Cholecystitis (Gallbladder Inflammation)

Cholecystitis is inflammation of the gallbladder. Gallstones that obstruct the cystic duct most commonly cause it. The obstruction commonly produces upper abdominal pain, but the inflammation of cholecystitis also can cause pain.

What Does the Gallbladder Do?

The primary function of the gallbladder is to store and concentrate bile that the liver produces and then release it into the intestine. Bile contains waste products that the liver produces. When fats from foods enter the small intestine, the release of an enzyme called cholecystokinin is triggered and signals the gallbladder to secrete bile into the intestine, which helps to digest the fats.

There are many causes of cholecystitis, for example:

• Gallstones blocking the cystic duct of the gallbladder
• Bile duct like scarring or narrowing
• Tumors
• Trauma to the gallbladder and/or the bile ducts
• Infections of the gallbladder

Risk factors for gallstones and associated cholecystitis include:

• High-fat diet
• Obesity
• Increasing age
• Female sex
• Diabetes
• Rapid weight loss
• HIV infection
• Pregnancy
• Drugs (for example, erythromycin, dapsone, narcotics and others)

The signs and symptoms of cholecystitis may include:

• Upper abdominal pain (most common symptom)
  • Pain may radiate to the right shoulder or scapula.
  • Pain may be intermittent but usually becomes constant once inflammation begins.
  • Pain may begin in the epigastric area and localizes in the right upper quadrant of the abdomen.
• Right upper quadrant tenderness and possible palpable, enlarged gallbladder
• Nausea
• Vomiting
• Fever
• Jaundice if the duct from the liver and gallbladder entering the intestine is blocked

The elderly and children may not have the classic findings; they may have vague findings that can delay diagnosis and, in some patients, lead to rapidly occurring complications.

The difference between these two types is that chronic cholecystitis results in recurring pain attacks without fever that are less severe and don’t last as long as acute cholecystitis attacks that can often have fever with the pain. Chronic cholecystitis lasts for months while acute is short term; also, chronic may occur as an extension of an acute attack.

In the medical literature, there are many “types” or terms for variations and/or complications of cholecystitis. Note a few below:

• Acalculous cholecystitis -- inflammatory disease of the gallbladder without evidence of gallstones or cystic duct blockage
• Emphysematous cholecystitis -- a rare form of acute cholecystitis in which necrosis of the gallbladder wall causes gas formation in the gallbladder’s lumen or wall
• Gangrenous cholecystitis -- gallbladder wall ischemia (loss of blood flow) with wall necrosis
• Pregnancy cholecystitis -- biliary colic (intermittent abdominal pains late in pregnancy)

In addition, some terms are similar to the term “cholecystitis.” For example, cholelithiasis means gallstone formation, and cholangitis means infection of the bile duct; choledocholithiasis is one or more gallstones in the common bile duct.

Diagnosis of cholecystitis begins with the patient’s history and physical exam. A number of tests help distinguish cholecystitis from other problems (pregnancy test, CBC, ALT and AST, bilirubin, alkaline phosphatase, amylase/lipase and urinalysis, for example). The following lists the diagnostic imaging methods used:

• Ultrasound (preferred initial test)
• X-rays
• CT
• MRI
• Hepatobiliary scintigraphy
• ERCP (endoscopic retrograde cholangiopancreatography)
• Endoscopic ultrasound

Treatment depends on the type of cholecystitis and/or the severity of complications. For example, doctors may treat patients with uncomplicated cholecystitis as an outpatient. Patients with complicated cholecystitis usually require a surgical intervention like a percutaneous drain or a cholecystectomy (gallbladder removal) or lithotripsy (fragmentation and extraction of gallstones). Some individuals need antibiotics.

There are at least 20 home remedies listed on the internet. They include apple cider, pear juice, peppermint, turmeric, honey, olive oil, lecithin and many others. Patients should discuss with their doctor about the use of such remedies before using them; there are no remedies for complicated cholecystitis.

For individuals with cholecystitis, experts suggest a low-fat diet with lean protein sources like fish or poultry. Avoid rapid weight loss and low food intake(less than 800 calories per day) since this can lead to gallstones. After a cholecystectomy, patients should eat smaller and more frequent meals that include:

• Lean protein sources
• Fat-free dairy products
• Vegetables
• Whole grains
• Fruits

You can reduce the risk of getting cholecystitis by slow weight loss, as rapid weight loss increases the risk of developing gallstones. Avoid obesity and a diet high in fat, as a diet high in fiber and low in fat helps to inhibit bile cholesterol from forming gallstones.