Cholecystitis: Symptoms, causes, diagnosis, and treatment

Cholecystitis is an inflammation of the gallbladder. It normally happens because a gallstone gets stuck at the opening of the gallbladder. It can lead to fever, pain, nausea, and severe complications.

Untreated, it can result in perforation of the gallbladder, tissue death and gangrene, fibrosis and shrinking of the gallbladder, or secondary bacterial infections.

Gallstones are involved in 95 percent of cholecystitis cases. These may be formed from cholesterol, a pigment known as bilirubin, or a mix of the two. It can also be triggered by biliary sludge when bile collects in the biliary ducts.

Other causes include trauma, critical illness, immunodeficiency, or certain medications. Some chronic medical conditions, like kidney failure, coronary heart disease, or certain types of cancer also increase the risk of cholecystitis.

In the United States, there were 215,995 hospital admissions for cholecystitis in 2012, and the average hospital stay was 3.9 days.

Acute cholecystitis starts suddenly. Chronic cholecystitis develops slowly over time.

Treatment

[gallstones are the main cause of cholecystitis]
A healthy diet can help prevent gallstones, a common cause of cholecystitis.

A patient with cholecystitis will be hospitalized, and they will probably not be allowed to consume any solid or liquid foods for some time. They will be given liquids intravenously while fasting. Pain medications and antibiotics may also be given.

Surgery is recommended for acute cholecystitis because there is a high rate of recurrence from inflammation related to gallstones. However, if there is a low risk of complications, surgery can be done as an outpatient procedure.

If there are complications, such as gangrene or perforation of the gallbladder, the patient will need immediate surgery to remove the gallbladder. If the patient has an infection, a tube may be inserted through the skin into the gallbladder to drain the infection.

Removal of the gallbladder, or cholecystectomy, can be performed by open abdominal excision or laparoscopically.

Laparoscopic cholecystectomy involves several small incisions in the skin. A camera is inserted into one incision to help the surgeon see inside the abdomen, and tools for removing the gallbladder and inserted through the other incisions.

The benefit of laparoscopy is that the incisions are small, so patients usually have less pain after the procedure and less scarring.

After surgically removing the gallbladder, the bile will flow directly into the small intestine from the liver. This does not normally affect the patient’s overall health and digestive system. Some patients may have more frequent episodes of diarrhea.

Diet

Upon recovery from the condition, it is important to make dietary adjustments that help bring bile production back to normal.

Be sure to eat smaller meals more frequently and avoid large servings or portions. These can upset the system and produce a gallbladder or bile duct spasm.

Avoid high-fat and fried foods, including whole milk products, and stick to lean proteins.

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Causes

The gallbladder is a small, pear-shaped organ connected to the liver, on the right side of the abdomen. It stores bile and releases it into the small intestine to help in the digestion of fat.

The gallbladder holds bile, a fluid that is released after we eat, especially after a meal that is high in fat, and this bile aids digestion. The bile travels out of the gallbladder through the cystic duct, a small tube that leads to the common bile duct, and from there into the small intestine.

The main cause of cholecystitis is gallstones or biliary sludge getting trapped at the gallbladder’s opening. This is sometimes called a pseudolith, or “fake stone.”

Other causes include:

injury to the abdomen from burns, sepsis or trauma, or because of surgery

shock

immune deficiency

prolonged fasting

vasculitis

An infection in the bile can lead to inflammation of the gallbladder.

A tumor may stop the bile from draining out of the gallbladder properly, resulting in an accumulation of bile. This can lead to cholecystitis.

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