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Cholecystitis - Overview

What is cholecystitis? Cholecystitis is inflammation of the gallbladder, a small organ near the liver that plays a part in digesting food. Normally, fluid called bile passes out of the gallbladder on its way to the small intestine. If the flow of bile is blocked, it builds up inside the gallbladder, causing swelling, pain, and possible infection. What causes cholecystitis? A gallstone stuck in the cystic duct , a tube that carries bile from the gallbladder, is most often the cause of sudden (acute) cholecystitis. The gallstone blocks fluid from passing out of the gallbladder. This results in an irritated and swollen gallbladder. Infection or trauma, such as an injury from a car accident, can also cause cholecystitis. Acute acalculous cholecystitis, though rare, is most often seen in critically ill people in hospital intensive care units. In these cases there are no gallstones. Complications from another severe illness, such as HIV or diabetes, cause the swelling. Long-term (chronic) cholecystitis is another form of cholecystitis. It occurs when the gallbladder remains swollen over time, causing the walls of the gallbladder to become thick and hard. What are the symptoms? The most common symptom of cholecystitis is pain in your upper right abdomen that can sometimes move around to your back or right shoulder blade. Other symptoms include:

Nausea or vomiting. Tenderness in the right abdomen. Fever. Pain that gets worse during a deep breath. Pain for more than 6 hours, particularly after meals. Older people may not have fever or pain. Their only symptom may be a tender area in the abdomen. How is cholecystitis diagnosed? Diagnosing cholecystitis starts when you describe your symptoms to your doctor. Next is a physical exam. Your doctor will carefully feel your right upper abdomen to look for tenderness. You may have blood drawn and an ultrasound, a test that uses sound waves to create a picture of your gallbladder. Ultrasound may show gallstones, thickening of the gallbladder wall, extra fluid, and other signs of cholecystitis. This test also allows doctors to check the size and shape of your gallbladder. You could also have a gallbladder scan, a nuclear scanning test that checks how well your gallbladder is working. It can also help find blockage in the tubes (bile ducts) that lead from the liver to the gallbladder and small intestine (duodenum). How is it treated? Treatment for cholecystitis will depend on your symptoms and your general health. People who have gallstones but don't have any symptoms may need no treatment. For mild cases, treatment includes bowel rest, fluids and antibiotics given through a vein, and pain medicine. The main treatment for acute cholecystitis is surgery to remove the gallbladder (cholecystectomy). Often this surgery can be done through small incisions in the abdomen (laparoscopic cholecystectomy), but sometimes it requires a more extensive operation. Your doctor may try to reduce swelling and irritation in the gallbladder before removing it. Sometimes acute cholecystitis is caused by one or more gallstones getting stuck in the main tube leading to the intestine, called the common bile duct. Treatment may involve an endoscopic procedure (endoscopic retrograde cholangiopancreatography, or ERCP) to remove the stones in the common bile duct before the gallbladder is removed. In rare cases of chronic cholecystitis, you may also receive medicine that dissolves gallstones over a period of time.

What is cholelithiasis?
Cholelithiasis is the medical name for hard deposits (gallstones) that may form in the gallbladder. Cholelithiasis is very common in the United States, especially in women over age 40.

The cause of cholelithiasis is not completely understood, but it is thought to have multiple factors. The gallbladder stores bile and releases it into the small intestine when it is needed for digestion. Gallstones can develop if the bile contains too much cholesterol or too much bilirubin (one of the components of bile), or if the gallbladder is dysfunctional and cannot release the bile.

Different types of gallstones form in cholelithiasis. The most common type, called a cholesterol stone, results from the presence of too much cholesterol in the bile. Another type of stone, called a pigment stone, is formed from excess bilirubin, a waste product created by the breakdown of the red blood cells in the liver. The size and number of gallstones varies in cholelithiasis; the gallbladder can form many small stones or one large stone. The course of cholelithiasis varies among individuals. Some people with cholelithiasis have no symptoms at all, while others may have severe abdominal pain, nausea and vomiting, and complete blockage that may pose the risk of infection. Cholelithiasis can lead to cholecystitis, inflammation of the gallbladder. Acute gallstone attacks may be managed with intravenous medications. Chronic (long-standing) cholelithiasis is treated by surgical removal of the gallbladder. Left untreated, cholelithiasis can lead to serious complications such as tissue damage, tears in the gallbladder, and infection that spreads to other parts of your body. Seek immediate medical care (call 911) for serious symptoms, such as high fever (higher than 101 degrees Fahrenheit), severe abdominal pain, abdominal swelling, and nausea with or without vomiting. Seek prompt medical care if you are being treated for cholelithiasis, but mild symptoms recur or are persistent.

What are the symptoms of cholelithiasis?


Cholelithiasis may cause irritation and inflammation of the gallbladder (cholecystitis) that can result in a number of symptoms. The symptoms can vary in intensity among individuals.

Common symptoms of cholelithiasis


You may experience cholelithiasis symptoms daily or just once in a while. At times any of these common symptoms can be severe:

Abdominal pain Abdominal swelling, distension or bloating Abdominal symptoms that occur within minutes after a meal Abdominal tenderness Clay-colored stools Fever and chills Loss of appetite Nausea with or without vomiting Pain that radiates from the abdomen to the right shoulder or back Sweating Yellowing of the skin and whites of the eyes (jaundice)

Serious symptoms that might indicate a life-threatening condition


In some cases, cholelithiasis can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these lifethreatening symptoms including:

Abdominal swelling, distension or bloating High fever (higher than 101 degrees Fahrenheit) Nausea with or without vomiting Severe abdominal pain

What causes cholelithiasis?


In most cases, cholelithiasis is caused by excessive amounts of cholesterol in the bile that is stored in the gallbladder. The cholesterol hardens to form stone-like substances. Increased body weight and older age are associated with increased levels of cholesterol in the bile. Thus, gallstones are more likely to occur in women, in people who are obese, and in older individuals. Some gallstones develop because the bile contains too much bilirubin, a waste product of the liver that is a component of bile. Gallstones that develop from excess bilirubin are called pigment stones.

What are the risk factors for cholelithiasis?


A number of factors increase your risk of developing cholelithiasis. Not all people with risk factors will get cholelithiasis. Risk factors for cholelithiasis include:

Age over 40 years Crash dieting, or losing weight rapidly (the bile then contains more cholesterol) Diabetes

Ethnicity (risk is higher in American Indians and Mexican Americans) Family history Female gender Liver disease Overweight or obesity Pregnancy (decreases the gallbladders ability to empty bile) Use of certain medications (cholesterol-lowering drugs increase cholesterol in the bile)

Reducing your risk of cholelithiasis


Although some risk factors, such as age and gender, cannot be modified, you may be able to lower your risk of cholelithiasis through lifestyle changes including:

Eating a healthy diet Getting regular physical activity Losing weight slowly Maintaining a healthy weight

How is cholelithiasis treated?


Treatment of cholelithiasis begins with seeking medical care from your health care provider. To determine if you have cholelithiasis, your health care provider may ask you to provide blood samples and undergo diagnostic tests. Some people with cholelithiasis never have any symptoms. If you have symptoms of cholelithiasis, you may be hospitalized and given antibiotics to prevent an infection. Food intake is normally stopped, and intravenous fluids are administered to let the digestive system rest. You may also receive medication for the abdominal pain associated with cholelithiasis. If you have recurrent episodes of cholelithiasis, the most common treatment is surgery to remove the gallbladder (cholecystectomy). There are two methods for this surgery: open cholecystectomy, when the whole organ is removed through a single incision; and laparoscopic cholecystectomy, when the gallbladder is removed in pieces through several smaller incisions. The laparoscopic technique is now used more frequently. Because the gallbladder is not an essential organ, most people who have had a cholecystectomy can live a normal life afterwards.

Treatment options for cholelithiasis


Several treatment options are now available for cholelithiasis. Laparoscopic cholecystectomy is currently the most frequently used technique. Options include:

Endoscopic retrograde cholangiopancreatography (ERCP), an imaging procedure that allows treatment of some bile duct problems, including removal of gallstones that are causing obstruction Laparoscopic cholecystectomy (removal of the gallbladder through multiple small incisions; this is less invasive and a more commonly used technique) Lithotripsy (technique that uses electric shock waves to dissolve gallstones; it is not commonly used today) Medication to dissolve gallstones (this treatment takes a long time, and gallstones may recur) Open cholecystectomy (removal of the gallbladder through a single, large incision; this is a more invasive and less commonly used technique)

What are the potential complications of cholelithiasis?


Cholelithiasis may cause serious complications if gallstones lodge in the common bile duct, which is the large duct formed where the major gallbladder bile duct joins the major liver bile duct. You can help minimize your risk of serious complications by following the treatment plan that you and your health care professional design specifically for you. Complications of cholelithiasis include:

Acute cholecystitis (sudden inflammation of the gallbladder) Cholangitis (an infection or inflammation of the common bile duct) Choledocholithiasis (gallstone in the common bile duct) Pancreatitis (infection or inflammation of the pancreas)