Chronic cholecystitis (patient information)

Cholecystitis
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Cholecystitis?
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-in-Chief: Meagan E. Doherty

Overview

Cholecystitis is inflammation of the gall bladder. There are two distinct types of cholecystitis, acute and chronic. Acute cholecystitis is a sudden inflammation of the gallbladder that causes severe abdominal pain. Chronic cholecystitis is long-standing swelling and irritation of the gall bladder.

What are the symptoms of Cholecystitis?

Acute Cholecystitis

The main symptom is abdominal pain that is located on the upper right side or upper middle of the abdomen. The pain may:

• Be sharp, cramping, or dull
• Come and go
• Spread to the back or below the right shoulder blade
• Be worse after eating fatty or greasy foods
• Occur within minutes of a meal

Other symptoms that may occur include:

• Abdominal fullness
• Clay-colored stools
• Excess gas
• Fever
• Heartburn
• Indigestion
• Nausea and vomiting
• Yellowing of skin and whites of the eyes (jaundice)

Chronic Cholecystitis

Attacks of upper abdominal pain, often with nausea or vomiting.

What causes Cholecystitis?

Acute Cholecystitis

In 90% of cases, acute cholecystitis is caused by gallstones in the gall bladder. Severe illness, alcohol abuse, and, rarely, tumors of the gall bladder may also cause cholecystitis.

Acute cholecystitis causes bile to become trapped in the gall bladder. The buildup of bile causes irritation and pressure in the gall bladder. This can lead to bacterial infection and perforation of the organ.

Chronic Cholecystitis

Chronic cholecystitis is usually caused by repeated attacks of acute cholecystitis. This leads to thickening of the gall bladder walls. The gall bladder begins to shrink and eventually loses the ability to perform its function, which is concentrating, storing, and releasing bile.

Who is at highest risk?

Risk Factors for Cholecystitis include:

• Gender: The disease occurs more often in women than in men
• Age: The incidence increases after age 40
• The presence or development of gallstones
• Race: Native Americans have a higher rate of gallstones

Diagnosis

Acute Cholecystitis

A physical exam will show that your abdomen is tender to the touch.

Your doctor may order the following blood tests:

• Amylase and lipase
• Bilirubin
• Complete blood count (CBC): may show a higher than normal white blood cell count
• Liver function tests

Imaging tests that can show gallstones or inflammation include:

• Abdominal ultrasound
• Abdominal CT scan
• Abdominal x-ray
• Oral cholecystogram
• Gallbladder radionuclide scan

Chronic Cholecystitis

Tests that reveal gallstones or inflammation in the gallbladder:

• Abdominal CT scan
• Abdominal ultrasound
• Gallbladder scan (HIDA scan)
• Oral cholecystogram

Diseases with similar symptoms

Acute Cholecystitis

• Perforated peptic ulcer
• Acute peptic ulcer exacerbation
• Amoebic liver abscess
• Acute amoebic liver colitis
• Acute pancreatitis
• Acute intestinal obstruction
• Renal colic
• Acute retrocolic appendicitis

Chronic Cholecystitis

• Peptic ulcer
• Hiatus hernia
• Colitis
• Functional bowel syndrome

When to seek urgent medical care?

Acute Cholecystitis

Call your health care provider if severe abdominal pain persists.

Call for an appointment with your health care provider if symptoms of cholecystitis recur after an acute episode.

Chronic Cholecystitis

Call for an appointment with your health care provider if you develop any symptoms of cholecystitis.

Treatment options

Acute Cholecystitis

Seek immediate medical attention for severe abdominal pain.

In the emergency room, patients with acute cholecystitis are given fluids through a vein and antibiotics to fight infection.

Although cholecystitis may clear up on its own, surgery to remove the gall bladder (cholecystectomy) is usually needed when inflammation continues or recurs. Surgery is usually done as soon as possible, however some patients will not need surgery right away.

Nonsurgical treatment includes pain medicines, antibiotics to fight infection, and a low-fat diet (when food can be tolerated).

Emergency surgery may be necessary if gangrene (tissue death), perforation, pancreatitis, or inflammation of the common bile duct occurs.

Occasionally, in very ill patients, a tube may be placed through the skin to drain the gallbladder until the patient gets better and can have surgery.

Chronic Cholecystitis

Surgery is the usual treatment. Surgery to remove the gall bladder (cholecystectomy) can be performed as an open or laparoscopic procedure. The open procedure requires a large cut in the upper-right part of the abdomen. Laparoscopic surgery uses instruments and a small camera inserted through a cluster of a few small cuts.

In patients who are poor candidates for surgery because of other diseases or conditions, the gallstones may be dissolved with medication taken by mouth.

Where to find medical care for Cholecystitis?

Directions to Hospitals Treating Cholecystitis

Prevention of Cholecystitis

Acute Cholecystitis

Removal of the gall bladder and gallstones will prevent further attacks. Follow a low-fat diet if you are prone to gallstone attacks.

Chronic Cholecystitis

The condition is not always preventable. Eating less fatty foods may relieve symptoms in people with acute cholecystitis who have not had their gall bladder removed. However, the benefit of a low-fat diet has not been proven.

What to expect (Outlook/Prognosis)?

Acute Cholecystitis

Patients who have surgery to remove the gall bladder usually do very well.

Possible Complications

• Empyema (pus in the gall bladder)
• Gangrene (tissue death) of the gall bladder
• Injury to the bile ducts draining the liver (a rare complication of cholecystectomy)
• Pancreatitis
• Peritonitis (inflammation of the lining of the abdomen)

Chronic Cholecystitis

Cholecystectomy is a common procedure with a low risk.

Possible Complications

• Cancer of the gallbladder (rarely)
• Jaundice
• Pancreatitis
• Worsening of the condition

Sources

• http://www.nlm.nih.gov/medlineplus/ency/article/000264.htm
• http://www.nlm.nih.gov/medlineplus/ency/article/000217.htm
• http://www.intelihealth.com/IH/ihtPrint/WSIHW000/9339/9709.html?hide=t&k=basePrint