An Overview of Cholecystitis

Cholecystitis is an inflammation of the gallbladder. The gallbladder is an organ in the digestive system that is located under the liver. The gallbladder is where bile, a substance used in digestion, is stored until it is needed. Symptoms of cholecystitis include pain in the upper center or right abdomen that can extend to the right shoulder or back, bloating, fever, nausea, vomiting, and abdominal tenderness. 

Cholecystitis might be diagnosed through the use of various procedures and/or tests that are used to get a picture of the gallbladder and the bile ducts. The most common reason for the gallbladder to be inflamed is a buildup of bile because gallstones are blocking the bile ducts. Treatment is usually with surgery to remove the gallbladder but in certain cases, more conservative therapies in the hospital might also be used.

The Gallbladder

The gallbladder is a small pouch-like organ, about 4 inches long. It is shaped like a pear and sits under the liver. The function of the gallbladder is to store the bile that’s made in the liver. Bile is a digestive compound that helps the body digest fat and absorb fat-digestible vitamins from foods. The bile is released from the gallbladder and into the small intestine through a duct called the cystic duct.

In some cases, the gallbladder might need to be removed because of disease or damage. People can live without their gallbladder and in most cases, there aren’t any long-term adverse effects. However, some people might experience diarrhea afterward or have issues with absorbing fats from their food.

Symptoms

The signs and symptoms of cholecystitis usually occur after a meal and in particular, when fatty foods are eaten. Symptoms can include:

• Abdominal tenderness
• Bloating
• Fever
• Nausea
• Pain in the center or upper right abdomen
• Pain that extends to the right shoulder or back
• Pale or light-colored stools
• Vomiting

Causes

There are several potential causes of cholecystitis. It may be necessary to undergo tests or procedures to find out the cause in order to be able to treat it. Cholecystitis is more common in men over the age of 60, women over the age of 50, those who are overweight, and people who live with diabetes. People who are of Native American or Hispanic origin may also be at a higher risk for developing cholecystitis.

Cholecystitis can be acute or it can be chronic (long-term). Acute cholecystitis will occur suddenly, with an abrupt start to symptoms. Chronic can occur when a bile duct becomes blocked for a time but then clears, and the process repeats itself. Over a period of time, the ongoing inflammation can lead to gallbladder damage. The gallbladder may become hard and unable to release bile into the bile ducts as effectively as it should.

Gallstones

The most common cause of gallbladder inflammation is having gallstones. Gallstones may form when there is an imbalance in the makeup of bile. The bile hardens into stones which can range in size from as small as a grain of sand to as large as a golf ball. When gallstones block the bile ducts and the bile can’t be released into the small intestine, it can result in inflammation.

Blockage in the Bile Duct

Other types of blockages in the bile duct that aren’t a gallstone or a tumor may also lead to cholecystitis. If bile becomes too thick, which can sometimes happen during pregnancy or after rapidly losing a lot of weight, it can also block the bile ducts.

Decreased Blood Flow

When blood vessels are damaged and blood flow to the gallbladder is affected, it could cause the gallbladder to become inflamed.

Infection

Certain viral infections, such as HIV, can cause inflammation in the gallbladder.

Tumor

The bile ducts could also be blocked or narrowed by the growth of a tumor. The buildup of bile that is unable to leave the gallbladder may cause inflammation. This is a rare occurrence of cholecystitis.

Diagnosis

Cholecystitis may be diagnosed through the use of one or more tests.

Abdominal Ultrasound

This test, which is sometimes called sonography, uses sound waves and is non-invasive. It can be used to visualize the organs in the abdomen, including the gallbladder, and look for any problems with them. Gallstones may be visible on the results of this test.

Blood Tests

A blood test will not diagnose a gallbladder problem, but it can be used to look for signs of an infection or inflammation, such as a higher than normal white blood cell count.

Computerized Tomography (CT)

This test, which is sometimes also called a CT scan, CAT scan, or computerized axial tomography, uses a series of X-rays that a computer can assemble into a 3D image. Having a detailed image of the gallbladder can help visualize any gallstones or the presence of cholecystitis.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

This test can be used to see the bile ducts and may also be used to remove certain types of gallstones. A thin, flexible tube is inserted into the mouth and down through the upper digestive tract and into the bile system.

Endoscopic Ultrasound

This test uses ultrasound and endoscopy together. Patients are sedated while a thin tube with an ultrasound probe and a camera are passed through either the mouth or the anus and into the intestines. Images from this test may help clinicians see certain gallbladder problems.

Hepatobiliary Iminodiacetic Acid (HIDA) Scan

This is a nuclear imaging study that’s also sometimes called a cholescintigraphy or hepatobiliary scintigraphy. A tracer that contains a small amount of radioactive material is injected into a vein. Images of the abdomen are taken while the tracer moves through the body and into the bile ducts.

Magnetic Resonance Cholangiopancreatography (MRCP)

During this test, an MRI machine is used to take high-resolution images of the gallbladder, including the bile ducts, and other abdominal organs. It’s a non-invasive test that can show the presence of gallstones or other abnormalities in the gallbladder.

Treatment

Treatment for cholecystitis may include surgery to remove the gallbladder and/or more conservative methods such as antibiotics or other medications that dissolve gallstones.

Surgery

Surgery to remove the gallbladder, called a cholecystectomy, is the most common treatment for cholecystitis. This surgery might take about an hour and is done under general anesthesia. The gallbladder is removed through an incision in the abdomen.

Cholecystectomy might be done with open or with laparoscopic surgery.

Open Surgery

In open surgery, a large incision (about 5 to 8 inches) is made to access and remove the gallbladder. The hospital stay will usually be a few days and the recovery at home may take several weeks. Open surgery might be done in situations where there is scarring that prevents a laparoscopic surgery, or there are other complications.

Laparoscopic Surgery

When the surgery is done laparoscopically, smaller incisions are made and special instruments are used to remove the gallbladder without making a larger incision. The recovery period will vary, but in general, the laparoscopic surgery may have a shorter recovery period and hospital stay (sometimes going home the same day).

In the majority of cases, laparoscopic surgery will be used to remove a gallbladder but there are situations where open surgery might be needed.

Bile Drainage

In a minority of cases, such as for patients who are too ill to undergo surgery, the bile might be drained from the gallbladder through a tube that is inserted through the abdomen and into the bile ducts. Surgery to remove the gallbladder might be done at a later time when the patient’s condition improves.

Watch and Wait

Conservative treatment, or “watch and wait” might be used in certain cases. This will likely include a hospital stay in order to closely monitor the patient's signs and symptoms. Antibiotics might be given to get the swelling and inflammation in the gallbladder under control. Pain medication might be used to treat any discomfort.

If smaller gallstones are present, medications that might dissolve the stones could be given, such as Actigall (ursodiol) or Chenix (chenodiol).

A Word From Verywell

Cholecystitis is a common condition and is usually treated with surgery to remove the gallbladder. In many cases, it might not be possible to prevent gallbladder inflammation, but some lifestyle changes that might lower the risk include keeping to a healthy weight, lowering cholesterol levels, exercising, and sticking to a lower-fat diet that includes plenty of fruits and vegetables.

Surgery to remove the gallbladder is considered safe and most people go on to live a healthy life afterward. When there are symptoms of a gallbladder problem, it is important to seek medical attention right away in order to get treatment and avoid potential complications.