Cholecystitis

What is cholecystitis?

Cholecystitis is inflammation of the gallbladder. The gallbladder is a small sac that lies under the liver on your right side. It is part of the digestive system. It stores bile made by the liver to help you digest fats.

How does it occur?

Acute cholecystitis is usually caused by a gallstone blocking the outlet from the gallbladder, so that bile cannot get out. The bile becomes concentrated and sometimes stagnant and infected. This irritates and inflames the inside of the gallbladder, causing severe pain.

The gallbladder may also become inflamed because of sludging of the fluid in it. Sludging is the formation of thickened fluid that has not yet formed stones. The sludge is thick enough to prevent a normal flow of bile so it has the same effect as gallstones. This is called acalculous cholecystitis and the symptoms and treatment are the same as when you have gallstones.

Sometimes there are other causes, such as injury, surgery, or body-wide infection.

What are the symptoms?

The main symptom of cholecystitis is severe pain in the upper right side of your abdomen that gets worse when you breathe in deeply. The pain may extend to your right shoulder blade. It may last from 15 minutes to several hours. You may have nausea and vomiting with the pain. You may also have a fever.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and will examine you. You may have one or more of the following tests:

• blood tests
• ultrasound scan
• X-rays
• nuclear gallbladder scan (called a HIDA or DISIDA scan).

How is it treated?

The most common treatment for cholecystitis is surgery to remove the gallbladder. If there is a stone stuck in the duct draining the gallbladder it may be removed during the surgery. If you are not very sick and other organs are not inflamed, you may be treated with pain medicine at home until you can see a surgeon at your convenience. If you are having severe symptoms, you may need to stay in the hospital for intravenous (IV) fluids, antibiotics, and pain medicine until your gallbladder is removed.

In the uncommon case that you cannot have surgery, other treatments may be tried. If there are just a few small stones, your provider may prescribe medicine to dissolve the stones. Sound waves have also been used to try to break up gallstones. With either of these methods, the stones will usually return.

If you have a severe infection of the gallbladder that makes surgery unsafe, your healthcare provider may advise drainage of the gallbladder until the infection can be controlled. A procedure called cholecystostomy may be done to put a tube into the gallbladder for drainage. The gallbladder can then be removed with surgery several weeks later when the infection is controlled.

How long will the effects last?

If you are having pain due to a gallstone that has become stuck in the bile duct, your symptoms will continue until you pass the stone or have surgery.

Sometimes gallstones can cause inflammation of the pancreas, another organ in the digestive system. This is an illness called pancreatitis. It can be very serious and usually needs to be treated at the hospital.

How can I take care of myself?

If you are not going to have surgery right away:

• Avoid fatty and greasy foods.
• Take your pain medicine as directed by your healthcare provider.
• Keep follow-up appointments with your provider. See your provider before your next scheduled checkup if your symptoms are getting worse.

How can I help prevent cholecystitis?

To help prevent cholecystitis cause by gallstones:

• Read the labels on food packages to learn the ingredients.
• Avoid fasting. Long periods of fasting can cause gallstones because the bile stays in the gallbladder too long.
• Keep a normal weight with a healthy diet and physical activity.
• Follow your healthcare provider's advice for weight control if you are overweight. You should not try to lose weight too fast because that can lead to more gallstones.
• Eat a high-fiber diet that includes healthy fats. Eat healthy foods that are high in fiber, such as whole grains, fresh fruits, and vegetables.