Cholecystitis is a gallbladder inflammation, which can lead to significant complications if left untreated. When a gallstone becomes lodged at the opening of the gallbladder, it can cause the organ to become distended. This condition often presents with symptoms like pain, fever, and a sick feeling of stomach. If cholecystitis is not addressed, it may result in severe outcomes including rupture of the gallbladder, gangrene, tissue death, fibrosis, secondary bacterial infections, or shrinking of the gallbladder.
The condition can be categorized into two kinds: acute and chronic. Acute cholecystitis arises suddenly, while chronic cholecystitis develops gradually over time. In the U.S., around 200,000 individuals are diagnosed with acute cholecystitis each year.
Research indicates that in the middle of 90 and 95 percent of individuals with cholecystitis develop gallstones, which may be composed of cholesterol, bilirubin, or a combination of both. Additionally, cholecystitis can happen when biliary sludge accumulates in the biliary system. Though less common, there are alternative causes of cholecystitis that may also be considered.
Causes
The size of the gall bladder is small, pear-figured organ located on the right side of the lower stomach, linked to the liver. Its primary function is to store bile, a digestive fluid, and release it into the small intestine to assist with fat digestion. This release occurs particularly after consuming a meal high in fat. Bile exits the gallbladder by the cystic duct, which leads to the normal bile duct and then to the small intestine.
Cholecystitis, or inflammation of the gallbladder, is commonly caused by biliary sludge or gallstones becoming captured at the opening of the gallbladder. In some cases, healthcare providers may refer to these obstructions as pseudoliths, or “fake stones.”
Other potential causes of cholecystitis include abdominal injury from burns, trauma, sepsis, or surgery, as well as shock, prolonged fasting, immune deficiency, and vasculitis. Each of these factors can contribute to the development of inflammation in the gallbladder.
Symptoms
The symptoms of cholecystitis typically include pain in the upper right quadrant of the abdomen, fever, and an elevated count of white blood cells. The pain is generally localized over the gallbladder and may be quite severe.
In acute cholecystitis condition, the pain begins suddenly and is intense, often worsening over time without intervention. It may be aggravated by deep breathing and can radiate to the right back or shoulder. Other signs associated with acute cholecystitis involve abdominal bloating, sensitivity in the upper right abdomen, loss of appetite, a sick feeling of the stomach, vomiting, and a light fever with chills. Symptoms often intensify after a high-fat meal, and a blood test may show a high count of white blood cells.
Chronic cholecystitis, on the other hand, presents with similar pain but typically occurs more frequently at the end of the day or at night. Symptoms develop slowly over months or weeks, and individuals usually do not experience chills or fever. Over time, the pain may increase, and chronic cholecystitis can eventually progress to acute cholecystitis.
Diagnosis
To diagnose cholecystitis, a healthcare provider will first inquire about the patient’s medical history, as cholecystitis frequently reoccurs. They will also assess the sensitivity of the gallbladder through a physical test.
If needed, the healthcare provider may order several tests to confirm the diagnosis. A complete blood count can indicate infection if there is a high count of white blood cells, and elevated levels of alkaline phosphatase, bilirubin, and serum aminotransferase can provide additional diagnostic clues.
Imaging tests like ultrasound or CT scans can help visualize the gallbladder and identify signs of cholecystitis. Additionally, a hepatobiliary iminodiacetic acid scan, also called as hepatobiliary scintigraphy, or scan, cholescintigraphy, creates detailed images of the liver, biliary tract, gallbladder, and small intestine. This scan helps track the flow and production of bile, allowing the healthcare provider to detect any blockages and determine their place.
Treatment
Treatment for cholecystitis often involves hospitalization, particularly if the condition is severe. During this time, patients may need to abstain from eating solid or liquid foods, and receive only intravenous fluids, antibiotics, and pain medication.
Surgery is frequently recommended for acute cholecystitis due to the high likelihood of reoccurrence associated with inflammation from gallstones. For those with a decreased risk of issues, surgery might be performed on an outpatient basis. However, if complications are present, prompt surgery is required to eliminate the gallbladder. In cases where an infection takes place, a tube may be kept over the epidermis into the gallbladder to empty it.
Gallbladder removal, or cholecystectomy, can be performed either through an open abdominal procedure or laparoscopically. Laparoscopic cholecystectomy includes making many small cuts in the skin. A camera is inserted through one cut to provide visibility inside the abdomen, while tools for removing the gallbladder are inserted through the other incisions. This method is beneficial because it typically results in less pain and scarring compared to open surgery.
After the gallbladder is removed, bile will flow straight from the liver into the small intestine. This usually does not impact digestive function or overall health, though some individuals may experience more frequent diarrhea.
Risk Factors
Several risk factors can elevate the likelihood of getting acute cholecystitis. These include diabetes, a history of physical trauma or critical illness, shock, prolonged fasting, immune deficiency, and vasculitis.
For chronic cholecystitis, additional risk factors include rapid weight loss, older age, obesity, and pregnancy. Gallstones are linked to most cases of cholecystitis, making their presence a significant risk factor. Conditions that increase the likelihood of developing gallstones include elevated estrogen levels, older age, having multiple childbirths, and an increased body mass index.
Prevention
To lower the risk of getting gallstones and consequently decrease the possibility of cholecystitis, several preventive measures can be effective. It is important to avoid saturated and trans fats, which can contribute to the formation of gallstones. Maintaining a consistent eating schedule with regular meals and not missing meals can also be beneficial. Additionally, engaging in regular physical exercise helps to manage body weight and overall health.
Another key factor is achieving and maintaining a healthy body weight, as obesity significantly heightens the chance of gallstones. It is crucial to avoid quick weight loss, which can also elevate the risk of gallstone formation. The Centers for Disease Control and Prevention recommend aiming for a gradual weight loss of around 1 to 2 pounds per week (approximately 0.5 to 1 kilogram). Staying closer to one’s ideal body weight helps to minimize the chance of getting gallstones and, subsequently, cholecystitis.
Summary
Cholecystitis is gallbladder inflammation, often caused by biliary sludge or gallstones. It presents with symptoms like severe pain, fever, and nausea. Treatment usually involves surgery to remove the gallbladder, which generally leads to a positive recovery. Risk factors include diabetes, obesity, rapid weight loss, and certain demographics. Preventive measures focus on a healthy diet, regular exercise, and gradual weight loss. Complications are rare but can occur, especially if the condition is related to other serious health issues, requiring prompt and careful medical attention.
