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Cholecystitis

CAug 12 04

 

What Is It?

Cholecystitis is an inflammation of the gallbladder, the small saclike organ located in the upper right-hand side of the abdomen, below the liver. The gallbladder temporarily stores bile, a liquid that contains fat-digesting enzymes produced in the liver. During a meal, bile moves from the gallbladder through tubes (called the cystic duct and the common bile duct) into the small intestine. Here, enzymes mix with partially digested food to help break down fats.

Cholecystitis usually develops when a person has gallstones, rocklike chemical deposits that form inside the gallbladder. If a gallstone blocks the cystic duct, bile becomes trapped in the gallbladder. Chemicals in the trapped bile or a bacterial infection can lead to inflammation of the gallbladder wall.

There are two types of cholecystitis:

  • Acute cholecystitis is the sudden inflammation of the gallbladder that causes abdominal pain.
  • Chronic cholecystitis is inflammation of the gallbladder that lasts a long time. It is caused by repeat attacks of acute cholecystitis. Damage to the walls of the gallbladder leads to a thickened, scarred gallbladder. Ultimately, the gallbladder can shrink and lose its ability to store and release bile.

Gallstones alone can cause pain without any infection. This typically is called biliary colic.

Experts estimate that at least 20 percent of women and 8 percent of men older than age 40 have gallstones and are at risk of developing cholecystitis. The risk of gallstones is greatest in:

  • Men and women older than age 60
  • Women who are pregnant or have had several pregnancies
  • Women who take estrogen-replacement therapy or birth-control pills
  • Obese people
  • People who have lost weight rapidly
  • People who eat a high-fat diet

Symptoms

Symptoms of acute cholecystitis may include:

  • Biliary colic, the steady ache or feeling of pressure in the upper abdomen — You may feel this discomfort in the center of the upper abdomen, just below the breastbone, or in the upper-right portion of the abdomen, near the gallbladder and liver. In some people, the abdominal pain of biliary colic spreads to between the shoulder blades, to the right shoulder blade or to the right shoulder. Symptoms typically start after eating.
  • Fever
  • Shaking chills
  • Nausea and/or vomiting
  • Loss of appetite
  • Jaundice (yellowing of the skin or eyes)
  • Dark urine
  • Pale, grayish bowel movements

Symptoms of chronic cholecystitis can include any of the above. Some people do not have any symptoms. If you have abdominal pain, it is usually very mild and goes away. You also may have indigestion or gas. These symptoms accompany so many other illnesses, so you may not be diagnosed with chronic cholecystitis until you have an episode of more severe symptoms during a sudden attack.

Diagnosis

Your doctor will review your medical history and ask about any prior episodes of abdominal discomfort, especially those triggered by high-fat meals. Your doctor will ask if you’ve had any recent rapid weight loss, and about medications you currently take, particularly birth-control pills and estrogen-replacement therapy (because these can lead to the formation of gallstones).

During the physical exam, your doctor will pay particular attention to the upper-right portion of your abdomen, where your liver and gallbladder are located. Blood tests can reveal infection, higher levels of white blood cells, and bilirubin and elevated gallbladder or liver enzymes, which suggest a blockage and/or irritation of the gallbladder wall and bile ducts.

Your doctor may order a radiology test to look for gallstones. Because the chemical composition of most gallstones makes them invisible on X-rays, other tests are used, including:

  • Ultrasound — This painless procedure uses sound waves to create images of the gallbladder and bile ducts. An ultrasound is usually the first (and often only) test needed to confirm that you have gallstones and cholecystitis. A gallbladder wall with a thickened appearance means you may have chronic cholecystitis.
  • Cholescintigraphy — This test looks for a blocked gallbladder or bile ducts. You are given an injection of a radioactive chemical that passes out of the blood into the bile ducts. A special camera takes pictures of the chemical’s path and can detect blockages in the flow of the chemical.

Expected Duration

If you have acute cholecystitis, the pain or discomfort of biliary colic may go away or become less severe after one to five hours if a trapped gallstone passes out of the cystic duct on its own. Your abdomen may continue to ache mildly for about 24 hours.

If the gallstone remains trapped, however, and infection and inflammation continue, your symptoms may get worse and you may develop complications, including a hole in the inflamed gallbladder wall (gallbladder perforation) and an infection that spreads to the lining of the abdomen (peritonitis). This is why people with cholecystitis usually are treated and observed in a hospital until their symptoms improve.

Symptoms of chronic cholecystitis may persist for years before a diagnosis is made. Surgery to remove the gallbladder will prevent symptoms from coming back.

Prevention

Because gallstones cause cholecystitis, you may be able to avoid cholecystitis by controlling the risk factors that can lead to the formation of gallstones. These include watching your weight and avoiding a high-fat diet. You can’t control all risk factors, such as your ethnic background, getting older and being pregnant.

Treatment

Acute cholecystitis requires hospitalization. You need antibiotics given intravenously (into a vein) to treat any infection and medications to control symptoms of nausea and abdominal pain. Once your pain lessens or goes away, there are no signs of infection, and you are able to drink and eat, you will be able to go home to continue your recovery.

Twenty-five percent of people who have acute cholecystitis develop another episode within one year; 60 percent have another episode within six years. For this reason, many doctors recommend that people with cholecystitis have the gallbladder removed surgically (cholecystectomy). Surgeons don’t like to operate on an inflamed gallbladder because that can lead to complications during surgery. Often, surgery is scheduled after a person has been discharged from the hospital and has recovered fully. If you have a mild case of acute cholecystitis and surgery can be performed early enough after your recovery, your surgeon may decide to do the cholecystectomy before you leave the hospital.

Chronic cholecystitis requires the removal of the gallbladder surgically.

When To Call A Professional

Call your doctor for an evaluation whenever you have severe abdominal pain, with or without nausea and vomiting. If you also have fever and shaking chills, you may have a serious infection, so you should call your doctor immediately.

Prognosis

Most people recover from episodes of acute cholecystitis within a few days to a few weeks. A more serious episode usually involves a complication of perforation of the gallbladder wall and the spread of infection. A person can become critically ill from a complication, and in a few cases the seriousness of the infection can be fatal.

Removing the gallbladder prevents cholecystitis from coming back, in most cases. Rarely, gallstones may remain hidden in bile ducts to cause another episode even after surgery.

Johns Hopkins patient information

Last revised: December 2, 2007
by Arthur A. Podosyan, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.
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