Cholecystitis

Cholecystitis is inflammation of the gallbladder. Most cases are caused

by gallstones. If you have cholecystitis you will normally be admitted to
hospital for treatment with painkillers, fluids, (and sometimes antibiotic
medicines) directly into a vein. The inflammation may settle down with
treatment. However, removal of the gallbladder is usually advised to
prevent further bouts of cholecystitis.

Understanding the gallbladder and bile

Bile is a fluid made in the liver. Bile contains various substances, including bile pigments, bile salts,
cholesterol and lecithin. Bile is passed into tiny tubes called bile ducts. The bile ducts join together
(like the branches of a tree) to form the main bile duct. Bile constantly drips down the bile ducts, into
the main bile duct, and then into the gut.

The gallbladder lies under the liver on the right side of the upper tummy (abdomen). It is like a pouch
which comes off the main bile duct and fills with bile. It is a 'reservoir' which stores bile. The
gallbladder squeezes (contracts) when we eat. This empties the stored bile back into the main bile
duct. The bile passes along the remainder of the bile duct into the duodenum (the first part of the gut
after the stomach).
Bile helps to digest food, particularly fatty foods.

What is cholecystitis, and how common is it?

Cholecystitis means inflammation of the gallbladder. The exact number of cases in the UK is not
known. However, it is not an uncommon condition, and it is quite a common cause for hospital
admission. Women are affected more often than men.

What are the symptoms of cholecystitis?

Symptoms tend to develop quite quickly, over a few hours or so. They include:

 Pain in the upper tummy (abdomen) - the main symptom. It is usually worse on the right side
under the ribs. The pain may radiate (travel) to the back or to the right shoulder. The pain tends
to be worse if you breathe in deeply.
 You may also develop a feeling of sickness (nausea); you may be sick (vomit) and you may
have a high temperature (fever).

What causes cholecystitis?

Most cases of cholecystitis are caused by gallstones
Gallstones occur when bile, which is normally fluid, forms stones. Gallstones commonly contain
lumps of fatty (cholesterol-like) material that has solidified and hardened. Sometimes bile pigments
or calcium deposits form gallstones. Sometimes just a few small stones are formed; sometimes a
great many. Occasionally, just one large stone is formed. About 1 in 3 women, and 1 in 6 men, form
gallstones at some stage in their life. They become more common with increasing age.

Most people with gallstones do not have any symptoms or problems, and do not know they have
them. Commonly, the stones simply stay in the gallbladder and cause no harm. However, in some
people, gallstones can cause problems. (See separate leaflet calledGallstones which briefly lists the
various problems that gallstones can cause.)
Cholecystitis is one problem that can occur with gallstones. About 19 in 20 cases of cholecystitis are
thought to be caused by gallstones. What seems to happen is that a gallstone becomes stuck in the
cystic duct (this is the tube that drains bile out from the gallbladder into the bile duct). Bile then builds
up in the gallbladder, which becomes stretched (distended). Because of this, the walls of the
gallbladder become inflamed. In some cases the inflamed gallbladder becomes infected. An infected
gallbladder is more prone to lead to complications (see below).

Other causes of cholecystitis are uncommon

No gallstones are found in about 1 in 20 cases of cholecystitis. In many of these cases it is unclear
as to why the gallbladder became inflamed and/or infected.

How is cholecystitis diagnosed?

An ultrasound scan is commonly done to clarify the diagnosis. This is a painless test which uses
sound waves to scan the tummy (abdomen). An ultrasound scan can usually detect gallstones, and
also whether the wall of the gallbladder is thickened (as occurs with cholecystitis). If the diagnosis is
in doubt then other more detailed scans may be done.
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What is the treatment for cholecystitis?

You will normally be admitted to hospital. Usually, you will not be allowed to eat or drink (to rest the
gallbladder), and you will be given fluids and painkillers directly into a vein through a 'drip'. With this
initial treatment the gallstone that caused the blockage often falls back into the gallbladder, and the
inflammation and symptoms often settle down. If the doctor suspects that the gallbladder has
become infected, you will also be given antibiotics directly into a vein through the 'drip'.

The gallbladder will usually be removed by an operation. The operation is often done within a few
days of being admitted to hospital. Sometimes the operation is delayed for several weeks until the
inflammation has settled. Different techniques to remove the gallbladder may be used depending on
various factors.

 Keyhole surgery is now the most common way to remove a gallbladder. The medical term for
this operation is laparoscopic cholecystectomy. It is called keyhole surgery as only small cuts
are needed in the tummy (abdomen) with small scars remaining afterwards. The operation is
done with the aid of a special telescope that is pushed into the abdomen through one small cut.
This allows the surgeon to see the gallbladder. Instruments pushed through another small cut
are used to cut out and remove the gallbladder. Keyhole surgery is not suitable for all people.
 Some people need a traditional operation to remove the gallbladder. This is called
cholecystectomy. In this operation a larger cut is needed to get at the gallbladder.

If you do not have your gallbladder removed, there is a reasonable chance that you will have no
further problems if the inflammation settles down. However, there is also a good chance that you
would have further bouts of cholecystitis in the future. This is why the usual treatment is to remove
the gallbladder.

Gallstones
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What are the possible complications of

cholecystitis?
If treatment is delayed or not available, in some cases the gallbladder becomes severely infected.
Some of the gallbladder tissue may even die and decay (become gangrenous). This can lead to
blood poisoning (septicaemia), which is very serious and can be life-threatening. Other possible
complications include the gallbladder bursting (perforating), or a channel (fistula) forming between
the gallbladder and gut as a result of continued inflammation.

After a gallbladder is removed

You do not need a gallbladder to digest food. Bile still flows from the liver to the gut once the
gallbladder is removed. However, there is no longer any storage area for bile between meals. The
flow of bile is therefore constant, without the surges of bile that occur from a gallbladder when you
eat a meal.

You can usually eat a normal diet without any problems after your gallbladder is removed. However,
up to half of people who have had their gallbladder removed have some mild tummy (abdominal)
pain or bloating from time to time. This may be more noticeable after eating a fatty meal. Some
people notice an increase in the frequency of passing stools (motions, or faeces) after their
gallbladder is removed. This is like mild diarrhoea. It can be treated by antidiarrhoeal medication if it
becomes troublesome.

What is cholecystitis?
Cholecystitis is inflammation of the gallbladder, a small organ near theliver that plays a
part in digesting food. Normally, fluid called bile passes out of the gallbladder on its way
to the small intestine. If the flow of bile is blocked, it builds up inside the gallbladder,
causing swelling, pain, and possible infection.

What causes cholecystitis?

A gallstone stuck in the cystic duct  , a tube that carries bile from the gallbladder, is
most often the cause of sudden (acute) cholecystitis. Thegallstone blocks fluid from
passing out of the gallbladder. This results in an irritated and swollen gallbladder.
Infection or trauma, such as an injury from a car accident, can also cause cholecystitis.

Acute acalculous cholecystitis, though rare, is most often seen in critically ill people in
hospital intensive care units. In these cases, there are no gallstones. Complications
from another severe illness, such asHIV or diabetes, cause the swelling.

Long-term (chronic) cholecystitis is another form of cholecystitis. It occurs when the

gallbladder remains swollen over time, causing the walls of the gallbladder to become
thick and hard.

What are the symptoms?

 The most common symptom of cholecystitis is pain in your upper right abdomen   that
can sometimes move around to your back or rightshoulder blade. Other symptoms
include:

 Nausea or vomiting.
 Tenderness in the right abdomen.
 Fever.
 Pain that gets worse during a deep breath.
 Pain for more than 6 hours, particularly after meals.
Older people may not have fever or pain. Their only symptom may be a tender area in
the abdomen.

How is cholecystitis diagnosed?

Diagnosing cholecystitis starts when you describe your symptoms to your doctor. Next
is a physical exam. Your doctor will carefully feel your right upper abdomen to look for
tenderness. You may have blood drawn and an ultrasound, a test that uses sound
waves to create a picture of your gallbladder. Ultrasound may show gallstones,
thickening of the gallbladder wall, extra fluid, and other signs of cholecystitis. This test
also allows doctors to check the size and shape of your gallbladder.

You could also have a gallbladder scan, a nuclear scanning test that checks how well
your gallbladder is working. It can also help find blockage in the tubes (bile ducts) that
lead from the liver to the gallbladder and small intestine (duodenum).
Acute cholecystitis
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Acute cholecystitis is a sudden swelling and irritation of the gallbladder. It causes severe belly pain.

See also: Chronic cholecystitis

Causes

The gallbladder is an organ that sits below the liver. It stores bile, which your body uses to digest fats in
the small intestine.

Acute cholecystitis occurs when bile becomes trapped in the gallbladder. This often happens because
agallstone blocks the cystic duct. This is the tube that bile travels into and out of the gallbladder. When a
stone blocks this duct, bile builds up, causing irritation and pressure in the gallbladder. This can lead to
swelling and infection.

Other causes include:

 Serious illnesses such as HIV or diabetes

 Tumors of the gallbladder (rare)

Some people are more at risk for gallstones. Risk factors include:

 Being female
 Pregnancy
 Hormone therapy
 Older age
 Being Native American or Hispanic
 Obesity
 Losing or gaining weight rapidly
 Diabetes

Sometimes the bile duct becomes blocked temporarily. When this occurs repeatedly, it can lead
to chronic cholecystitis. This is swelling and irritation that continues over time. Eventually, the gallbladder
becomes thick and hard. It also does not store and release bile as well.

Symptoms

The main symptom is pain in the upper right side or upper middle of your belly that usually lasts at least
30 minutes. You may feel:

 Sharp, cramping, or dull pain

 Steady pain
 Pain that spreads to your back or below your right shoulder blade
Other symptoms that may occur include:

 Clay-colored stools
 Fever
 Nausea and vomiting
 Yellowing of skin and whites of the eyes (jaundice)

Exams and Tests

A physical exam will show that it hurts to touch your belly.

Your doctor may order the following blood tests:

 Amylase and lipase
 Bilirubin
 Complete blood count (CBC)
 Liver function tests

Imaging tests can show gallstones or inflammation. You may have one of these tests:

 Abdominal ultrasound
 Abdominal CT scan
 Abdominal x-ray
 Oral cholecystogram
 Gallbladder radionuclide scan

Treatment

If you have severe belly pain, seek medical attention right away.

In the emergency room, you'll be given fluids through a vein. You also may be given antibiotics to fight
infection.

Cholecystitis may clear up on its own. However, if you have gallstones, you will probably need surgery to
remove your gallbladder.

Nonsurgical treatment includes:

 Antibiotics to fight infection

 Low-fat diet (if you are able to eat)
 Pain medicines

You may need emergency surgery if you have complications such as:

 Gangrene (tissue death)

 Perforation (a hole that forms in the wall of the gallbladder)
  Pancreatitis (inflamed pancreas)
 Persistent bile duct blockage
 Inflammation of the common bile duct

If you are very ill, a tube may be placed in your gallbladder and through your skin to drain it. Then, once
you are feeling better, you may have surgery.

Outlook (Prognosis)

Most people who have surgery to remove their gallbladder recover completely.

Possible Complications

 Empyema (pus in the gallbladder)

 Gangrene
 Injury to the bile ducts draining the liver (may occur after gallbladder surgery)
 Pancreatitis
 Perforation
 Peritonitis (inflammation of the lining of the abdomen)

When to Contact a Medical Professional

Call your health care provider if:

 Severe belly pain does not go away

 Symptoms of cholecystitis return

Prevention

Removing the gallbladder and gallstones will prevent further attacks.

Alternative Names

Cholecystitis - acute

References

Glasgow RE, Mulvihill SJ. Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ,
eds.Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Saunders
Elsevier; 2010:chap 66.

Jackson P, Evans S. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL,
eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Saunders Elsevier; 2012:chap. 55.