Cholecystitis is inflammation in your gallbladder. Your gallbladder is a small pear-shaped organ tucked away under your liver in the upper right section of your abdomen. Your gallbladder’s job is to store bile – a fat-digesting fluid made by the liver – and to release it to your small intestine after you eat a meal. Cholecystitis usually develops when the bile gets trapped in your gallbladder and becomes infected with bacteria. Bile gets trapped when gallstones block the flow of bile out of your gallbladder.
What causes cholecystitis?
Cholecystitis is commonly caused by gallstones that have blocked your cystic duct, which prevents bile from exiting your gallbladder. Your gallbladder becomes swollen and may become infected with bacteria. Less common causes include blocked bile ducts due to scarring, reduced blood flow to your gallbladder, tumors that block the flow of bile from your gallbladder, or viral infections that inflame your gallbladder.
What are the symptoms of cholecystitis?
Symptoms can be acute or chronic.
Acute cholecystitis comes on suddenly and causes severe, ongoing pain. More than 95% of people with acute cholecystitis have gallstones. Pain begins in your mid to upper right abdomen and may spread to your right shoulder blade or back. Pain is strongest 15 to 20 minutes after eating and it continues. Pain that remains severe is considered a medical emergency.
Chronic cholecystitis means you’ve had repeated attacks of inflammation and pain. Pain tends to be less severe and doesn’t last as long as acute cholecystitis. The repeated attacks are usually caused by gallstones blocking the cystic duct intermittently.
Other signs and symptoms of cholecystitis may include:
Treatment of cholecystitis usually takes place in the hospital. Treatments may include:
Fasting, to rest the gallbladder.
IV fluids to prevent dehydration.
Pain medication.
Antibiotics to treat infection.
Removing the gallbladder. This surgery, called a cholescystectomy, is usually performed by making tiny cuts (incisions) through the abdomen to insert a laparoscope (tiny camera) to see inside the abdomen and surgical instruments to remove the gallbladder. The gallbladder is usually removed within 24 to 48 hours of admission if you have a confirmed case of acute cholecystitis.
Draining the gallbladder to treat and prevent the spread of infection. This procedure, called percutaneous cholecystostomy, is usually reserved for those who are too ill to undergo surgery.
Removing gallstones in the area blocking the common bile duct. This procedure, done by an endoscopist, called endoscopic retrograde cholangiopancreatography (ERCP), is reserved for patients with a suspected or confirmed blocked common bile duct, and can clear the duct of stones and sludge.
What is it like to recover from gallbladder surgery?
Recovery from gallbladder surgery, when done laparoscopically, is usually uneventful. As with any surgery there can be minimal pain at the incision sites. Most patients are discharged from the hospital shortly after the surgery, and do not require additional testing or interventions. If the surgery is done through a larger wound (open surgery) then the recovery can be slower and require more days in the hospital.
Can I live without my gallbladder?
Yes, you can live a normal life without a gallbladder. Since the gallbladder’s main role is the storage of the bile, and bile is made continuously by the liver, you don’t need your gallbladder for normal digestion. Bile can still flow directly from your liver, through the common bile duct and into the small intestine.
What complications can occur if cholecystitis is not treated?
Complications can range from ongoing infection to possible death.
Severely Infected gallbladder: A blocked gallbladder that is extremely uncomfortable and painful. Without treatment, it could lead to an overwhelming infection, or even gangrene of the gallbladder.
Cholangitis: An acute infection of the main bile ducts and liver that can be extremely life-threating if not promptly treated.
Inflamed pancreas (Pancreatitis): Your common bile duct and the pancreatic duct share the same “valve” into the duodenum. If a gallstone blocks that valve, the potent pancreatic enzyme juice excreted by the pancreases gets backed up causing pancreatitis, which can also be severe and life threatening.
What if I have cholecystitis during pregnancy?
During early and later pregnancy cholecystitis can be treated by antibiotics. Surgery is usually a safe option during the second trimester, but can also be performed safely at any time if antibiotics fail to treat the infection
How is cholecystitis diagnosed?
Your healthcare professional will ask about your symptoms. They may order blood work to check your white blood cell count and how well your liver is working. A higher than normal white blood cell count is a sign of an infection, inflammation, or an abscess.
Imaging tests that could be ordered include:
Abdominalultrasound: This test uses sound waves to examine the gallbladder and the bile ducts. It helps identify signs of inflammation in your gallbladder, the presence of gallstones, and thickening or swelling of the gallbladder wall.
Hepatobiliary nuclear imaging (HIDA scan): This is an imaging test that involves an injected radioactive substance. A gamma camera sees the radiation as it moves through the different tracts of the digestive system. If that substance doesn’t enter your gallbladder, then the healthcare provider knows the organ is blocked, indicating cholecystitis. This test can also detect the function of the gallbladder and its ability to eject the bile once stimulated. This is called the ejection fraction of the gallbladder, which is considered normal when it is above 30-35%.
Magnetic Resonance Cholangiopancreatography (MRCP): This type of MRI shows details of your liver, gallbladder, bile ducts, structures and ducts of the pancreas as well. It can show gallstones, inflammation or blockage of the bile ducts and gallbladder and if there is any inflammation of the pancreas.
Abdominal Computed Tomography (CT Scan): This X-ray test shows details of your liver, gallbladder and bile ducts. It shows inflammation of the gallbladder.
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