Cholecystitis - Symptoms, Diagnosis, Prevention & Treatment

Cholecystitis - Inflammation of the Gall Bladder

Dr.Nitin Rao profile Authored by Dr.Nitin Rao on 12 Jun 2014 - 14:10.

Cholecystitisis means inflammation of the gallbladder. Gallbladder is a hollow, pear-shaped small organ residing beneath the liver (right side of the abdomen). It stores and concentrates bile which is responsible for lipid digestion. Whenever we eat a fatty meal, the gallbladder contracts and the concentrated bile through bile duct is delivered to the duodenum where it mixes with the food that we have eaten and the process of digestion starts.

Types of Cholecystitis:

Based on the root causes, Cholecystitis is divided into two types:

  • Calculous Cholecystitis – This is the most common cause of cholecystitis and happens usually as a result of stones in the gallbladder getting stuck at the gallbladder neck or the cystic duct. Calculous Cholecystitis often leads to ischemia ( restriction in blood supply to tissues) and necrosis (death of body tissue).

  • Acalculous Cholecystitis – This contributes a smaller percentage to cause of cholecystitis. This may be due to blockage due to other causes, including tumor, and also seen often in patients having diabetes.

Causes:

As mentioned above gallstones is the commonest cause for cholecystitis.

Symptoms of Cholecystitis is usually exaggerated after a heavy meal, especially if the meal is rich in fat. A patient having Cholecystitis may experience the following symptoms:

  • Stomach pain (especially in the right side where the gallbladder is situated)
  • Pain may be steady and severe, which often radiates to the back or shoulders.
  • Excessive sweating
  • Fever and/or chills
  • Nausea and vomiting
  • Tenderness in the stomach that can be felt externally by normal touch
  • Bloating of the stomach
  • Irritation in the stomach
  • Increased heart rate (tachycardia)

Diagnosis

The diagnosis of Cholecystitis may involve multiple modalities including physical examinations, blood tests and imaging tests.

Physical Examination: It includes doctor's review to understand the condition and physical assessment to reveal the following:

  • Fever
  • Increased heart rate (tachycardia)
  • Tenderness
  • Palpable gallbladder
  • Symptoms of the jaundice

Blood Tests:

To trace out the signs of any infection.

  • Raised levels of Alanine aminotransferase (ALT) and aspartate aminotransferase (AST).
  • Assay of bilirubin and alkaline phosphatase – to reveal the bile duct blockage.
  • Elevated levels of amylase (rule out any pancreatitis).
  • Urine examinations – to rule out any urinary tract infection and stones.

Imaging Tests:

The commonest test done would be an Ultrasound scan which will pick up stones, thickness of the gallbladder wall, pus collection in gallbladder, any collections around the gallbladder. A computerized tomography (CT) scan may also be required at times. Rarely a hepatobiliary iminodiacetic acid (HIDA) scan may be needed to confirm acute cholecystitis.

Risk factors

Several factors may put an individual to risk of developing Cholecystitis. Some common factors include:

  • Obesity
  • Being a woman – women have a greater risk of developing gallstones as compared to men.
  • Age - Risk of developing gallstones increases with age.
  • Certain groups with specific ethnic origin.
  • Sudden weight loss.
  • Sudden weight gain.
  • Taking several drugs, especially hormones.
  • Being pregnant
  • Hemolysis (breakdown of blood cells)

Complications

If not treated right or on time, Cholecystitis may lead to several severe health issues. These prominently include:

  • Enlargement of gallbladder with filling of pus into it (empyema).
  • Enlargement of gallbladder with only mucus (mucocele).
  • Gangrene of gallbladder wall and perforation.
  • Spread of pus/bile in abdominal cavity if gallbladder perforates.
  • If a stone from gallbladder passes down to bile ducts then, cholangitis, jaundice, pancreatitis.
  • Rarely if a large stone passes into the intestine then can cause bowel obstruction.
 

Treatments and Drugs

Treatment for cholecystitis usually includes medications like antibiotics, pain killers and removal of the gallbladder. Once the diagnosis of cholecystitis is confirmed, the patient may have to stay in the hospital till his/her complete treatment of stabilizing the affected gall bladder is done. After stabilizing the gallbladder with antibiotics, experts may plan for a surgery to avoid recurrences of the Cholecystitis. However, in chronic cases, bursting of the gallbladder or gangrene, immediate surgery to remove the gallbladder, may be required.

Selection of the treatment for Cholecystitis often depends on the severity of the disease, the causes and the complications. Common treatment to control Cholecystitis may include:

  • Fasting: Experts may advise you to not to drink or eat anything initially to rest the gallbladder. However, the patient can be given fluids through an IV (arm).
     
  • Drugs and Medications: It mainly includes antibiotics to treat an infection, certain pain killers to relieve the pain and antiemetics, to relieve nausea and to prevent electrolyte abnormalities.
     
  • Surgery: The surgery performed to remove the gallbladder permanently is called Cholecystectomy. It is a useful option, since Cholecystitis can recur very frequently. The surgery is performed either laparoscopically or by open method, however presently laparoscopic method has become the standard. In laparoscopic method, the surgeon makes 3-4 small 5mm to 1cm incisions and introduces camera and instrument through these holes to remove the gallbladder. In a small number of cases even though the operation was started as a laparoscopic procedure it gets converted to an open operation to by the time surgery is completed.
 

Following preventive measures can be practiced to minimize the formation of gallstones:

  • Weight must be reduced gradually, as sudden weight loss may worsen or increase the risk of developing gallstones.
  • Regularly exercises are encouraged to stay healthy.
  • Eating fruits, vegetables and whole grains can help, while high fat and food low in fiber can be risky.
  • A healthy weight must be maintained at all times.
*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.