Cholecystitis

Cholecystitis

Histopathology of eosinophilic cholecystitis

Inflammation of the gallbladder, typically causing fever, nausea, and often severe abdominal pain. Depending on the presentation, it can be considered acute or chronic cholecystitis.

Cholecystitis

Causes

Acute cholecystitis occurs when bile becomes trapped in the gallbladder due to a blockage in the bile ducts. Some of the causes for this include gallstone which can get dislodged from the gallbladder and block the cystic duct leading to backup of the bile. When a stone blocks this duct, bile builds up, causing irritation and pressure in the gallbladder which in turn can lead to swelling and infection.

• Gallstones
• Serious illnesses, such as HIV or diabetes
• Tumors of the gallbladder which are generally considered rare.

Some people are more at risk for gallstones as noted below.

Chronic cholecystitis

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Chronic calculous cholecystitis

• Most of the time, chronic cholecystitis is caused by repeated attacks of acute (sudden) cholecystitis.
• Most of these attacks are caused by gallstones in the gallbladder.
• These attacks cause the walls of the gallbladder to thicken.
• The gallbladder begins to shrink. Over time, the gallbladder is less able to concentrate, store, and release bile.
• The disease occurs more often in women than in men.
• It is more common after age 40. Birth control pills and pregnancy are factors that increase the risk for gallstones.

Risk factors

Risk factors include:

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

Enlarged gallbladder with gallstone and cholecystitis

• Sometimes, the bile duct becomes blocked temporarily when it is called acute cholecystitis.
• When this occurs repeatedly, it can lead to long-term or chronic cholecystitis.
• This is swelling and irritation that continues over time.
• Eventually, the gallbladder becomes thick and hard.

It does not store and release bile as well as it did.

Management

A thorough history and physical examination should be obtained including prior history of similar episodes, food intake, especially recent intake of fatty foods. Enquire about the nature of the pain, severity, and any radiation to the right shoulder which can happen with cholecystitis. During the physical examination, palpate the abdomen for tenderness, rigidity, rebound tenderness, and also elicit Murphy's sign.

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Severe acute ulcerated and hemorrhagic cholecystitis

Blood tests include:

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

Imaging studies

• Abdominal ultrasound
• Abdominal CT scan or MRI 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 may be given fluids through a vein.
• You also may be given antibiotics to fight infection.
• Cholecystitis may clear up on its own.

Ultrasonography of cholecystitis

Surgery

If you have gallstones leading cholecystitis, especially of it happens repeatedly, you will probably need surgery to remove your gallbladder.

Nonsurgical treatment includes:

• Antibiotics you take at home 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) of the gallbladder
• Perforation (a hole that forms in the wall of the gallbladder)
• Pancreatitis (inflamed pancreas)
• Persistent bile duct blockage
• Inflammation of the common bile duct

Xanthogranulomatous cholecystitis

If you are very ill, a tube may be placed through your belly into your gallbladder to drain it. Once you feel better, your provider may recommend that you have surgery.

Prognosis

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

Possible Complications

• Untreated, cholecystitis may lead to any of the following health problems:
• 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)

Prevention

Reducing fatty food intake and removal of gallbladder can prevent further attacks

Cholecystitis Resources
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