Cholecystitis

Cholecystitis (ko-luh-sis-TIE-tis) is inflammation of the gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, beneath your liver. The gallbladder holds a digestive fluid that's released into your small intestine (bile).

In most cases, gallstones blocking the tube leading out of your gallbladder cause cholecystitis. This results in a bile buildup that can cause inflammation. Other causes of cholecystitis include bile duct problems, tumors, serious illness and certain infections.

If left untreated, cholecystitis can lead to serious, sometimes life-threatening complications, such as a gallbladder rupture. Treatment for cholecystitis often involves gallbladder removal.

Symptoms

Signs and symptoms of cholecystitis may include:

• Severe pain in your upper right or center abdomen
• Pain that spreads to your right shoulder or back
• Tenderness over your abdomen when it's touched
• Nausea
• Vomiting
• Fever

Cholecystitis signs and symptoms often occur after a meal, particularly a large or fatty one.

When to see a doctor

Make an appointment with your doctor if you have worrisome signs or symptoms. If your abdominal pain is so severe that you can't sit still or get comfortable, have someone drive you to the emergency room.

Causes

Cholecystitis occurs when your gallbladder becomes inflamed. Gallbladder inflammation can be caused by:

• Gallstones. Most often, cholecystitis is the result of hard particles that develop in your gallbladder (gallstones). Gallstones can block the tube (cystic duct) through which bile flows when it leaves the gallbladder. Bile builds up, causing inflammation.
• Tumor. A tumor may prevent bile from draining out of your gallbladder properly, causing bile buildup that can lead to cholecystitis.
• Bile duct blockage. Kinking or scarring of the bile ducts can cause blockages that lead to cholecystitis.
• Infection. AIDS and certain viral infections can trigger gallbladder inflammation.
• Blood vessel problems. A very severe illness can damage blood vessels and decrease blood flow to the gallbladder, leading to cholecystitis.

Risk factors

Having gallstones is the main risk factor for developing cholecystitis.

Complications

Cholecystitis can lead to a number of serious complications, including:

• Infection within the gallbladder. If bile builds up within your gallbladder, causing cholecystitis, the bile may become infected.
• Death of gallbladder tissue. Untreated cholecystitis can cause tissue in the gallbladder to die (gangrene). It's the most common complication, especially among older people, those who wait to get treatment, and those with diabetes. This can lead to a tear in the gallbladder, or it may cause your gallbladder to burst.
• Torn gallbladder. A tear (perforation) in your gallbladder may result from gallbladder swelling, infection or death of tissue.

Prevention

You can reduce your risk of cholecystitis by taking the following steps to prevent gallstones:

1. Lose weight slowly. Rapid weight loss can increase the risk of gallstones. If you need to lose weight, aim to lose 1 or 2 pounds (0.5 to about 1 kilogram) a week.
2. Maintain a healthy weight. Being overweight makes you more likely to develop gallstones. To achieve a healthy weight, reduce calories and increase your physical activity. Maintain a healthy weight by continuing to eat well and exercise.
3. Choose a healthy diet. Diets high in fat and low in fiber may increase the risk of gallstones. To lower your risk, choose a diet high in fruits, vegetables and whole grains.

Diagnosis

Tests and procedures used to diagnose cholecystitis include:

• Blood tests. Your doctor may order blood tests to look for signs of an infection or signs of gallbladder problems.
• Imaging tests that show your gallbladder. Abdominal ultrasound, endoscopic ultrasound, or a computerized tomography (CT) scan can be used to create pictures of your gallbladder that may reveal signs of cholecystitis or stones in the bile ducts and gallbladder.
• A scan that shows the movement of bile through your body. A hepatobiliary iminodiacetic acid (HIDA) scan tracks the production and flow of bile from your liver to your small intestine and shows blockage. A HIDA scan involves injecting a radioactive dye into your body, which attaches to bile-producing cells so that it can be seen as it travels with the bile through the bile ducts.

Treatment

Treatment for cholecystitis usually involves a hospital stay to control the inflammation in your gallbladder. Sometimes, surgery is needed.

At the hospital, your doctor will work to control your signs and symptoms. Treatments may include:

• Fasting. You may not be allowed to eat or drink at first in order to take stress off your inflamed gallbladder.
• Fluids through a vein in your arm. This treatment helps prevent dehydration.
• Antibiotics to fight infection. If your gallbladder is infected, your doctor likely will recommend antibiotics.
• Pain medications. These can help control pain until the inflammation in your gallbladder is relieved.
• Procedure to remove stones. Your doctor may perform a procedure called endoscopic retrograde cholangiopancreatography (ERCP) to remove any stones blocking the bile ducts or cystic duct.

Your symptoms are likely to decrease in two or three days. However, gallbladder inflammation often returns. Most people with the condition eventually need surgery to remove the gallbladder.

Gallbladder removal surgery is called a cholecystectomy. Usually, this is a minimally invasive procedure, involving a few tiny incisions in your abdomen (laparoscopic cholecystectomy). An open procedure, in which a long incision is made in your abdomen, is rarely required.

The timing of surgery depends on the severity of your symptoms and your overall risk of problems during and after surgery. If you're at low surgical risk, surgery may be performed within 48 hours or during your hospital stay.

Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder. You don't need your gallbladder to live normally.

Preparing for an appointment

Make an appointment with your doctor if you have signs or symptoms that worry you. If your doctor suspects you have cholecystitis, he or she may either refer you to a doctor who specializes in the digestive system (gastroenterologist) or send you to a hospital.

What you can do

• Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
• Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements you're taking.
• Take a family member or friend along, if possible. Someone who accompanies you can help you remember the information you get.
• Write down questions to ask your doctor.

For cholecystitis, some basic questions to ask your doctor include:

• Is cholecystitis the likely cause of my abdominal pain?
• What are other possible causes for my symptoms?
• What tests do I need?
• Do I need gallbladder removal surgery?
• How soon do I need surgery?
• What are the risks of surgery?
• How long does it take to recover from gallbladder surgery?
• Are there other treatment options for cholecystitis?
• Should I see a specialist?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?

Don't hesitate to ask other questions, as well.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• When did your symptoms begin?
• Have you had pain like this before?
• Are your symptoms constant or do they come and go?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

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