Overview
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 build up that can cause inflammation. Other causes of cholecystitis include bile duct problems, tumours, 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 depends upon its cause and in many cases, it may involve gallbladder removal.
Symptoms
Severe pain in your upper right or centre abdomen
Pain that spreads to your right shoulder or back
Tenderness over your abdomen when it’s touched
Nausea
Vomiting
Fever
When to see a doctor
Causes
- 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.
- Tumour. A tumour may prevent bile from draining out of your gallbladder properly, causing bile build up 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
Complications
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
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.
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.
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
- Blood tests. Your doctor may order blood tests to look for signs of an infection or signs of gallbladder problems which includes a CBC, LFT, etc.
- Imaging tests that show your gallbladder. Abdominal ultrasound, endoscopic ultrasound (USG), 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
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.
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 your appointment
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.
Questions to ask your doctor
- 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
- 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?
