Cholecystitis is an inflammation of the gallbladder. The gallbladder is the small saclike organ located in the upper right side of the abdomen, just below the liver. The gallbladder temporarily stores bile, which is a liquid that contains a fat-digesting substance produced in the liver. During a meal, bile moves from the gallbladder through small, tubelike passages (called the cystic duct and the common bile duct) into the small intestine. Here, bile mixes with food to help break down fats.

Cholecystitis usually develops when a person has gallstones, which are rocklike chemical deposits that form inside the gallbladder. If a gallstone blocks the cystic duct, bile becomes trapped in the gallbladder. Chemicals in the trapped bile or a bacterial infection can lead to inflammation of the gallbladder itself.

There are two types of cholecystitis:

• Acute cholecystitis is the sudden inflammation of the gallbladder that causes abdominal pain.



• Chronic cholecystitis is inflammation of the gallbladder that lasts a long time. It may be caused by repeat attacks of acute cholecystitis. Damage to the walls of the gallbladder leads to a thickened, scarred gallbladder. Ultimately, the gallbladder can shrink and lose its ability to store and release bile.

Gallstones alone can cause episodes of pain without any infection. This is called biliary colic.

Women are more likely than men to get gallstones. The risk of gallstones also is higher in:

• Anyone older than age 60
• Women who are pregnant or have had several pregnancies
• Women who take estrogen replacement therapy or birth control pills
• Obese people
• People who have lost weight rapidly
• People who eat a high-fat diet

Symptoms of acute cholecystitis may include:

• Pain � You may feel this discomfort in the center of the upper abdomen, just below the breastbone, or in the upper right portion of the abdomen, near the gallbladder and liver. In some people, the pain spreads to between the shoulder blades, to the right shoulder blade, or to the right shoulder. Symptoms typically start after eating.
• Fever
• Shaking chills
• Nausea and/or vomiting
• Loss of appetite
• Jaundice (yellowing of the skin or eyes)
• Dark urine and pale, grayish bowel movements � These symptoms appear when gallstones pass out of the gallbladder and into the common bile duct, blocking the flow of bile out of the liver.

When gallstones in the common bile duct block the flow of bile from the liver to the intestine, the patient may develop a serious infection of the bile ducts called cholangitis. The typical symptoms of cholangitis are fever, right upper abdominal pain and jaundice. Another possible problem that may occur when gallstones pass into the common bile duct is acute pancreatitis (inflammation of the pancreas). Because the duct from the pancreas also flows into the common bile duct, stones there can block the pancreas, which causes it to become inflamed. Like cholangitis, acute pancreatitis can be serious.

Symptoms of chronic cholecystitis can include any of the above. However, some people do not have any symptoms. If you have abdominal pain, it is usually very mild, and comes and goes. You also may have indigestion or gas. These symptoms accompany so many other illnesses, so you may not be diagnosed with chronic cholecystitis until you have an episode of more severe symptoms during a sudden attack.

Your doctor will review your medical history and ask about any prior episodes of abdominal discomfort, especially those triggered by high-fat meals. Your doctor will ask if you've had any recent rapid weight loss and about medications you currently take, particularly birth control pills and estrogen replacement therapy (because these can lead to the formation of gallstones).

During the physical exam, your doctor will pay particular attention to the upper right portion of your abdomen, where your liver and gallbladder are located. Blood tests may reveal an elevated white blood cell count, which suggests an infection, or elevated liver enzymes, which suggests a blockage and/or irritation of the gallbladder and bile ducts.

Your doctor may order radiology tests to look for gallstones. Because the chemical composition of most gallstones often makes them invisible on X-rays, other tests are used, including:

• Ultrasound � This painless procedure uses sound waves to create images of the gallbladder and bile ducts. An ultrasound is usually the first (and often only) test needed to confirm that you have gallstones and cholecystitis. A gallbladder wall with a thickened appearance means you may have acute or chronic cholecystitis. Enlarged bile ducts suggest that a stone may have passed out of the gallbladder and into the common bile duct, causing a blockage.



• Cholescintigraphy � This test looks for a blocked gallbladder or bile ducts. You are given an injection of a radioactive chemical that passes out of the blood into the bile ducts. A special camera takes pictures of the chemical's path and can detect blockages in the flow of the chemical.



• CT scan � This test is not quite as good as ultrasound for detecting gallstones, but usually provides an excellent view of the gallbladder, plus the surrounding structures (liver, bile ducts, intestines and pancreas).

If you have biliary colic, the pain or discomfort may go away or become less severe after several hours if a trapped gallstone passes out of the cystic duct on its own. Your abdomen may continue to ache mildly for about 24 hours.

If you have acute cholecystitis, however, and infection and inflammation continue, your symptoms may get worse and you could develop complications, including a hole in the inflamed gallbladder wall (gallbladder perforation) and an infection that spreads to the lining of the abdomen (peritonitis). This is why people with cholecystitis usually are treated and observed in a hospital until their symptoms improve.

Symptoms of chronic cholecystitis may persist for years before a diagnosis is made. Surgery to remove the gallbladder will prevent symptoms from coming back.

Because gallstones cause cholecystitis, you may be able to avoid cholecystitis by controlling the risk factors that can lead to the formation of gallstones. These include watching your weight and avoiding a high-fat diet.

Acute cholecystitis usually requires hospitalization. You need antibiotics given intravenously (into a vein) to treat infection and medications to control symptoms of nausea and abdominal pain. Once your pain lessens or goes away, there are no signs of infection, and you are able to drink and eat, you will be able to go home to continue your recovery. Alternatively, your doctor may wish you to stay in the hospital until you have surgery to remove your gallbladder.

Twenty-five percent of people who have acute cholecystitis develop another episode within 1 year; 60% have another episode within 6 years. For this reason, most doctors recommend that people with cholecystitis have the gallbladder removed surgically (cholecystectomy). Sometimes, surgery is scheduled after a person has been discharged from the hospital and has recovered fully. In some cases, your surgeon may decide to do the cholecystectomy before you leave the hospital.

Chronic cholecystitis requires the removal of the gallbladder surgically.

Call your doctor if you have severe abdominal pain, fever and shaking chills, or jaundice.

Most people recover from episodes of acute cholecystitis within a few days to a few weeks. Rarely, a person can become critically ill from a complication, such as gallbladder perforation, cholangitis or pancreatitis and in a few cases the condition can be fatal.

Removing the gallbladder prevents cholecystitis from coming back. Rarely, gallstones may remain hidden in bile ducts to cause other problems after surgery.

American College of Surgeons
Division of Education
http://www.facs.org/patienteducation/index.html

National Digestive Diseases Information Clearinghouse (NDDIC)
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Bethesda, MD 20892-3570
Toll-Free: 1-800-891-5389
Phone: 301-654-3810
Fax: 301-907-8906
E-Mail: nddic@info.niddk.nih.gov
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