones and may show the condition of the gallbladder.
- Blood test: A high white blood cell count may indicate an infection. High levels of bilirubin, alkaline phosphatase and serum aminotransferase may also help the doctor make a diagnosis.
- Computerized tomography (CT) or ultrasound scans: Images of the gallbladder may reveal signs of cholecystitis.
- Hepatobiliary iminodiacetic acid (HIDA) scan: Also known as a cholescintigraphy, hepatobiliary scintigraphy or hepatobiliary scan, this scan creates pictures of the liver, gallbladder, biliary tract and small intestine.
This allows the doctor to track the production and flow of bile from the liver to the small intestine and determine whether there is a blockage, and where any blockage is.
A patient with cholecystitis will be hospitalized, and they will probably not be allowed to consume any solid or liquid foods for some time. They will be given liquids intravenously while fasting. Pain medications and antibiotics may also be given.
Surgery is recommended for acute cholecystitis, because there is a high rate of recurrence from inflammation related to gallstones. However, if there is a low risk of complications, surgery can be done as an outpatient procedure.
If there are complications, such as gangrene or perforation of the gallbladder, the patient 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.
Removal of the gallbladder, or cholecystectomy, can be performed by open abdominal excision or laparoscopically.
Laparoscopic cholecystectomy involves several small incisions in the skin. A camera is inserted into one incision to help the surgeon see inside the abdomen, and tools for removing the gallbladder and inserted through the other incisions.
The benefit of laparoscopy is that the incisions are small, so usually patients have less pain after the procedure and less scarring.
After surgically removing the gallbladder, the bile will flow directly into the small intestine from the liver. This does not normally affect the patient's overall health and digestive system. Some patients may have more frequent episodes of diarrhea.
Complications and prevention
Untreated acute cholecystitis can lead to:
A healthy diet can help prevent gallstones, a common cause of cholecystitis.
- A fistula, a kind of tube or channel can develop if a large stone erodes the wall of the gallbladder. This can link the gallbladder and the duodenum, and the stone may pass through.
- 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 a perforation, or tear, in the gallbladder, as well as infection and tissue death.
- Tissue death: Gallbladder tissue can die and gangrene develop, leading to perforation, or the bursting of the bladder. Without treatment, 10 percent of patients with acute cholecystitis will experience localized perforation, and 1 percent will develop free perforation and peritonitis.
If a gallstone becomes impacted in the cystic duct, it can compress and block the common bile duct, and this can lead to cholestasis. This is rare.
Gallstones can sometimes pass from the gallbladder into the biliary tract, leading to an obstruction of the pancreatic duct. This may cause pancreatitis.
In 3 percent to 19 percent of cases, acute cholecystitis can lead to a pericholecystic abscess. Symptoms include nausea, vomiting, and abdominal pain.
Some measures can reduce the risk of developing gallstones, and this can decrease the chance of developing cholecystitis:
- Avoiding saturated fats
- Keeping to a regular breakfast, lunch and dinner times and not skipping meals
- Exercising 5 days per week for at least 30 minutes each time
- Losing weight, because obesity increases the risk of gallstones
- Avoiding rapid weight loss as this increases the risk of developing gallstones
A healthy weight loss is generally around 1 to 2 pounds, or 0.5 to 1 kilograms, of bodyweight per week.
The nearer a person is to their ideal bodyweight, the lower the risk will be of developing gallstones. Gallstones are more prevalent in people with obesity, compared with those who have an appropriate bodyweight for their age, height, and body frame.