Cholecystitis

What is cholecystitis?

Cholecystitis is an inflammation of the gallbladder wall and nearby abdominal lining. Cholecystitis is usually caused by a gallstone in the cystic duct, the duct that connects the gallbladder to the hepatic duct. Other causes of cholecystitis may include the following:

• Bacterial infection in the bile duct system. The bile duct system is the drainage system that carries bile from the liver and gallbladder into the area of the small intestine called the duodenum.

• Tumor of the pancreas or liver.

• Decreased blood supply to the gallbladder. This can sometimes occur in persons with diabetes.

• Gallbladder "sludge." This "sludge" is a thick material that cannot be absorbed by bile in the gallbladder and most commonly occurs in pregnant women or individuals who have experienced a rapid weight loss.

Cholecystitis can occur suddenly or gradually over many years.

What are the symptoms of cholecystitis?

A typical attack of cholecystitis usually lasts two to three days. However, each individual may experience symptoms differently. Symptoms may include:

• Intense and sudden pain in the upper right part of the abdomen

• Recurrent painful attacks for several hours after meals

• Pain (often worse with deep breaths and extends to lower part of right shoulder blade)

• Nausea

• Vomiting

• Rigid abdominal muscles on right side

• Slight fever

• Chills

• Jaundice. A yellowing of the skin and eyes.

• Itching (rare)

• Loose, light-colored bowel movements

• Abdominal bloating

The symptoms of cholecystitis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is cholecystitis diagnosed?

In addition to a complete medical history and medical examination, diagnostic procedures for cholecystitis may include the following:

• Ultrasound (also called sonography). A diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen, such as the liver, spleen, and kidneys, and to assess blood flow through various vessels.

• Hepatobiliary scintigraphy. An imaging technique of the liver, bile ducts, gallbladder, and upper part of the small intestine.

• Cholangiography. X-ray examination of the bile ducts using an intravenous (IV) dye (contrast).

• Cholescintigraphy (also called HIDA scan). A small amount of nonharmful radioactive material is injected simulating the gallbladder to contract. This test diagnoses abnormal contraction of the gallbladder or obstruction of the bile ducts. 

• Percutaneous transhepatic cholangiography (PTC). A needle is introduced through the skin and into the liver where the dye (contrast) is deposited and the bile duct structures can be viewed by X-ray.

• Endoscopic retrograde cholangiopancreatography (ERCP). A procedure that allows the doctor to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. The procedure combines X-ray and the use of an endoscope, which is a long, flexible, lighted tube. The scope is guided through the patient's mouth and throat, then through the esophagus, stomach, and duodenum. The doctor can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope, and a dye is injected which will allow the internal organs to appear on an X-ray.

• Computed tomography scan (CT or CAT scan). A diagnostic imaging procedure using a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

What is the treatment for cholecystitis?

Specific treatment for cholecystitis will be determined by your doctor based on:

• Your age, overall health, and medical history

• Extent of the disease

• Your tolerance of specific medicines, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

Treatment for acute cholecystitis usually involves a hospital stay to reduce stimulation to the gallbladder. Antibiotics are usually administered to fight the infection. Fluids are given intravenously and the stomach is kept empty until symptoms resolve. Sometimes, the gallbladder is surgically removed, either immediately or later after the episode of acute cholecystitis has resolved.

Other treatment options may include:

• Oral dissolution therapy. Drugs made from bile acid are used to dissolve the stones

• Medications. These are used to prevent the formation of gallstones.

• Low-fat diet

• Pain management

The overall prognosis for cholecystitis is favorable. In some individuals, complications may arise if other organs are involved. Gallstones can return in the bile duct system after surgical removal of the gallbladder.