Topic Overview
What is cholecystitis?
Cholecystitis is inflammation of the
gallbladder, a small organ near the liver 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. The
gallstone 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 as HIV 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 right
shoulder 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).
How is it treated?
Treatment for cholecystitis
will depend on your symptoms and your general health. People who have
gallstones but don't have any symptoms may need no treatment. For mild cases,
treatment includes bowel rest, fluids and antibiotics given through a vein, and
pain medicine.
The main treatment for acute cholecystitis is
surgery to remove the gallbladder (cholecystectomy). Often this surgery can be
done through small incisions in the abdomen (laparoscopic cholecystectomy),
but sometimes it requires a more extensive operation. Your doctor may try to
reduce swelling and irritation in the gallbladder before removing it.
Sometimes acute cholecystitis is caused by one or more gallstones getting stuck in the main tube leading to the intestine, called the
common bile duct. Treatment may involve an
endoscopic procedure (endoscopic retrograde
cholangiopancreatography, or ERCP) to remove the stones in the common bile duct
before the gallbladder is removed.
In rare cases of chronic cholecystitis, you may also
receive medicine that dissolves gallstones over a period of time.