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 antibiotics) directly into a vein. The inflammation may settle down wit h treatment. However, removal of the gallbladder is usually advised to prevent further bouts of cholecystitis.
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 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 contracts (squeezes) 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 .
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.
- Pain in the upper abdomen is 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 nausea (feeling sick), vomiting and a fever (high temperature).
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 cholesterol-like (fatty) 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.
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 abdomen. An ultrasound scan can usually detect gallstones, and also if 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.
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 in the same day or 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 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, may be 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.
What are the possible complications of cholecystitis?
If treatment is delayed or not available, in some cases the gallbladder becomes severely infected and even gangrenous. This can lead to blood poisoning (septicemia), which is very serious and can be life-threatening. Other possible complications include: the gallbladder may perforate (burst), or a fistula (channel) may form between the gallbladder and gut as a result of continued inflammation also Cholangitis and biliary pancreatitis with obstructive Jaundice are common complications.
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, some of people who have had their gallbladder removed have some mild 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 feces) after their gallbladder is removed. This is like mild diarrhea. It can be treated by antidiarrhoeal medication if it becomes troublesome.
The gallbladder is a pear-shaped sac-like organ with a muscular wall that is 3 to 6 inches (7.5 to 15 cm) long, located in the right upper side of the abdomen, under the liver. It is connected to the liver and intestine through small tubes called bile ducts.
The primary purpose of the gallbladder is to store and concentrate bile, a greenish-brown fluid that is produced by the liver. Bile is needed to digest and absorb fatty foods, and to absorb important fat soluble vitamins.
Between meals, the gallbladder is relaxed and bile flows into the gallbladder, where it is stored and concentrated (figure 1). With meals, fatty foods in the small intestine cause the gallbladder to contract (squeeze) and partially empty into the intestine. A few hours later, the gallbladder relaxes and begins to store bile again.
WHAT ARE GALL STONES?
Gallstones are collections of solid material in the gallbladder. Gallstones may be as small as tiny specks or as large as the gallbladder itself. The vast majority, however, are smaller than 1 inch (2.5 cm) and are one of two major types, cholesterol or pigment. Gallstone type is important since cholesterol stones are more likely to respond to non-surgical treatments than pigment stones.
- Cholesterol gallstones account for approximately 80 percent of gallstones in developed countries, including the United States.
- Pigment stones account for about 20 percent of gallstones.
GALLSTONES RISK FACTORS
Experts do not know for sure why gallstones develop. However, many people have bile with an abnormally high concentration of cholesterol and/or calcium from which stones may develop. There are a number of factors that increase the risk of developing gallstones
- Sex – Gallstones are more common in women.
- Age – The risk of gallstones increases with age. The condition is extremely rare in children and becomes progressively more frequent over time, especially after age 40 years.
- Family history and genetics – Gallstones are more common in certain families, suggesting that genetics has a role in gallstone development.
- Other factors – Other conditions can increase the risk of developing gallstones, including:
- Use of medicines that contain estrogen (such as birth control pills)
- Frequent fasting
- Rapid weight loss (including patients who have surgical weight loss treatments)
- Lack of physical activity
- Diabetes mellitus
- Sickle cell disease (and other conditions associated with rapid destruction of red blood cells, such as in patients with mechanical heart valves)
- Cirrhosis or severe scarring of the liver
- Certain medicines
Silent gallstones – The majority of people who have gallstones do not have symptoms; their stones remain “silent”. Silent gallstones are often found on an ultrasound or CT scan done for other reasons. Silent stones do not need to be treated since the first symptoms of gallstones are usually mild and there are risks involved in removing the gallbladder.
If you have silent gallstones, you should be aware of the initial symptoms of gallstone disease because you may need treatment if you develop symptoms
Biliary colic – Biliary colic, also known as gallstone pain or biliary pain, is the most common symptom of gallstones. It causes attacks of abdominal pain, often located in the right upper belly just under the lower ribs. You may also feel nausea, and vomiting, and pain in the right shoulder or back.
Biliary colic usually happens when the gallbladder contracts in response to a fatty meal. This compresses the stones, blocking the opening. As the gallbladder relaxes several hours after the meal, the pain subsides. In some people, the pain happens without having eaten anything.
Once you have a first attack of biliary colic, there is a good chance you will have more symptoms in the future. Such recurrent symptoms are usually more severe and occasionally associated with complications.
Complications of gallstones
Acute cholecystitis – Acute cholecystitis refers to inflammation of the gallbladder. This happens when there is a complete blockage of the gallbladder, caused by a gallstone. Unlike biliary colic, which resolves within a few hours, pain is constant with acute cholecystitis and fever is common.
Acute cholecystitis is a serious condition that requires immediate medical treatment in the hospital. Treatment includes IV fluids, pain medicine, and sometimes, antibiotics. Surgery to remove the gallbladder is usually recommended during the hospitalization or shortly thereafter. If not treated, acute cholecystitis can lead to gallbladder rupture, a life-threatening condition
Choledocholithiasis – This complication can develop if one or more gallstones leave the gallbladder and block the area where bile exits. It may lead to:
- Jaundice, which is a yellow discoloration of the skin and eyes.
- Acute cholangitis, which is an infection of the bile ducts that causes pain, chills, and fever. This requires prompt treatment, usually involving removal of the gallstone with a non-surgical procedure known as endoscopic retrograde cholangiopancreatography, or ERCP.)
- Acute pancreatitis, which is sudden inflammation of the pancreas, leading to severe abdominal pain. (See GALLSTONE DIAGNOSIS )
There are two parts to diagnosing gallstones: determining if gallstones are present, and determining if gallstones are the cause of symptoms.
Gallstones are usually found using ultrasound, a painless test that uses sound waves to create an image of the gallbladder. An ultrasound is the most sensitive test with which to find gallbladder stones, but gallstones can also be seen on other imaging tests.
Having gallstones does not mean that the gallstones are the cause of your symptoms. Thus, other tests may be recommended if there is doubt about the relationship of the gallstones to your symptoms.
- Surgical therapy: Remove the gallbladder and stones if symptomatic or other indications.
Cholecystectomy is a surgery that removes the gallbladder.
It is one of the most commonly performed surgeries in the United States.