What are the main causes of chronic cholecystitis. How is chronic cholecystitis diagnosed. What are the most effective treatment options for chronic cholecystitis. Who is at higher risk of developing chronic cholecystitis.

Understanding Chronic Cholecystitis: An Overview

Chronic cholecystitis is a persistent inflammatory condition affecting the gallbladder, characterized by ongoing irritation and dysfunction of this vital organ. This condition can significantly impact a person’s quality of life and, if left untreated, may lead to more severe complications. To fully grasp the implications of chronic cholecystitis, it’s essential to explore its causes, symptoms, and available treatment options.

The Underlying Causes of Chronic Cholecystitis

The primary cause of chronic cholecystitis is often linked to the presence of gallstones, a condition known as cholelithiasis. In fact, over 90% of chronic cholecystitis cases are associated with gallstones. These small, hardened deposits can obstruct the cystic duct, leading to inflammation and impaired gallbladder function.

How do gallstones contribute to chronic cholecystitis? When gallstones intermittently block the flow of bile, they cause repeated episodes of inflammation and swelling in the gallbladder wall. This ongoing irritation can result in a chronic inflammatory state, ultimately leading to the development of chronic cholecystitis.

Other Contributing Factors

• Bile stasis due to impaired gallbladder emptying
• Occlusion of the common bile duct (e.g., from tumors or strictures)
• Lithogenic bile composition
• Reduced mucosal protection in the gallbladder
• Impaired gallbladder contraction due to affected cholecystokinin receptors

Risk Factors and Epidemiology of Chronic Cholecystitis

Understanding the risk factors associated with chronic cholecystitis is crucial for identifying individuals who may be more susceptible to developing this condition. The epidemiology of chronic cholecystitis closely mirrors that of gallstone disease, as the two conditions are often interlinked.

Key Risk Factors

1. Female gender
2. Obesity
3. Rapid weight loss
4. Pregnancy
5. Advanced age
6. Hispanic or Native American ethnicity

Why are women more prone to developing chronic cholecystitis? The higher incidence in women is primarily attributed to hormonal factors. Estrogen has been shown to increase bile cholesterol levels and decrease gallbladder contractility. As a result, women of reproductive age or those using estrogen-containing contraceptives have a two-fold increase in gallstone formation compared to males.

Prevalence and Incidence

Gallstone disease affects approximately 10-20% of the world’s population at some point in their lives. In the United States alone, about 14 million women and 6 million men between the ages of 20 and 74 have gallstones. The incidence of gallstone formation increases with age, with over one-quarter of women older than 60 having gallstones.

Pathophysiology of Chronic Cholecystitis

The pathophysiology of chronic cholecystitis involves a complex interplay of factors that contribute to the ongoing inflammation and dysfunction of the gallbladder. Understanding these mechanisms is crucial for developing effective treatment strategies and preventive measures.

Key Pathophysiological Mechanisms

• Occlusion of the cystic duct or impaired gallbladder emptying
• Increased free radical-mediated damage from hydrophobic bile salts
• Reduced mucosal protection due to lower levels of prostaglandin E2
• Impaired gallbladder contraction due to affected cholecystokinin receptors
• Continuous inflammatory state in the gallbladder wall

How does chronic cholecystitis progress over time? The condition typically follows a smoldering course, characterized by ongoing inflammation and intermittent exacerbations. These exacerbations can manifest as acute biliary colic, which presents as episodes of increased pain. In some cases, chronic cholecystitis may progress to a more severe form known as acute cholecystitis, requiring urgent medical intervention.

Recognizing the Symptoms of Chronic Cholecystitis

Identifying the symptoms of chronic cholecystitis is crucial for early diagnosis and timely treatment. While the presentation can vary among individuals, there are several common signs and symptoms associated with this condition.

Common Symptoms

• Recurrent right upper quadrant abdominal pain
• Nausea and vomiting
• Bloating and indigestion
• Intolerance to fatty foods
• Intermittent fever
• Jaundice (in severe cases)

Why does chronic cholecystitis cause right upper quadrant pain? The pain is typically localized to the right upper quadrant of the abdomen due to the anatomical location of the gallbladder. The inflammation and increased pressure within the gallbladder can stimulate pain receptors in the surrounding tissues, leading to discomfort in this specific area.

Diagnostic Approaches for Chronic Cholecystitis

Accurate diagnosis of chronic cholecystitis is essential for determining the appropriate course of treatment. Healthcare providers employ a combination of clinical evaluation, laboratory tests, and imaging studies to confirm the diagnosis and assess the severity of the condition.

Diagnostic Tools and Techniques

1. Physical examination
2. Blood tests (e.g., complete blood count, liver function tests)
3. Ultrasound imaging
4. Hepatobiliary iminodiacetic acid (HIDA) scan
5. Computed tomography (CT) scan
6. Magnetic resonance cholangiopancreatography (MRCP)

Why is ultrasound considered the gold standard for diagnosing chronic cholecystitis? Ultrasound is the preferred initial imaging modality due to its high sensitivity and specificity in detecting gallstones and gallbladder wall thickening. It is also non-invasive, readily available, and cost-effective compared to other imaging techniques.

Treatment Options for Chronic Cholecystitis

The management of chronic cholecystitis aims to alleviate symptoms, prevent complications, and address the underlying cause of the condition. Treatment approaches can range from conservative measures to surgical interventions, depending on the severity of the disease and the patient’s overall health status.

Conservative Management

• Dietary modifications (low-fat diet)
• Pain management with analgesics
• Ursodeoxycholic acid for gallstone dissolution (in select cases)

Surgical Intervention

Cholecystectomy, or surgical removal of the gallbladder, is the definitive treatment for chronic cholecystitis. This procedure can be performed using two main approaches:

1. Laparoscopic cholecystectomy (minimally invasive)
2. Open cholecystectomy (traditional surgical approach)

Why is laparoscopic cholecystectomy preferred over open cholecystectomy? Laparoscopic cholecystectomy is associated with shorter hospital stays, faster recovery times, and reduced postoperative pain compared to open cholecystectomy. It has become the gold standard for gallbladder removal in most cases of chronic cholecystitis.

Complications and Long-term Outlook of Chronic Cholecystitis

While chronic cholecystitis can often be managed effectively with appropriate treatment, it’s important to be aware of potential complications that may arise if the condition is left untreated or poorly controlled.

Potential Complications

• Acute cholecystitis
• Gallbladder perforation
• Biliary tract obstruction
• Gallstone pancreatitis
• Gallbladder cancer (rare)

What is the long-term prognosis for patients with chronic cholecystitis? The prognosis for patients who undergo cholecystectomy is generally excellent. Most individuals experience complete resolution of symptoms and can return to their normal activities within a few weeks of surgery. However, a small percentage of patients may experience persistent symptoms, a condition known as postcholecystectomy syndrome.

Preventive Measures and Lifestyle Modifications

While not all cases of chronic cholecystitis can be prevented, there are several lifestyle modifications and preventive measures that can help reduce the risk of developing this condition or manage its symptoms in those already affected.

Preventive Strategies

1. Maintaining a healthy weight
2. Eating a balanced diet low in saturated fats
3. Regular exercise
4. Avoiding rapid weight loss
5. Staying hydrated
6. Managing underlying health conditions (e.g., diabetes)

How can dietary changes help prevent chronic cholecystitis? A diet low in saturated fats and high in fiber can help reduce the risk of gallstone formation, which is a primary cause of chronic cholecystitis. Additionally, maintaining a healthy weight through proper nutrition and regular exercise can decrease the likelihood of developing gallbladder problems.

In conclusion, chronic cholecystitis is a complex condition that requires a comprehensive understanding of its causes, symptoms, and treatment options. By recognizing the risk factors and implementing appropriate preventive measures, individuals can take proactive steps to maintain their gallbladder health. For those already diagnosed with chronic cholecystitis, working closely with healthcare providers to develop an effective management plan is crucial for improving quality of life and preventing potential complications.

Chronic Cholecystitis – StatPearls – NCBI Bookshelf

Continuing Education Activity

Chronic cholecystitis is a prolonged, subacute condition caused by the mechanical or functional dysfunction of the emptying of the gallbladder. It presents with chronic symptomatology that can be accompanied by acute exacerbations of more pronounced symptoms (acute biliary colic), or it can progress to a more severe form of cholecystitis requiring urgent intervention (acute cholecystitis). This activity reviews the pathophysiology of chronic cholecystitis and highlights the role of the interprofessional team in its management.

Objectives:

• Recall the cause of chronic cholecystitis.

• Describe the workup of a patient with suspected chronic cholecystitis.

• Summarize the treatment options for chronic cholecystitis.

• Review the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by chronic cholecystitis.

Access free multiple choice questions on this topic.

Introduction

Chronic cholecystitis is a chronic condition caused by ongoing inflammation of the gallbladder resulting in mechanical or physiological dysfunction its emptying. It presents as a smoldering course that can be accompanied by acute exacerbations of increased pain (acute biliary colic), or it can progress to a more severe form of cholecystitis requiring urgent intervention (acute cholecystitis). There are classic signs and symptoms associated with this disease as well as prevalence in certain patient populations. The two forms of chronic cholecystitis are calculous (occuring in the setting of cholelithiasis), and acalculous (without gallstones). However most cases of chronic cholecystitis are commonly associated with cholelithiasis.

Etiology

Chronic cholecystitis mostly occurs in the setting of cholelithiasis. The proposed etiology is recurrent episodes of acute cholecystitis or chronic irritation from gallstones invoking an inflammatory response in the gallbladder wall. Sometimes the term is used to describe abdominal pain resulting from dysfunction in the emptying of the gallbladder. This overlaps with Sphincter of Oddi dysfunction and is best referred to as biliary or gallbladder dyskinesia.  

Risk factors for cholelithiasis include:

• Female gender

• Obesity

• Rapid weight loss

• Pregnancy

• Advanced age

• Hispanic or Pima Indians

Epidemiology

The epidemiology of chronic cholecystitis mostly parallels with that of cholelithiasis. Specific data on this disease entity is limited. 

Gallstone disease is very common. About 10-20% of the world population will develop gallstones at some point in their life and about 80% of them are asymptomatic[1]. There are approximately 500,000 cholecystectomies done yearly in the United Stated for gallbladder disease. The incidence of gallstone formation increases yearly with age. Over one-quarter of women older than the age of 60 will have gallstones. In the United States, approximately 14 million women and 6 million men with an age range of 20 to 74 have gallstones. Obesity increases the likelihood of gallstones, especially in women due to increases in the biliary secretion of cholesterol. On the other hand, patients with drastic weight loss or fasting have a higher chance of gallstones secondary to biliary stasis. Furthermore, there is also a hormonal association with gallstones. Estrogen has been shown to result in an increase in bile cholesterol as well as a decrease in gallbladder contractility. Women of reproductive age or on estrogen-containing contraceptives have a two-fold increase in gallstone formation compared to males. People with chronic illnesses such as diabetes also have an increase in gallstone formation as well as reduced gallbladder wall contractility due to neuropathy.[2]

Pathophysiology

Occlusion of the cystic duct or malfunction of the mechanics of the gallbladder emptying is the basic underlying pathologies of this disease. Over 90% of chronic cholecystitis is associated with the presence of gallstones. Gallstones, by causing intermittent obstruction of the bile flow, most commonly by blocking the cystic duct lead to inflammation and edema in the gall bladder wall. Occlusion of the common bile duct such as in neoplasms or strictures can also lead to stasis of the bile flow causing gallstone formation with resultant chronic cholecystitis.[3]

It has been proposed that lithogenic bile leads to increased free radical-mediated damage from hydrophobic bile salts. That, in association with reduced mucosal protection due to lower levels of prostaglandin E2 results in a continuous inflammatory state. When the cholecystokinin receptors of the smooth muscle are affected, there is impaired gall bladder contraction that leads to stasis and worsens the permissive environment where lithogenic bile promotes inflammation.[4]

Histopathology

The gallbladder wall may be thickened to variable degrees, and there may be adhesions to the serosal surface. In some cases, due to extensive fibrosis, the gallbladder may appear shrunken. Smooth muscle hypertrophy, especially in prolonged chronic conditions, is present. Calcium bilirubinate or cholesterol stones are most often present and can vary in size from sand-like to completely filling the entire gallbladder lumen. They can be multiple or singular. The acalculous disease may reveal sludge or very viscous bile. These findings are usual precursors to gallstones and are formed from increased biliary salts or stasis. Normal appearing bile can also be present. Various species of bacteria can be found in 11% to 30% of the cases. Rokitansky-Aschoff sinuses are present or accentuated in 90% of the time in chronic cholecystitis specimens. These are a herniation of intraluminal sinuses from increased pressures possibly associated with ducts of Luschka. The mucosa will exhibit varying degrees of inflammation. T lymphocytes are the common cells followed by plasma cells and histiocytes. Metaplastic changes can be seen. There is usually hypertrophy of the muscularis mucosa with varying degrees of mural fibrosis and elastosis. A variant in which calcium deposition and hyaline fibrosis leads to diffuse thinning of the gallbladder wall is called hyalinizing cholecystitis. The brittle consistency also gives it the name porcelain gallbladder.[5]

History and Physical

Symptomatic patients with chronic cholecystitis usually present with dull right upper abdominal pain that radiates around the waist to the mid back or right scapular tip. The pain may be exacerbated by fatty food intake but the classical post-prandial pain of acute cholecystitis is less common. Nausea and occasional vomiting also accompany complaints of increased bloating and flatulence. Often the symptoms occur in the evening or at night. Symptoms are usually present over weeks to months as opposed to the abrupt, severe presentation of acute cholecystitis. There might be a gradual worsening of symptoms or an increase in the frequency of episodes. Fever and tachycardia are rare. Elderly patients with cholecystitis may present with vague symptoms and they are at risk of progression to complicated disease. Hence a high index of clinical suspicion is required in the diagnosis of this condition. 

Evaluation

Laboratory testing is not specific or sensitive in making a diagnosis of chronic cholecystitis. Leukocytosis and abnormal liver function tests may not be present in these patients, unlike the acute disease. However basic laboratory testing in the form of a metabolic panel, liver functions, and complete blood count should be performed. Cardiac testing including EKG and troponins should be considered in the appropriate clinical setting.

The diagnostic investigation of choice when chronic cholecystitis is suspected clinically is a right upper quadrant ultrasound. This non-invasive study that is readily available in most facilities can accurately evaluate the gallbladder for a thickened wall or inflammation. It also aids in the evaluation of gallstones or sludge. Computerized tomography (CT) with intravenous contrast usually reveals cholelithiasis, increased attenuation of bile, and gallbladder wall thickening. The gallbladder itself may appear distended or contracted, however, pericholecystic inflammation and fluid collection are usually absent.[6] A distended gallbladder and increased enhancement of adjacent hepatic tissue go more in favor of acute cholecystitis, whereas hyperenhancement of the gallbladder wall is more commonly seen in the chronic disease.[7] Given the overlapping findings between acute and chronic cholecystitis, sometimes ultrasound and CT may be adequate to come to a final diagnosis. A magnetic resonance imaging (MRI) study is a useful alternative in patients who are unable to undergo a CT scan due to radiation concerns or renal injury.[8] The diagnostic test of choice to confirm chronic cholecystitis is the hepatobiliary scintigraphy or a HIDA scan with cholecystokinin(CCK). The most common scintigraphic findings are delayed gallbladder visualization (between 1-4 hours) and delayed increased biliary to bowel transit time. [9] The tracer is injected intravascularly and gets concentrated in the gallbladder. CCK is then administered and the percentage of gallbladder emptying (ejection fraction – EF) is calculated. An EF below 35% at the 15-minute cutoff is considered a dyskinetic gallbladder and is suggestive of chronic cholecystitis.  

Treatment / Management

The preferred treatment for chronic cholecystitis is elective laparoscopic cholecystectomy. It has a low morbidity rate and can be performed as an outpatient surgery. An open cholecystectomy is also an option however requires hospital admission and longer recovery time. This surgery is indicated in patients who are not laparoscopic candidates such as those with extensive prior surgeries and adhesions. Endoscopic retrograde cholangiopancreatography (ERCP) is usually done when choledocholithiasis is a concern. These patients usually undergo ERCP prior to elective surgery. 

Patients who are not surgical candidates or who prefer not to undergo surgery can be closely observed and managed conservatively. A low-fat diet can help reduce the frequency of symptoms. In patients with symptomatic cholelithiasis, the use of ursodeoxycholic acid (UDCA or ursodiol) has been shown to decrease rates of biliary colic and acute cholecystitis.[10] However, the literature on its role in chronic cholecystitis is limited. The management of asymptomatic patients with incidentally detected chronic cholecystitis depends on patient characteristics. Asymptomatic patients with no radiological or clinical concerns of malignancy can also be closely monitored with follow-up imaging. 

Differential Diagnosis

There are other common medical conditions that can mimic the presentation of chronic cholecystitis. A thorough analysis of the clinical presentation often can guide appropriate workup. Common clinical features of these disorders are as follows:

• Acute cholecystitis: A continuous, severe pain in the right side of the abdomen lasting for hours associated with fever, nausea, and vomiting in an ill-looking patient is suggestive of acute cholecystitis[11].

• Gall bladder cancer: Chronic abdominal symptoms associated with weight loss or other constitutional symptoms should raise suspicion of this. Imaging and histology are helpful in making a definitive diagnosis.

• Peptic ulcer disease: The presence of epigastric abdominal pain and early satiety should alert the possibility of peptic ulcer disease. Alarm symptoms include weight loss, anemia, melena or dysphagia[12].

• GERD: Burning sensation in the epigastrium or retrosternal region that may be associated with regurgitation of food material.

• Gastric cancer: the presence of alarm symptoms of peptic ulcer disease, persistent vomiting, evidence of malignancy or other risk factors should alert to the possibility of this[13].
• Myocardial infarction: In cases of the inferior wall or right ventricular ischemia, the presenting symptoms may be epigastric pain with nausea and vomiting. Other cardiac symptoms like dizziness or SOB or risk factors for coronary ischemia should prompt a workup for the same[14].
• Mesenteric ischemia: the acute variant presents with severe acute abdominal pain and the chronic variant typically with post-prandial pain. Old age, risk factors for atherosclerosis, blood in stools, and weight loss are concerning features of this condition[15].
• Mesenteric vasculitis: presence of ongoing abdominal symptoms unexplained by regular workup and the presence of other features consistent with systemic vasculitis could be related to this relatively underrecognized but dangerous condition[16].

Prognosis

The majority of uncomplicated cases of cholecystitis have an excellent outcome. In many cases, supportive treatments can help with symptoms. Most cases are treated with elective cholecystectomy to prevent future complications. While surgery is safe, bile duct injuries can happen and need to be monitored in the post-operative period.

Complications

The proliferation of bacteria in the gallbladder can lead to acute cholecystitis or pus collections. In some cases, the gallstone may erode into the duodenum and impact in the terminal ileum, presenting as gallstone ileus. Rarely the patient may develop emphysematous cholecystitis due to the presence of gas-forming organisms like clostridia, E.coli, and klebsiella. This presentation is most common in diabetics and carries a high mortality rate. The relationship between chronic cholecystitis and gall bladder cancer is controversial. Though chronic inflammation has been shown to be associated with increased risk of cancer[17], the data on this is limited. Xanthogranulomatous cholecystitis is a variant of chronic cholecystitis in which continued inflammation leads to extensive thickening and fibrosis extending locally beyond the gall bladder wall. In this severe variant, the occurrence of complications like abscesses and fistulas are more common. It is considered a pre-malignant condition. Porcelain gallbladder tends to be asymptomatic in most cases. The association with malignancy is again controversial but the consensus is that it carries a slightly increased risk of cancer. [18]

Consultations

The diagnosis is usually made at the level of primary care or in the inpatient setting. A gastroenterology consult is mandated when gallstone obstruction of the biliary system is suspected. Otherwise, most patients are referred to general surgery for consideration of elective cholecystectomy. 

Enhancing Healthcare Team Outcomes

The diagnosis and management of cholecystitis is a multi-disciplinary team approach. A high index of suspicion is vital in the diagnosis. Referral to the surgical team followed by decision making on the need for laparoscopic surgery are the next steps. Good surgical care with good postoperative follow up is also essential. Counseling for food habits with nutritionist support and lifestyle changes are crucial in patients being treated conservatively.

Figure

Porcelain gallbladder. Contributed by Sunil Munakomi, MD

References

1.

Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012 Apr;6(2):172-87. [PMC free article: PMC3343155] [PubMed: 22570746]

2.

Andercou O, Olteanu G, Mihaileanu F, Stancu B, Dorin M. Risk factors for acute cholecystitis and for intraoperative complications. Ann Ital Chir. 2017;88:318-325. [PubMed: 29068324]

3.

Wang L, Sun W, Chang Y, Yi Z. Differential proteomics analysis of bile between gangrenous cholecystitis and chronic cholecystitis. Med Hypotheses. 2018 Dec;121:131-136. [PubMed: 30396466]

4.

Guarino MP, Cong P, Cicala M, Alloni R, Carotti S, Behar J. Ursodeoxycholic acid improves muscle contractility and inflammation in symptomatic gallbladders with cholesterol gallstones. Gut. 2007 Jun;56(6):815-20. [PMC free article: PMC1954869] [PubMed: 17185355]

5.

Benkhadoura M, Elshaikhy A, Eldruki S, Elfaedy O. Routine histopathological examination of gallbladder specimens after cholecystectomy: Is it time to change the current practice? Turk J Surg. 2018 Sep 11;:1-4. [PubMed: 30248293]

6.

Smith EA, Dillman JR, Elsayes KM, Menias CO, Bude RO. Cross-sectional imaging of acute and chronic gallbladder inflammatory disease. AJR Am J Roentgenol. 2009 Jan;192(1):188-96. [PubMed: 19098200]

7.

Yeo DM, Jung SE. Differentiation of acute cholecystitis from chronic cholecystitis: Determination of useful multidetector computed tomography findings. Medicine (Baltimore). 2018 Aug;97(33):e11851. [PMC free article: PMC6112975] [PubMed: 30113479]

8.

Kaura SH, Haghighi M, Matza BW, Hajdu CH, Rosenkrantz AB. Comparison of CT and MRI findings in the differentiation of acute from chronic cholecystitis. Clin Imaging. 2013 Jul-Aug;37(4):687-91. [PubMed: 23541278]

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Chamarthy M, Freeman LM. Hepatobiliary scan findings in chronic cholecystitis. Clin Nucl Med. 2010 Apr;35(4):244-51. [PubMed: 20305411]

10.

Guarino MP, Cocca S, Altomare A, Emerenziani S, Cicala M. Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed. World J Gastroenterol. 2013 Aug 21;19(31):5029-34. [PMC free article: PMC3746374] [PubMed: 23964136]

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Huffman JL, Schenker S. Acute acalculous cholecystitis: a review. Clin Gastroenterol Hepatol. 2010 Jan;8(1):15-22. [PubMed: 19747982]

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Malik TF, Gnanapandithan K, Singh K. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 29, 2021. Peptic Ulcer Disease. [PubMed: 30521213]

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Ajani JA, Lee J, Sano T, Janjigian YY, Fan D, Song S. Gastric adenocarcinoma. Nat Rev Dis Primers. 2017 Jun 01;3:17036. [PubMed: 28569272]

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Albulushi A, Giannopoulos A, Kafkas N, Dragasis S, Pavlides G, Chatzizisis YS. Acute right ventricular myocardial infarction. Expert Rev Cardiovasc Ther. 2018 Jul;16(7):455-464. [PubMed: 29902098]

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Gnanapandithan K, Feuerstadt P. Review Article: Mesenteric Ischemia. Curr Gastroenterol Rep. 2020 Mar 17;22(4):17. [PubMed: 32185509]

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Gnanapandithan K, Sharma A. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 2, 2021. Mesenteric Vasculitis. [PubMed: 31536217]

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Goetze TO. Gallbladder carcinoma: Prognostic factors and therapeutic options. World J Gastroenterol. 2015 Nov 21;21(43):12211-7. [PMC free article: PMC4649107] [PubMed: 26604631]

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Patel S, Roa JC, Tapia O, Dursun N, Bagci P, Basturk O, Cakir A, Losada H, Sarmiento J, Adsay V. Hyalinizing cholecystitis and associated carcinomas: clinicopathologic analysis of a distinctive variant of cholecystitis with porcelain-like features and accompanying diagnostically challenging carcinomas. Am J Surg Pathol. 2011 Aug;35(8):1104-13. [PubMed: 21716080]

Cholecystitis | Symptoms and Treatment

What is cholecystitis?

Cholecystitis means inflammation of the gallbladder. Most cases are caused by gallstones. Women are affected more often than men. If you have acute cholecystitis you will normally be admitted to hospital for treatment with painkillers and fluids (and sometimes antibiotic medicines) passed directly into a vein.

The inflammation may settle down with treatment. However, surgical removal of the gallbladder is usually advised to prevent further bouts of cholecystitis.

You can find out more about the gallbladder and gallstones in our separate leaflet called Gallstones and Bile.

How do gallstones cause cholecystitis?

Most people with gallstones do not have any symptoms or problems and do not know they have them. Commonly, the stones simply stay in the gallbladder and cause no harm. However, in some people, gallstones can cause problems. See the separate leaflet called Gallstones and Bile for more details.

Gallstones causing cholecystitis

Cholecystitis is one problem that can occur with gallstones. About 19 in 20 cases of cholecystitis are thought to be caused by gallstones. What seems to happen is that a gallstone becomes stuck in the cystic duct (this is the tube that drains bile out from the gallbladder into the bile duct). Bile then builds up in the gallbladder, which becomes stretched (distended). Because of this, the walls of the gallbladder become inflamed. In some cases the inflamed gallbladder becomes infected. An infected gallbladder is more prone to lead to complications.

Cholecystitis symptoms

The symptoms of acute cholecystitis tend to be quite characteristic. They usually come on rather quickly and you can feel very unwell.

• Pain in the upper tummy (abdomen) – the main symptom. It is usually worse on the right side, under the ribs. The pain may travel (radiate) to the back or to the right shoulder and tends to last several hours. The pain tends to be worse if you breathe in deeply.
• You may also develop a feeling of sickness (nausea).
• You may be sick (vomit).
• You may have a high temperature (fever).

If you are examined by a healthcare professional, they may find you have a positive ‘Murphy’s sign’, meaning that you notice an increase in pain when the doctor places their hand under your ribs on the right hand side, and then asks you to take a deep breath.

What does an ultrasound scan do?

An ultrasound scan is a generally painless test which uses sound waves to scan the tummy (abdomen). It takes around 30 minutes to complete the scan. An ultrasound scan can usually detect gallstones and also whether the wall of the gallbladder is thickened (as occurs with cholecystitis). If the diagnosis is in doubt then other more detailed scans may be done.

Are there any other tests I might need?

In hospital you may also have the following tests:

• Monitoring of your temperature, pulse and blood pressure.
• Assessment of your urine output.
• Blood tests.
• A computerised tomography (CT) scan of the tummy (abdomen).

What else could cause these symptoms?

The symptoms of cholecystitis are quite characteristic but other conditions can sometimes appear similar. These include appendicitis, a stomach ulcer, pancreatitis and pneumonia. All of these can make you seriously unwell so it’s important to get the diagnosis right. The tests performed in hospital will help to check the diagnosis.

Cholecystitis treatment

Unless you are too unwell for surgery, the target set by the National Institute for Health and Care Excellence (NICE) is for your operation to be performed within a week of diagnosis. Different techniques to remove the gallbladder may be used depending on various factors.

• Keyhole surgery is now the most common way to remove a gallbladder. The medical term for this operation is laparoscopic cholecystectomy. It is called keyhole surgery as only small cuts are needed in the tummy (abdomen) with small scars remaining afterwards. The operation is done with the aid of a special telescope that is pushed into the abdomen through one small cut. This allows the surgeon to see the gallbladder. Instruments pushed through another small cut are used to cut out and remove the gallbladder. Keyhole surgery is not suitable for all people.
• Some people need a traditional operation to remove the gallbladder. This is called cholecystectomy. In this operation a larger cut is needed to get at the gallbladder.
• A newer approach called natural orifice transluminal endoscopic surgery (NOTES) is still in the development stage. An operating telescope is inserted into one of the natural openings of the body such as the mouth, anus or vagina to perform the surgery.

Do I have to have surgery?

If you do not have your gallbladder removed, there is a reasonable chance that you will have no further problems if the inflammation settles down. However, there is also a good chance that you would have further bouts of cholecystitis. This is why the usual treatment is to remove the gallbladder.

What you can expect after surgery, including possible complications, is covered in our separate leaflet called Gallstones and Bile.

Cholecystitis (Gallbladder… | Cary Gastroenterology Associates

Your gallbladder may not be an organ you know well, but this tiny, pear-shaped organ performs a very important service. The gallbladder stores and concentrates bile that allows you to digest fats. Composed mainly of cholesterol, bile salts, and bilirubin, bile is a compound produced by the liver and stored in the gallbladder until your body needs it. After your food is partially digested in the stomach, it enters the small intestine. Bile is released into the small intestine by the gallbladder to help break down fats in your food. 

What is Cholecystitis?

When everything is functioning normally, you would never know your gallbladder is doing its job. However, when the flow of bile gets blocked, things start to go downhill quickly. Gallstones are deposits that develop when the components of bile, such as bilirubin and cholesterol, stay in the gallbladder and solidify into hard, pebble-like masses. These deposits may be solid masses or may only be a thick, viscous sludge. As many as 80% of gallstones do not cause symptoms, but the rest are not easily ignored. 

When these gallstones lodge in the bile ducts and block the release of bile, a backup of bile can result. Obstructions in the bile ducts may cause your gallbladder to swell and will likely cause intense pain and tenderness on the right side of the abdomen. You may also have back pain, known as biliary colic. If the blockage is not cleared, your gallbladder can become inflamed. You may also be at risk for infection and lack of blood flow (known as ischemia). This condition is known either as acute cholecystitis or acute calculous cholecystitis (ACC) depending on the specific cause. If you experience repeated episodes of acute cholecystitis your gallbladder may become damaged, resulting in chronic cholecystitis. This shrinking and thickening of the gallbladder wall may result in an inability to store bile and increase the likelihood of blockages.

For most people, a gallbladder attack will last one to four days and then subside. If your attack is particularly severe, the wall of your gallbladder may rupture or perforate. When this happens, surgery will likely be necessary. It is also possible for pus to build up inside the gallbladder in a condition called empyema. It is also not uncommon to develop a bacterial infection before or even during a gallbladder attack. 

Most of the symptoms of cholecystitis are similar to other conditions such as pancreatitis. If you are having a gallbladder attack, you will nearly always experience intense pain, though symptoms of cholecystitis vary from person to person. Upper abdominal pain, especially in the right upper quadrant, is the most common complaint. With acute calculous cholecystitis, the pain often intense and comes on suddenly. It is usually described as cramping, dull, or steady. The pain of an ACC gallbladder attack can become incapacitating. The pain of a gallbladder attack usually lasts more than six hours. It will often begin at night or a few hours following a meal. Pain from a gallbladder attack may worsen with a deep breath and can radiate into the right shoulder blade or the upper back. You may also experience dark urine, and clay-colored stools if the attack persists. Jaundice is also possible, which is typically first seen as a yellowing of the whites of the eyes.  

In addition to pain, you may also experience nausea, vomiting, and the pain may cause shortness of breath when inhaling. A stiffening of the muscles of the abdomen may also occur, as well as bloating, chills, and fever. If you are an older individual, you may not develop pain or a fever. You will likely still experience tenderness in the upper right side of your abdomen, decreased food intake, and may even experience altered mental state.

Acute Acalculous Cholecystitis (AAC)

Acute acalculous cholecystitis (AAC) is a bit of a different story. This gallbladder disease occurs in the absence of gallstones or any blockage of the cystic ducts. Less than 15% of cholecystitis cases are acalculous. Typically they occur in hospitalized patients who are already suffering from other maladies. The specific causes of acalculous cholecystitis are not well known. It is commonly associated with an increased mortality rate, which is due in large part because it occurs in people who are already experiencing severe medical conditions.

In addition to the standard symptoms of a gallbladder attack, if you have ACC you may have an increased white blood cell count (leukocytosis), decreased muscle contraction in your intestines, gallbladder abscess, and possibly even gangrene. Other, less specific symptoms include diarrhea, fatigue, upset stomach, and jaundice.

Causes of Cholecystitis 

Nearly all cases of acute calculous cholecystitis are associated with a gallstone obstructing the cystic duct. The cystic duct is a short tube that allows bile from the gallbladder to enter the common bile duct. When this duct is blocked, cholesterol-saturated bile can build up in the gallbladder. The longer the cystic duct is blocked, the more severe your gallbladder attack is likely to be. 

A brief blockage that clears on its own may result in short term pain. If the blockage lasts longer than a few hours, inflammation of the gallbladder and surrounding tissue may result. Inflammation will cause the gallbladder to become enlarged, stiff have thickened walls and may exude pericholecystic fluid. If your attack is this severe, secondary infections are likely. These can be quite serious and result in gangrene, necrosis, or gas building up in the wall of the gallbladder. At this stage, you may be at risk for perforation or rupture of the gallbladder if you do not receive medical treatment. 

Acute Acalculous Cholecystitis (AAC)

AAC is not caused by gallstones blocking the cystic duct. Instead, an underlying condition or clinical trauma is responsible. This can include end-stage renal disease, major burns, surgery, polytrauma, post-hemorrhagic shock resuscitation, or systemic inflammation produced by leukemia. Viral, parasitic, bacterial, and infectious diseases are also potential causes of AAC. The exact cause of AAC is not known, but it is suspected that reduced blood flow to the gallbladder or biliary stasis (bile immobility) caused by not eating may contribute. 

AAC can also be caused by infections that kill gallbladder tissue. Other medical conditions such as vasculitis (inflammation of blood vessels), diabetes mellitus, opioid addiction, sickle cell anemia, dehydration, and cystic artery obstruction can all damage the gallbladder.  

How is Cholecystitis Diagnosed and Evaluated?

Unlike many other conditions and diseases, acute cholecystitis does not have one specific test that provides for a conclusive diagnosis. Instead, abdominal ultrasound and being admitted to the hospital for observation is the best way for your doctor to reach a diagnosis. If your symptoms suggest you may be suffering from a gallbladder attack, he or she will perform a physical examination. This can include probing for the gallbladder just below the ribs to see if it is painful to the touch. Typically your doctor will be looking for local signs or symptoms, systemic signs, and a result from an imaging test to confirm a diagnosis. Your doctor will also likely order a blood test to see if you have elevated levels of white blood cells or elevated C-reactive protein levels that may signal an infection or inflammation.

Directly observing gallstones, thickening in the gallbladder wall, or a blockage of your cystic duct are all possible using the right imaging techniques. In addition to x-rays, two imaging techniques commonly used if you have cholecystitis are hepatobiliary scintigraphy (HIDA scan) and abdominal ultrasound. Abdominal ultrasound is often the first test tried as it is more commonly available, is not invasive and has a high accuracy in identifying gallbladder stones. Ultrasound can also show gallbladder wall thickening and the presence of pericholecystic fluid.

A hepatobiliary iminodiacetic acid (HIDA) scan can track the flow of bile from the liver all the way through to the small intestine. Since these scans show the entire path bile follows, they are useful in showing any blockage. If your doctor orders this test, you will receive an injection of HIDA, a radioactively labeled compound that will end up in your bile. A specialized camera then traces the movement of bile by looking for this fluid. This test has limitations, though, and carries the risk of exposing you to radiation.  It can also be inaccurate if you have elevated bilirubin levels which will prevent the liver from secreting compounds like HIDA into your bile.

Blood tests are part of nearly every medical diagnosis, and gallbladder attacks are no exception. Your doctor will be looking for an increase in white blood cell count and C-reactive protein which can be an indicator of inflammation. If your serum amylase levels are higher than normal, you may also have gallstone pancreatitis or gangrenous cholecystitis. 

How is Cholecystitis Treated?

If you are admitted to the hospital with suspected cholecystitis, you will likely be prevented from eating or drinking anything until it is determined whether or not you will need surgery. If your doctor suspects your case does not need immediate surgery, you will likely be prevented from eating for a period of time while you receive hydration and pain medication via an intravenous solution of fluids and electrolytes. 

The most common treatment for a severe gallbladder attack is a cholecystectomy—the removal of your gallbladder. It is possible to simply remove the gallstones, though there is a high rate of recurrence of symptoms within a few years. For this reason, your surgeon will likely suggest removing the entire gallbladder. Gallbladder removal is typically done via laparoscopic cholecystectomy. During this procedure, a thin, flexible tube known as a laparoscope is inserted through a small incision in the abdomen, allowing your surgeon to inspect and remove the diseased tissue. 

If you are older, have other systemic dysfunction, have an autoimmune deficiency, or other significant risk factors, your doctor may be reluctant to perform a cholecystectomy due to potential complications. In these cases, a cholecystostomy drainage tube can be placed in your gallbladder to help ensure proper drainage in the future. 

Talk to Your Doctor

Any time you experience severe pain in your abdomen, particularly if it is accompanied by dark-colored urine, fever, vomiting, and yellowing of the whites of the eyes, you should seek medical attention immediately. A gallbladder attack, especially one that is severe and lasts more than a few hours may be severe enough for the gallbladder to rupture. This can put you at risk of a generalized infection in your abdomen that can be difficult to treat, and could even prove to be lethal. 
If you have experienced mild gallbladder attacks that clear up on their own, you may be at risk of developing chronic cholecystitis. It is better to catch gallbladder damage early rather than risk needing to have it removed later. 

Make an appointment today with Cary Gastroenterology Associates. We can help you understand your symptoms, and know more about the risks posed by cholecystitis. Knowing the warning signs, understanding treatment options can help you make better decisions about how to care for your body.

Cholecystitis // Middlesex Health

Overview

Cholecystitis (ko-luh-sis-TIE-tis) is inflammation of the gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, beneath your liver. The gallbladder holds a digestive fluid that’s released into your small intestine (bile).

In most cases, gallstones blocking the tube leading out of your gallbladder cause cholecystitis. This results in a bile buildup that can cause inflammation. Other causes of cholecystitis include bile duct problems, tumors, serious illness and certain infections.

If left untreated, cholecystitis can lead to serious, sometimes life-threatening complications, such as a gallbladder rupture. Treatment for cholecystitis often involves gallbladder removal.

The gallbladder serves as a reservoir for a yellow-green fluid produced in your liver (bile). Bile flows from your liver into your gallbladder, where it’s held until needed during the digestion of food. When you eat, your gallbladder releases bile into the bile duct, where it’s carried to the upper part of the small intestine (duodenum) to help break down fat in food.

Symptoms

Signs and symptoms of cholecystitis may include:

• Severe pain in your upper right or center abdomen
• Pain that spreads to your right shoulder or back
• Tenderness over your abdomen when it’s touched
• Nausea
• Vomiting
• Fever

Cholecystitis signs and symptoms often occur after a meal, particularly a large or fatty one.

When to see a doctor

Make an appointment with your doctor if you have worrisome signs or symptoms. If your abdominal pain is so severe that you can’t sit still or get comfortable, have someone drive you to the emergency room.

Causes

Cholecystitis occurs when your gallbladder becomes inflamed. Gallbladder inflammation can be caused by:

• Gallstones. Most often, cholecystitis is the result of hard particles that develop in your gallbladder (gallstones). Gallstones can block the tube (cystic duct) through which bile flows when it leaves the gallbladder. Bile builds up, causing inflammation.
• Tumor. A tumor may prevent bile from draining out of your gallbladder properly, causing bile buildup that can lead to cholecystitis.
• Bile duct blockage. Kinking or scarring of the bile ducts can cause blockages that lead to cholecystitis.
• Infection. AIDS and certain viral infections can trigger gallbladder inflammation.
• Blood vessel problems. A very severe illness can damage blood vessels and decrease blood flow to the gallbladder, leading to cholecystitis.

Risk factors

Having gallstones is the main risk factor for developing cholecystitis.

Complications

Cholecystitis can lead to a number of serious complications, including:

• Infection within the gallbladder. If bile builds up within your gallbladder, causing cholecystitis, the bile may become infected.
• Death of gallbladder tissue. Untreated cholecystitis can cause tissue in the gallbladder to die (gangrene). It’s the most common complication, especially among older people, those who wait to get treatment, and those with diabetes. This can lead to a tear in the gallbladder, or it may cause your gallbladder to burst.
• Torn gallbladder. A tear (perforation) in your gallbladder may result from gallbladder swelling, infection or death of tissue.

Prevention

You can reduce your risk of cholecystitis by taking the following steps to prevent gallstones:

1. Lose weight slowly. Rapid weight loss can increase the risk of gallstones. If you need to lose weight, aim to lose 1 or 2 pounds (0.5 to about 1 kilogram) a week.
2. Maintain a healthy weight. Being overweight makes you more likely to develop gallstones. To achieve a healthy weight, reduce calories and increase your physical activity. Maintain a healthy weight by continuing to eat well and exercise.
3. Choose a healthy diet. Diets high in fat and low in fiber may increase the risk of gallstones. To lower your risk, choose a diet high in fruits, vegetables and whole grains.

Diagnosis

Tests and procedures used to diagnose cholecystitis include:

• Blood tests. Your doctor may order blood tests to look for signs of an infection or signs of gallbladder problems.
• Imaging tests that show your gallbladder. Abdominal ultrasound, endoscopic ultrasound, or a computerized tomography (CT) scan can be used to create pictures of your gallbladder that may reveal signs of cholecystitis or stones in the bile ducts and gallbladder.
• A scan that shows the movement of bile through your body. A hepatobiliary iminodiacetic acid (HIDA) scan tracks the production and flow of bile from your liver to your small intestine and shows blockage. A HIDA scan involves injecting a radioactive dye into your body, which attaches to bile-producing cells so that it can be seen as it travels with the bile through the bile ducts.

Treatment

Treatment for cholecystitis usually involves a hospital stay to control the inflammation in your gallbladder. Sometimes, surgery is needed.

At the hospital, your doctor will work to control your signs and symptoms. Treatments may include:

• Fasting. You may not be allowed to eat or drink at first in order to take stress off your inflamed gallbladder.
• Fluids through a vein in your arm. This treatment helps prevent dehydration.
• Antibiotics to fight infection. If your gallbladder is infected, your doctor likely will recommend antibiotics.
• Pain medications. These can help control pain until the inflammation in your gallbladder is relieved.
• Procedure to remove stones. Your doctor may perform a procedure called endoscopic retrograde cholangiopancreatography (ERCP) to remove any stones blocking the bile ducts or cystic duct.

Your symptoms are likely to decrease in two or three days. However, gallbladder inflammation often returns. Most people with the condition eventually need surgery to remove the gallbladder.

Gallbladder removal surgery is called a cholecystectomy. Usually, this is a minimally invasive procedure, involving a few tiny incisions in your abdomen (laparoscopic cholecystectomy). An open procedure, in which a long incision is made in your abdomen, is rarely required.

The timing of surgery depends on the severity of your symptoms and your overall risk of problems during and after surgery. If you’re at low surgical risk, surgery may be performed within 48 hours or during your hospital stay.

Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder. You don’t need your gallbladder to live normally.

Special surgical tools and a tiny video camera are inserted through four incisions in your abdomen during laparoscopic cholecystectomy. Your abdomen is inflated with carbon dioxide gas to allow room for the surgeon to work with surgical tools.

Preparing for an appointment

Make an appointment with your doctor if you have signs or symptoms that worry you. If your doctor suspects you have cholecystitis, he or she may either refer you to a doctor who specializes in the digestive system (gastroenterologist) or send you to a hospital.

What you can do

• Be aware of pre-appointment restrictions. When you make the appointment, ask if there’s anything you need to do in advance, such as restrict your diet.
• Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements you’re taking.
• Take a family member or friend along, if possible. Someone who accompanies you can help you remember the information you get.
• Write down questions to ask your doctor.

For cholecystitis, some basic questions to ask your doctor include:

• Is cholecystitis the likely cause of my abdominal pain?
• What are other possible causes for my symptoms?
• What tests do I need?
• Do I need gallbladder removal surgery?
• How soon do I need surgery?
• What are the risks of surgery?
• How long does it take to recover from gallbladder surgery?
• Are there other treatment options for cholecystitis?
• Should I see a specialist?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?

Don’t hesitate to ask other questions, as well.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• When did your symptoms begin?
• Have you had pain like this before?
• Are your symptoms constant or do they come and go?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

©1998-2021 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. Terms of Use

Gallstones – Complications – HSE.ie

A small number of people with gallstones may develop serious problems. This can happen if the gallstones cause a severe blockage. It can also happen if they move into another part of the digestive system.

Complications include:

• inflammation of the gallbladder (acute cholecystitis)
• jaundice
• infection of the bile ducts (acute cholangitis)
• acute pancreatitis
• cancer of the gallbladder
• gallstone ileus

Inflammation of the gallbladder (acute cholecystitis)

In some cases of gallstone disease a bile duct can become permanently blocked. This can lead to a build-up of bile inside the gallbladder. This can cause the gallbladder to become infected and inflamed.

The medical name for inflammation of the gallbladder is acute cholecystitis.

Symptoms include:

• pain in your upper abdomen that travels towards your shoulder blade. Unlike biliary colic, the pain usually lasts longer than 5 hours
• a high temperature (fever) of 38 degrees Celsius or above
• a rapid heartbeat

Around 1 in 7 people will also experience jaundice.

Acute cholecystitis is usually first treated with antibiotics. This is to settle the infection.

Keyhole surgery may be used to remove the gallbladder. This operation can be more difficult when performed as an emergency. It could become an open procedure in an emergency.

Sometimes a severe infection can lead to a gallbladder abscess. The medical name for this is empyema of the gallbladder. Antibiotics alone don’t always treat these. They may need to be drained.

An inflamed gallbladder can tear. This can lead to peritonitis. Peritonitis is inflammation of the inside lining of the abdomen.

If this happens, you may need to have antibiotics given into a vein. This is called intravenous antibiotics. You may need surgery to remove a section of the lining if part of it becomes severely damaged.

Jaundice

If a gallstone passes out of the gallbladder into the bile duct and blocks the flow of bile, jaundice occurs.

Symptoms of jaundice include:

• yellowing of the skin and eyes
• dark brown urine
• pale poo
• itching

Sometimes the stone passes from the bile duct on its own. If it does not, the stone needs to be removed.

Read more about treatment for gallstones

Infection of the bile ducts (acute cholangitis)

If the bile ducts become blocked, bacteria can infect them. The medical term for a bile duct infection is acute cholangitis.

Symptoms include:

• pain in your upper abdomen that travels towards your shoulder blade
• a high temperature – above 38 degrees Celsius
• jaundice
• chills
• confusion
• itchy skin
• generally feeling unwell

Antibiotics will help to treat the infection. But it’s also important to help the bile from the liver to drain. This can be then with an endoscopic retrograde cholangiopancreatography (ERCP).

Acute pancreatitis

Acute pancreatitis can develop when a gallstone blocks the opening of the pancreas. This will cause it to become inflamed.

The most common symptom is a sudden severe dull pain around the top of your stomach.

The pain of acute pancreatitis often gets worse until it reaches a constant ache. The ache may travel from your abdomen and along your back. You may feel worse after you have eaten. Leaning forward or curling into a ball may help to relieve the pain.

Other symptoms of acute pancreatitis can include:

• feeling sick
• being sick
• diarrhoea
• loss of appetite
• a high temperature of 38 degrees Celsius or above
• tenderness of the abdomen
• jaundice

There’s currently no cure for acute pancreatitis. Treatment focuses on supporting the functions of the body until it passes.

This usually involves admission to hospital so you can get:

• fluids into a vein (intravenous fluids)
• pain relief
• nutritional support
• oxygen through tubes into your nose

With treatment, your condition should improve within a week. You should be well enough to leave hospital after 5 to 10 days.

Cancer of the gallbladder

Gallbladder cancer is a rare. But it’s a serious complication of gallstones.

A history of gallstones increases your risk of developing gallbladder cancer. About 4 out of every 5 people who have cancer of the gallbladder also have a history of gallstones.

People with a history of gallstones have a less than 1 in 10,000 chance of developing gallbladder cancer.

Your GP may recommend that your gallbladder be removed if you have:

• a family history of gallbladder cancer
• high levels of calcium inside your gallbladder

Symptoms of gallbladder cancer

They may remove it as a precaution, even if your gallstones aren’t causing any symptoms.

The symptoms of gallbladder cancer are like those of complicated gallstone disease. They include:

• abdominal pain
• high temperature (fever) of 38 degrees Celsius or above
• jaundice

Treatment of gallbladder cancer

Gallbladder cancer can be treated with a combination of:

• surgery
• chemotherapy
• radiotherapy

Gallstone ileus

Another rare but serious complication of gallstones is gallstone ileus. This is where the bowel becomes blocked by a gallstone.

Gallstone ileus can happen when an abnormal channel opens up near the gallbladder. Gallstones are then able to travel through the channel and can block the bowel. This channel is known as a fistula.

Symptoms of gallstone ileus include:

• abdominal pain
• being sick
• swelling of the abdomen
• constipation

A bowel obstruction needs immediate medical treatment. If it’s not treated, there’s a risk that the bowel could split open (rupture). This could cause internal bleeding and widespread infection.

If you think you have a blocked bowel, contact your GP as soon as possible.

You’ll usually need surgery to remove the gallstone and unblock the bowel. The type of surgery you have depends on where in the bowel the blockage has occurred.

Symptoms You May Not Realize Are Being Caused by Gallbladder Disease: Rockwall Surgical Specialists: General Surgery

If you’re like most people, your gallbladder is unlikely to cross your mind until it begins causing problems. Gallbladder issues can cause pain and other prominent symptoms as well as vague symptoms that you’re less likely to realize are caused by gallbladder disease. Learn how gallbladder issues affect your body, when to seek professional help, and how treatment can provide relief.

What is the gallbladder?

The gallbladder is a small, pear-shaped organ about 3-4 inches in length. Its job is to store bile, a digestive fluid that aids your body in absorbing fat and the fat-soluble vitamins A, D, E, and K.

When you eat fat-containing foods, your gallbladder contracts and releases bile into the small intestine, where it breaks the fat down. A healthy gallbladder does this without pain or problems. People with gallbladder problems tend to experience pain and discomfort after eating fatty meals because their gallbladder is either blocked or has stopped functioning properly.

Common gallbladder disease symptoms

In many cases, gallbladder disease can cause significant pain, typically following meals that contain fat. Sticking to a low-fat diet is one approach to easing gallbladder pain. However, doing so doesn’t address the root of the problem; you may need to have your gallbladder removed. Some of the most prominent symptoms of gallbladder disease include:

• Nausea
• Vomiting
• Acid reflux
• Abdominal pain

Gallbladder pain usually occurs in the middle to upper-right part of your abdomen. In some people, the pain is severe and frequent, while others may experience mild pain that comes and goes.

Complications of gallbladder disease

Without treatment, gallbladder problems can become life-threatening. Gallbladder disease can cause infection that may spread to other parts of the body. It’s important to seek immediate medical attention if you experience an unexplained fever. This may be a sign of infection.

A bile duct blockage can cause jaundice. Yellow-tinted skin is a warning sign that you may have a blockage in your bile duct. Chronic diarrhea is also a complication of gallbladder disease.

Lesser-known gallbladder disease symptoms

While pain is certainly one of the most common symptoms of gallbladder disease, you may have other symptoms that you might not realize are related to a gallbladder problem. Some examples:

Lack of appetite

People with gallbladder disease may experience a lack of appetite without recognizing the true cause. If you have other symptoms of gallbladder problems and notice that your appetite isn’t as robust as you’re used to, it may be a signal of gallbladder disease.

Fat-soluble vitamin deficiency

Because bile is needed to absorb fat-soluble vitamins, you may experience a deficiency in crucial nutrients like vitamin D. Indications that you have low levels of fat-soluble vitamins — such as experiencing fatigue (low vitamin D) or bruising easily (low vitamin K) — serve as a warning sign that something may be amiss with your gallbladder.

Dark urine

If you suspect that you have gallbladder problems, your urine may provide a clue. A blockage of the bile duct can cause urine to appear darker than normal. Report any changes in your urine color to your doctor, along with any other symptoms you may be experiencing.

Change in bowel habits

If you find yourself making more trips to the bathroom or if the consistency of your stool has changed, this may be a signal that your gallbladder isn’t working properly. A change in bowel habits is a commonly overlooked symptom of gallbladder disease.

When you need your gallbladder removed, the team at Rockwall Surgical Specialists offers the latest advancements in gallbladder surgery, including laparoscopic and robotic surgery. To learn more, call one of our convenient locations to schedule an appointment or request a booking online.

Cholecystitis: Practice Essentials, Background, Pathophysiology

Author

Alan A Bloom, MD Associate Clinical Professor of Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Gastroenterology, Veterans Affairs Hospital, Bronx

Alan A Bloom, MD is a member of the following medical societies: American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, New York Academy of Medicine, New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

Clinton S Beverly, MD Clinical Assistant Professor, Department of Surgery, Mercer University School of Medicine

Clinton S Beverly, MD is a member of the following medical societies: American College of Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Nothing to disclose.

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

webmd.com”>Disclosure: Nothing to disclose.

Jack A Di Palma, MD Director, Division of Gastroenterology, Professor, Department of Internal Medicine, University of South Alabama College of Medicine

Jack A Di Palma, MD is a member of the following medical societies: American College of Gastroenterology and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Don Gladden, DO Staff Physician, Department of Emergency Medicine, Seton Medical Center Williamson

Don Gladden, DO is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Eugene Hardin, MD, FAAEM, FACEP Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

webmd.com”>Disclosure: Nothing to disclose.

Samuel M Keim, MD Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine

Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Alexandre F Migala, DO Staff Physician, Department of Emergency Medicine, Denton Regional Medical Center

Alexandre F Migala, DO is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Osteopathic Association, Association of Military Osteopathic Physicians and Surgeons, and Texas Medical Association

webmd.com”>Disclosure: Nothing to disclose.

Anil Minocha, MD, FACP, FACG, AGAF, CPNSS Professor of Medicine, Director of Digestive Diseases, Medical Director of Nutrition Support, Medical Director of Gastrointestinal Endoscopy, Internal Medicine Department, University of Mississippi Medical Center; Clinical Professor, University of Mississippi School of Pharmacy

Anil Minocha, MD, FACP, FACG, AGAF, CPNSS is a member of the following medical societies: American Academy of Clinical Toxicology, American Association for the Study of Liver Diseases, American College of Forensic Examiners, American College of Gastroenterology, American College of Physicians, American Federation for Clinical Research, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

webmd.com”>Tushar Patel, MB, ChB Professor of Medicine, Ohio State University Medical Center

Tushar Patel, MB, ChB is a member of the following medical societies: American Association for the Study of Liver Diseases and American Gastroenterological Association

Disclosure: Nothing to disclose.

Rahul Sharma, MD, MBA, FACEP Medical Director and Associate Chief of Service, NYU Langone Medical Center, Tisch Hospital Emergency Department; Assistant Professor of Emergency Medicine, New York University School of Medicine

Rahul Sharma, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Physician Executives, Phi Beta Kappa, and Society for Academic Emergency Medicine

webmd.com”>Disclosure: Nothing to disclose.

Peter A D Steel, MA, MBBS Attending Physician, Department of Emergency Medicine, Joan and Sanford I Weill Cornell Medical Center, New York Presbyterian Hospital

Peter A D Steel, MA, MBBS is a member of the following medical societies: American College of Emergency Physicians, British Medical Association, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Alan BR Thomson, MD Professor of Medicine, Division of Gastroenterology, University of Alberta, Canada

webmd.com”>Alan BR Thomson, MD is a member of the following medical societies: Alberta Medical Association, American College of Gastroenterology, American Gastroenterological Association, Canadian Association of Gastroenterology, Canadian Medical Association, College of Physicians and Surgeons of Alberta, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Jeffery Wolff, DO Consulting Staff, Department of Gastroenterology, Brooke Army Medical Center; Staff Gastroenterologist, Landstuhl Regional Medical Center

Jeffery Wolff, DO, is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

90,000 causes and symptoms, diagnosis, treatment and prevention

Concomitant factors provoking inflammation of the gallbladder:

• congenital or acquired features of the anatomical shape of the bladder;
• violation of the outflow of bile, congestion;
• low level of physical activity;
• decrease in gastric secretion, which leads to a chain of disorders of the digestive processes;
• liver and gallbladder injuries;
• starvation or malnutrition for a long time.

Chronic cholecystitis can be almost asymptomatic, therefore it is diagnosed at later stages. During this period, the examination may show signs of a prolonged inflammatory process: the formation of adhesions, thickening of the walls of the bladder, changes in their elasticity, impaired outflow of bile.

How to recognize cholecystitis

The acute course of the process is characterized by paroxysmal sharp pains in the right hypochondrium. Pain can be radiated to the right shoulder or scapula area.There is tension in the abdomen, bloating. If the bile duct is blocked by a stone, hepatic colic develops. Its symptoms are: jaundice, discoloration of feces, darkening of urine.

Attacks take place against the background of a sharp deterioration in general health: the temperature rises, dizziness, nausea, up to vomiting with an admixture of bile are felt. Usually attacks of cholecystitis occur after eating too fatty foods or after prolonged physical exertion.

Chronic inflammation of the gallbladder has less pronounced symptoms: periodic pulling pains in the right hypochondrium, which disappear after taking antispasmodic drugs.

Diagnostic methods and approach to treatment

The basis for the diagnosis is the complex of data collected during the interview and examination of the patient. Auxiliary diagnostic studies are carried out to clarify the preliminary diagnosis. Typically assigned:

Treatment of cholecystitis should be carried out only in a hospital setting. Lack of attention to your health and neglect of dangerous symptoms can cause serious complications. The presence of a purulent process requires surgical intervention to eliminate the focus of infection.If necessary, the gallbladder is removed using modern endoscopic technologies.

In the postoperative period, antibacterial therapy is recommended, as well as drugs aimed at eliminating general intoxication. Also, the doctor may prescribe pain relievers and drugs that reduce the secretory function of the stomach. An important component of therapy is a therapeutic diet aimed at regulating the function of the digestive system.

Chronic cholecystitis, treatment of chronic cholecystitis in the NEARMEDIC network of clinics

More about the disease

Chronic cholecystitis is an inflammatory disease of the gallbladder that develops for a long time.Most often, this form of inflammation is formed after the manifestation of acute cholecystitis. A common cause of pathology is blockage of the excretory ducts of the gallbladder with calculi, but other etiology options are also possible. Patients suffering from this disease complain of pain in the right hypochondrium, diarrhea, nausea, vomiting and other symptoms. Unpleasant sensations may periodically disappear, but during exacerbations, the soreness increases.

In most cases, chronic cholecystitis is complicated by an infectious process of a bacterial or fungal nature.Pathogenic microflora can enter the organ from the cavity of the gastrointestinal tract or from distant anatomical areas. Prolonged stagnation of bile contributes to the development of infection. In addition, the course of cholecystitis is negatively affected by existing diseases, such as diabetes mellitus and HIV infection. A delay in treatment increases the risk of developing dangerous complications, therefore it is recommended to be examined by a gastroenterologist even in the early stages of inflammation, when abdominal pain and symptoms of indigestion appear.

Body work

The gallbladder is an anatomical part of the liver. This sac-like organ is required for the deposition of bile synthesized by the liver cells and for the elimination of fluid into the small intestine during digestion. The release of bile into the duodenal cavity promotes the assimilation of fatty foods and improved absorption of nutrients. In the organ, there is a constant accumulation of secretions, leading to an increase in the viscosity of the liquid. After food enters the intestines, hormones stimulate the relaxation of special valves and the release of bile into the digestive tract through special ducts.

Other organ functions:

• Maintenance of metabolism.
• Improvement of small intestine motility.
• Excretion of excess cholesterol and bilirubin from the body.
• Activation of enzymes necessary for the assimilation of protein foods.

The gallbladder is often exposed to pathological influences. Disruption of the muscular membrane of the organ can hinder the secretion of bile – this process not only harms digestion, but also contributes to the formation of stones, which can subsequently completely clog the bile ducts and damage the inner membranes of the gallbladder.Normally, the organ does not contain microflora, however, with diseases and anatomical defects, it is possible for pathogenic and opportunistic microorganisms to enter the gallbladder from the intestine.

Causes of occurrence

The inflammatory process in the gallbladder can be provoked by various factors. First of all, this is stagnation of bile, which disrupts the functions of the organ and contributes to the occurrence of infection. Escherichia coli, streptococci, lamblia and other pathogens can enter the organ from the intestine.In this case, the occurrence of infection can be the direct cause of inflammation or a consequence of such a pathological process.

Possible causes:

• Blockage of the biliary tract due to anatomical defect, stones or valve malfunction.
• Gallstone disease is a common pathology of the gallbladder. Concrements can form in the organ due to a violation of the chemical composition of bile and stagnation of secretions.
• Malignant or benign tumor.A growing neoplasm can make it difficult to evacuate bile from the organ.
• Primary infections. In patients with HIV infection, a variety of viruses can infect the gallbladder.
• Impaired motility of the gallbladder and its ducts. With insufficient or chaotic contractility of the smooth muscles of the organ, the outflow of bile into the intestine is difficult.

Chronic inflammation can occur if the patient has not been treated for acute cholecystitis. This pathology persists for many years and significantly worsens the quality of human life.

Risk factors

There are various forms of predisposition to the disease associated with individual characteristics of a person, primary pathologies, nutrition and heredity. Doctors must take into account the presence of risk factors for cholecystitis during examinations.

Key risk factors:

• Female sex and age from 25 to 45 years.
• Obesity and significant weight loss over several months.
• Taking certain medications.In particular, the risk of developing inflammation in the gallbladder increases with the use of hormonal drugs.
• Pregnancy.
• Chronic diseases of the intestines, liver and pancreas.
• Surgical treatment of abdominal organs, trauma.
• Chronic foci of inflammation in different parts of the body.
• Long-term administration of parenteral nutrition.
• Improper diet or prolonged fasting.
• Alcohol abuse.
• Myocardial infarction and other heart diseases.
• Vascular disorders in diabetes mellitus.
• Abnormal reflux of pancreatic secretions into the gallbladder (pancreatobiliary reflux).
• Insufficient physical activity.

Effective measures for the prevention of pathology are based on the elimination of risk factors, are associated with the lifestyle and individual history of the patient.

Forms of the disease

Doctors classify chronic cholecystitis based on the cause of the inflammation and the nature of the course of the disease.There is also a classification based on the severity of the symptoms.

Basic Shapes:

• Chronic calculous cholecystitis is the most common variant of the disease that occurs due to blockage of the excretory ducts of the organ by calculi. It is characterized by severe symptoms during exacerbations. The inflammatory process can spread to adjacent anatomical structures, including the diaphragm and pleura.
• Chronic non-calculous cholecystitis is a rarer form of the disorder, often diagnosed in patients with severe illness.In this case, the inflammatory process occurs due to trauma, surgery, severe infection and other reasons not related to the formation of stones. If not treated promptly, non-calculous cholecystitis can cause death of the patient.

The danger of chronic inflammation is due to worn-out symptoms. Patients pay attention to discomfort only during exacerbations, as a result of which the disease gradually progresses and causes complications.

Symptoms and Signs

The symptomatic picture of the disease depends on the severity of the inflammatory process, the patient’s age and the frequency of exacerbations.The predominant sign is usually soreness in the right hypochondrium, extending to the back and central abdomen. If inflammation affects the diaphragm, pain in the right arm and scapula may occur.

Additional features:

• Abdominal muscle tension.
• Severe weakness, fatigue.
• Appearance of cold sweat.
• Nausea and vomiting.
• Lack of appetite.
• Loose stools.
• Bloating.
• Rapid heartbeat.
• Shortness of breath.
• Low blood pressure.
• Yellowing of the skin and mucous membranes.
• Chest pain.

Due to insufficient intake of vitamins and minerals in the body, symptoms such as pallor of the skin and constant fatigue occur. Against the background of the development of complications, more severe pathological signs appear. For prolonged severe abdominal pain and persistent fever, seek medical attention as soon as possible.

Diagnostics

The gastroenterologist can prescribe the necessary examinations for the patient. During the appointment, the doctor will ask the patient about the complaints and examine the anamnestic information. A physical examination can detect jaundice, bloating, and tenderness in certain areas of the body. Based on the data obtained, the doctor will prescribe the necessary instrumental and laboratory tests.

Required diagnostic manipulations:

• Ultrasound examination of the gallbladder and bile ducts.The advantages of the method are safety and real-time imaging of organs. The doctor can immediately detect stones in the gallbladder, changes in the walls of the organ and other pathological signs indicating cholecystitis.
• Blood test to detect inflammatory and infectious processes. With severe inflammation in the blood, the number of leukocytes increases. Also, the diagnostic criterion is the concentration of liver enzymes.
• Sampling of bile from an organ using duodenal intubation.The specialist sends the obtained material to the laboratory for the detection of pathogenic microflora.
• X-ray contrast study of the gallbladder (cholecystography). The doctor receives information about the size, shape and functional activity of the organ. With the help of this study, anatomical abnormalities, gallstone disease or other ailments can be detected.

If the doctor cannot make a diagnosis after requesting the results of the listed tests, it is possible to additionally prescribe gastroscopy, computed tomography or survey laparoscopy.It is necessary to determine the cause of the inflammation as accurately as possible.

Treatment

In chronic cholecystitis, the main method of treatment is a special diet that reduces the negative effect on the organ. Medications may be prescribed to eliminate infection and inflammation. If the disease has become the cause of dangerous complications, such as gangrene of the gallbladder or peritonitis, surgery is necessary.

Main purposes:

• Diet therapy.The patient needs frequent fractional meals. It is necessary to exclude the constant use of fatty foods, alcohol, beans and fried meat. The diet should be followed for a long time to prevent recurrence of the disease. When the gallbladder is removed, patients are assigned a lifelong diet.
• Antibiotics and anti-inflammatory drugs. For chronic infection, it is recommended to obtain a sample of microflora using probing and select an effective antimicrobial agent using a laboratory test.
• Antispasmodics and pain relievers to relieve symptoms.
• Choleretic medicines. Medicines in this group are used to improve the excretion of bile into the duodenum.

To the main methods of surgical treatment of cholecystitis, doctors refer to the removal of the gallbladder or the extraction of calculi that clog the ducts of the organ. With severe complications of the disease, complex open intervention in the abdominal cavity may be required.

Complications

Chronic cholecystitis can provoke the development of severe complications even with erased symptoms.The main danger is a focus of infection that can spread to other organs.

Major complications:

• Gallbladder gangrene – destruction of organ tissue, leading to a purulent process in the abdominal cavity.
• Peritonitis – extensive inflammation of the peritoneum, causing severe symptoms and intoxication of the whole body. This pathology can occur against the background of perforation of the inflamed gallbladder.
• Inflammation of the pancreas due to the penetration of the contents of the gallbladder into the organ.
• A severe infectious process in which pathogenic microorganisms spread through the bloodstream (sepsis).

Timely surgical treatment prevents the development of such complications.

Thus, chronic cholecystitis is a frequent consequence of acute inflammation of the gallbladder. The symptomatology of the disease persists for many years and negatively affects the quality of human life. A consultation with a gastroenterologist will help the patient choose an effective treatment for the disease.

90,000 Cholecystitis in dogs – treatment, diagnosis

Cholecystitis in dogs is a common condition that causes inflammation of the gallbladder. The main danger of this disease is the difficulty of diagnosis. Experts from a veterinary clinic in Moscow will tell you about how cholecystitis proceeds and how to restore the health of your pet.

Read this article

What is this?

Cholecystitis is a pathological process provoked by inflammation of the mucous membranes of the gallbladder and its pathways.The disease rarely manifests itself in the early stages, therefore, only periodic examinations in a veterinary clinic will help to detect it in a timely manner.

Each of the elements of bile ensures the breakdown of fats, their further absorption and removal of cholesterol. Inflammatory processes disrupt the normal activity of the bladder, which is why cholecystitis is recognized as one of the most dangerous diseases for dogs.

Types of cholecystitis:

• Obstructive.

Occurs when the ducts are squeezed.This condition can occur due to a large pancreas, the formation of a mucocele, and the formation of stones in the gallbladder.

• Non-obstructive.

It occurs when the development of cholecystitis is caused by a bacterial or parasitic infection in the pet’s body.

Causes of cholecystitis

Cholecystitis is an inflammatory disease that can be provoked by various causes. Among the most common:

• Incorrect power supply.
  Poor quality dry food, canned food, raw meat and minced meat, table-feeding can all lead to a diagnosis of cholecystitis in your animal. A disturbed drinking regime is also a provoking factor.
• Helminthic diseases.
  Diphyllobothriasis, alveococcosis, dipylidiosis and other parasites can cause the development of cholecystitis. Helminths provoke severe intoxication of the animal’s body, irritating the mucous membranes and causing organ inflammation.
• Digestive disorders.
  Pancreatitis, ulcers, fatty liver hepatosis and other pathological conditions affecting the digestive tract lead to cholecystitis. The most dangerous provoking factor is gallstone disease.
• Obesity.
  Excessive weight inappropriate, combined with lack of physical activity, disrupts the contractile function of the bladder. This inevitably leads to the development of inflammation accompanying cholecystitis.
• Birth defects.
  Abnormalities of the biliary system may not be acquired, but congenital.At the same time, they are easier to diagnose, but their elimination using conservative methods of treatment is rather problematic.

Pay attention! Large breeds of dogs are prone to cholecystitis, so they are in a special risk group.

Symptoms of the disease

The gallbladder is one of the organs that affect the functioning of the intestines and the metabolism in the animal’s body. Even a slight disruption in his activity can affect the general condition of your pet.

Symptoms of cholecystitis in dogs:

• deterioration of the general condition,
• lethargy and drowsiness,
• decrease and loss of appetite,
• pain in the right side,
• tarnishing and loss of hair,
• temperature rise.

Pay attention! In severe cases, the whites of the eyes turn yellowish.

In the initial stages of cholecystitis, the dog shows signs of exhaustion: the pet dramatically loses weight, refuses any food.Vomiting is observed, usually after eating. When stroking the abdominal region, the animal whines, soreness appears.

Diagnostic Methods

It will be possible to correctly diagnose cholecystitis in dogs only when contacting a specialized veterinary clinic. Reception begins with a visual examination and assessment of the pet’s condition: its weight, coat, skin, etc.

Diagnostic methods used:

Using the ultrasound method, it is possible to identify congenital defects of the gallbladder that were inherited: excess bile, sediment, etc.

Stages of cholecystitis treatment

If the signs of cholecystitis in the dog are moderate and the likelihood of rupture of the gallbladder is minimal, conservative treatment is prescribed. The preparation of a therapy regimen should be trusted only by an experienced veterinarian who is ready to advise you on all issues that arise.

Conservative treatment includes:

• infusion therapy,
• taking medications,
• diet food.

Antibiotics are prescribed taking into account their tolerance by the body of the animal, as well as on the basis of a study of the bacterial culture of bile. Additionally, choleretics, antioxidants and vitamin and mineral complexes are prescribed.

The next stage of treatment is to eliminate the causes of the disease. If the inflammatory processes are caused by an infection that has entered the body, a drug from the group of penicillin or aminoglycosides is prescribed. When parasites are identified as a result of the examination, funds are prescribed to eliminate helminths.

If cholecystitis was diagnosed in the last stages or drug treatment does not give a visible effect, then surgery is performed. It aims to remove the gallbladder. After the operation, provided that the diet is followed, your pet’s health will not be at risk.

Other treatments:

• Intravenous administration of solutions to prevent dehydration and liver intoxication;
• Antiparasitic therapy aimed at destroying helminths in the blood, lungs, brain, etc.;
• Supportive therapy for the restoration of the dog’s body after the destruction of worms with the appointment of probiotics;
• For severe pain that may occur in the last stages of the development of cholecystitis, pain relievers are prescribed;
• Physiotherapy prescribed after the examination of the pet will help to stimulate blood circulation and reduce painful sensations.

A treatment regimen may include various forms and methods. It is determined taking into account the severity of the disease, its symptoms, as well as the condition of the animal.The dosage and duration of medication is determined by your veterinarian. We strongly recommend that you follow all instructions from a specialist. This will ensure the effectiveness of the treatment in the shortest possible time.

Diet food

To maintain your pet’s health, you need to carefully monitor its nutrition. Choose foods with a balanced composition or fortified with vitamins. Don’t forget to include high-carotene vegetables in your diet.

List of Recommended Products:

• carrot,
• pumpkin,
• lean meat,
• bird,
• rice,
• buckwheat,
• curd,
• eggs.

During the dietary period (the first 1–2 months after surgery), give your dog a grated meal. Feed your pet in small portions 6-7 times a day. This diet restores gallbladder function.

Prevention of cholecystitis

To keep your pet from being bothered by gallbladder problems, experienced veterinarians recommend a number of preventive measures.

Among them:

• exclusion from the animal’s diet of cheap dry food and canned food, as well as products from the table,
• rejection of spicy and sweet,
• addition of foods fortified with minerals and vitamin A to the diet,
• organization of active games,
• timely treatment of diseases.

Regularly sign up at the Berloga veterinary clinic in Moscow for preventive examinations.

See also:

Chronic cholecystitis | Medical Center “Doctor 2000”

Chronic cholecystitis is an inflammatory process occurring in the gallbladder, accompanied by motor-tonic disorders of the biliary system and the formation of stones.

Reasons

Usually it is caused by a violation of the microflora caused by such infectious diseases as streptococci, escherichia, staphylococci, proteas, Pseudomonas aeruginosa, enterococci.Sometimes chronic cholecystitis caused by pathogenic bacterial microflora (Shigella, Salmonella), viral and protozoal infection is observed. The penetration of microbes into the gallbladder occurs by lymphogenous, hematogenous and contact pathways. Another cause of gallbladder inflammation is parasite infestation. Damage to the biliary tract occurs in giardiasis, opisthorchiasis, fascioliasis, strongyloidosis, ascariasis and can cause partial obstruction of the common bile duct and cholangiogenic abscess (ascariasis), cholangitis (fascioliasis), severe biliary tract dysfunction (giardiasis).

One of the most common factors in the development of chronic cholecystitis is a violation of the outflow of bile and its stagnation. Usually the disease occurs against the background of cholelithiasis or biliary dyskinesia. The alimentary factor also plays an important role in the formation of the disease. Irregular eating with long intervals between meals, fatty and spicy foods, as well as overeating at night can cause spasm of the sphincter of Oddi, stasis of bile. Excessive consumption of flour and sweet foods, fish and eggs, as well as a lack of fiber, cause a decrease in the pH of bile and a violation of its colloidal stability.The development of cholesterol occurs gradually. Functional disorders of the neuromuscular system lead to its hypo- or atony. The introduction of microbial flora contributes to the progression of inflammation of the mucous membrane of the gallbladder.

Features

The clinical picture of chronic cholecystitis is characterized by a long progressive course with periodic exacerbations. The symptomatology of the disease is due to the presence of an inflammatory process in the gallbladder and a violation of the flow of bile into the duodenum due to concomitant dyskinesia.The clinic of chronic cholecystitis is based on pain syndrome. The pain is concentrated in the right hypochondrium, less often in the epigastric region, spreads to the right scapula, clavicle, shoulder, and sometimes to the left hypochondrium. Most often, pain occurs due to a violation of the diet (the use of fried and fatty foods, eggs, cold and carbonated drinks, beer, wine and spicy snacks), physical activity, severe stress, hypothermia, or concomitant infections. The intensity of pain depends on the degree of development and localization of the inflammatory process, the presence and type of dyskinesia.Severe paroxysmal pain is characteristic of the inflammatory process in the neck and duct of the gallbladder, and constant pain is characteristic of the lesion of the body and the bottom of the bladder. In chronic cholecystitis, accompanied by hypotonic dyskinesia, the pain is less intense, but is constant and pulling in nature. Aching, almost never-ending pain can be observed with pericholecystitis. It intensifies with shaking, turning or bending of the trunk. On palpation, tenderness is determined in the right hypochondrium, positive pain symptoms of cholecystitis.

Symptoms

Kera’s symptom – pain when pressing in the projection of the gallbladder. Murphy’s symptom is a sharp increase in pain on palpation of the gallbladder on inspiration. Symptom Grekov-Ortner – soreness in the gallbladder area when tapping along the costal arch on the right. Symptom Georgievsky-Mussey – pain when pressing on the right phrenic nerve between the legs of the sternocleidomastoid muscle. Dyspeptic syndrome is accompanied by belching, bitterness, or a persistent bitter taste in the mouth.Often, patients complain of a feeling of fullness in the upper abdomen, intestinal distention, and stool disturbance. Less common is nausea, vomiting with a bitter taste. When combined with hypo- and atony of the gallbladder, vomiting reduces pain and a feeling of heaviness in the right hypochondrium. In hypertensive dyskinesia, vomiting causes increased pain. In vomit, as a rule, an admixture of bile is found.

Vomiting is usually triggered by dietary disturbances, emotional and physical overload. In the phase of exacerbation of cholecystitis, an increase in body temperature is possible.More often, subfebrile fever (characteristic of catarrhal inflammatory processes), less often – reaches febrile values ​​(with destructive forms of cholecystitis or due to complications).

Jaundice is not typical for chronic cholecystitis, but icteric coloration of the skin and mucous membranes can be observed when the outflow of bile is difficult due to the accumulation of mucus, epithelium or parasites in the common bile duct or with developed cholangitis. Atypical forms of chronic cholecystitis are observed in 1/3 of patients. The cardialgic form is characterized by prolonged dull pain in the region of the heart that occurs after a heavy meal, often in the supine position. There may be arrhythmias such as extrasystoles. The esophagalgic form is characterized by severe heartburn, combined with dull pain behind the sternum. After a heavy meal, you may experience a cola feeling behind the breastbone. The pain is long lasting. Occasionally, there are slight difficulties in the passage of food through the esophagus. The intestinal form manifests itself in the form of a weak, clearly not localized pain throughout the abdomen and its swelling, constipation is possible.

Diagnostics

In the analysis of blood in the exacerbation phase, an increase in ESR, neutrophilic leukocytosis, a shift in the leukocyte formula to the left, eosinophilia are often found. In complicated forms, the levels of bilirubin, cholesterol, and transaminases may increase in the blood.

Ultrasound and X-ray research methods are most often used. The main method for diagnosing cholecystitis, ultrasound, allows not only to establish the absence of calculi, but also to assess the contractility and condition of the gallbladder wall (chronic cholecystitis is evidenced by its thickening of more than 4 mm).In chronic cholecystitis, thickening and hardening of the gallbladder wall, and its deformation are often revealed.

ultrasound has no contraindications and can be used during the acute phase of the disease, with hypersensitivity to contrast agents, pregnancy, impaired patency of the biliary tract. When the bilirubin level is above 51 μmol / l and clinically obvious jaundice, endoscopic retrograde pan-creatocholangiography is performed to find out its causes. Sometimes it is difficult to distinguish between cholecystitis and biliary dyskinesia.Dyskinesias are not characterized by fever, neutrophilic leukocytosis and increased ESR. An ultrasound scan in combination with duodenal intubation helps to clarify the diagnosis.

Diet

The diet should help prevent stagnation of bile in the gallbladder and reduce inflammation. A fractional meal is recommended (5-6 times a day), including low-fat meats and fish, cereals, puddings, cheese cakes, salads. Weak tea, fruit, vegetable and berry juices are allowed after the exacerbation subsides.Vegetable fats (olive, sunflower oil) containing polyunsaturated fatty acids, vitamin E are very useful. Polyunsaturated fatty acids help normalize cholesterol metabolism, participate in the synthesis of PGs that thin bile, and increase the contractility of the gallbladder. With a sufficient amount of protein and vegetable fats in the diet, the cholesterol index increases and the lithogenicity of bile decreases.

Inflammation of the gallbladder. Causes. Diagnostics.Treatment.

What is gallbladder inflammation

An inflammatory disease characterized by the course of pathological processes in the mucous membrane of the gallbladder hymen, most often occurs in old age after 50-60 years. Gallbladder inflammation is more common in women than in male patients. According to statistics, this disease is in second place among common surgical pathologies.

Symptoms of gallbladder inflammation:

Often, the manifestation of symptoms in each patient occurs individually, but the most common include:

• dull severe pain, localized to the right under the ribs;
• bitterness in the mouth and belching;
• stool disorders of all possible manifestations;
• nausea, less often vomiting;
• predominance of yellow in the shade of the face;
• increase in body temperature to 39, accompanied by chills;
• rapid changes in weight;
• headaches.

If there is increased physical activity, feasts accompanied by eating fatty foods in large quantities, drinking alcohol, as well as mental and emotional disorders, this leads to increased pain outbreaks.

Consultation can be obtained by phone: +7 (495) 961-27-67

Causes of the disease

The appearance and further development of inflammatory processes are often caused by parasitism on the mucous membrane, that is, conditionally pathogenic manifestations of microflora, which are activated when immunity is weakened. Getting from the intestine into the gallbladder of lamblia, roundworms, Escherichia coli or bacteria, cause the onset of inflammation.

Main sources:

• Periodontal disease.
• Diseases of the respiratory system, such as sinusitis.
• Inflammatory processes in the gastrointestinal tract: appendicitis, dysbiosis.
• Prostatitis or female form of adnexitis.
• Urinary tract infections.
• Viral formations in the liver.
• The presence of parasites in the biliary tract.

There are also minor causes of gallbladder inflammation:

• age-related changes;
• genetic aggravated predisposition;
• metabolic disorders;
• stagnation of bile;
• dietary abuse, including overeating and irregularity;
• sedentary way of life;
• hormonal disruptions, pregnancy, hormone intake;
• the presence of immunodeficiency;
• chronic infections.

Diagnosing the disease

Detection of the disease begins with traditional palpation and external examination for the presence of yellowness and other skin manifestations. In addition, the doctor will write a referral for:

If these studies are not enough to make a diagnosis, our specialist will offer to undergo additional diagnostics, the results of which will allow you to see the state of the gallbladder as accurately as possible:

• Radioisotope scanning.
• Roentgen.
• Duodenal intubation.

Methods of disease treatment

The cure of inflammatory processes without a combination of various types of treatment remains unlikely, therefore, in addition to the conservative method, apply a diet, as well as auxiliary methods.

In the first place is strict adherence to the diet and diet, which includes the intake of products processed by the steam method, or by cooking.The diet is gentle, because it combines the optimal number of carbohydrates and protein, with a minimum quantitative composition of fats, salt, fiber and cholesterol. There is also a division of food intake into portions, up to six times a day.

As for medication support, our doctors distinguish these areas of therapy:

• taking antispasmodics;

• if the presence of infectious parasites is observed, then the appointment of antibiotics;

• anti-inflammatory recommendations are determined;

• detoxification and deworming;

• antioxidant practice in crisis situations;

• restoration of immunity;

• bringing in the normal functioning of the functions of the biliary tract.

Such therapy is optimal for the treatment of non-acute forms of the disease, and the treatment of inflammation of the gallbladder in acute pain and colic occurs with the use of surgery or lithotripsy.

Consultation can be obtained by phone: +7 (495) 961-27-67

Why are our gastroenterologists better than others?

• The knowledge and experience of the doctors of our clinic allow us to achieve amazing success in the treatment of gastroenterological diseases.

• The Health Clinic has the most modern diagnostic equipment, which allows an accurate diagnosis and treatment to begin.

• Location in the very center of Moscow, within walking distance from two metro stations.

• Attractive prices

• Convenient time to visit the doctor.

We work to ensure that you are healthy.

Consultation can be obtained by phone: +7 (495) 961-27-67

90,000 drug search, prices and availability of drugs in pharmacies of Pervomaysky and Ukraine

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90,000 Cholecystitis in dogs, treatment of gallbladder inflammation in dogs

Contents of article

It would seem that humans and dogs have in common? But it turns out that our smaller brothers suffer from the same diseases as people.

One of such ailments is cholecystitis. This disease is very secretive and is diagnosed at a fairly late stage, so the owners need to know what cholecystitis in a dog is, how it manifests itself and what causes it.

Cholecystitis and its classification

Normally, bile, consisting of bile acids, water, bilirubin, cholesterol and electrolytes, is located in the gallbladder and is transported from here to the duodenum, where it plays an important role in the digestive process:

• promotes the digestion of fats by breaking them down into small particles;
• improves the absorption of processed fats;
• enhances the excretion of cholesterol.

Any disturbance in this well-adjusted process is the cause of the disease of the biliary system.Cholecystitis is a condition caused by inflammation of the mucous membrane of the gallbladder in dogs and damage to its ducts.

Depending on the cause, cholecystitis is divided into:

1. Obstructive, arising against the background of compression of the bile ducts by an enlarged pancreas, neoplasms of the liver, intestines, and also due to the development of mucocele (dropsy) of the gallbladder or the formation of stones in it.
2. Non-obstructive, which is associated with the presence of an infection in the dog’s body.In this case, the infection can be of bacterial or parasitic origin.
3. Rupture of the gallbladder due to long-term chronic processes or mechanical trauma to the organ.

Also distinguish between acute and chronic cholecystitis.

What is the cause of cholecystitis?

Veterinarians believe that dogs have cholecystitis for the following reasons:

1. The chronic form of the disease can be inherited.
2. Congenital malformations of the gallbladder.
3. Infectious diseases (enteritis, plague, etc.), as a result of which the causative agent of the disease enters the gallbladder from the intestine.
4. The presence of endoparasites (lamblia, hepatic fluke, etc.) affecting the liver.
5. Unbalanced diet, lack of vitamin A.
6. Mechanical trauma to the gallbladder.

Most often, problems with the biliary system occur in middle-aged or elderly animals, and in German shepherds, the risk of cholecystitis is especially high.

Symptoms of cholecystitis

The liver and gallbladder are the most important organs that have a direct impact on digestion and many metabolic processes in the dog’s body. Therefore, any failure in this mechanism has the most negative effect on the general condition of the animal, its appetite and has certain signs.

The owner of the dog should be attentive to his pet if he observes the following symptoms:

1. Deterioration of the dog’s well-being, expressed by weakness, apathetic behavior, drowsiness.
2. Changes in the structure of the coat – it stops shining, becomes inelastic, may fall out.
3. The dog’s appetite decreases, it may even completely refuse food and lose weight.
4. There are problems with the gastrointestinal tract – the dog may be tormented by vomiting or intestinal upset.
5. The animal has a pain in the right side and when stroking in this area, the dog whines and worries.
6. In severe cases, a yellow discoloration of the whites of the eyes and mucous membranes of the nose and mouth may appear.
7. The urine becomes orange-yellow, while the feces, on the contrary, become discolored.
8. The temperature can sometimes rise.

Many of the listed symptoms may relate to other diseases, so only a veterinarian can make an accurate diagnosis.

Diagnostics of the disease and treatment of cholecystitis

For an accurate diagnosis, the veterinarian will prescribe a comprehensive examination for your pet, including various types of diagnostics:

1. General and biochemical blood tests.
2. General urine analysis.
3. Ultrasound of the abdominal organs.
4. Roentgen.

Based on the results of a blood test, changes in liver parameters are visible, which, first of all, indicate problems with the gallbladder. Ultrasound examination will show congenital abnormalities of the gallbladder, excess bile, suspension or sediment.

If a doctor suspects a cholelithiasis, an X-ray may be required, and in order to exclude an infectious or parasitic cause of cholecystitis, a laboratory study of bile is performed.

After the diagnosis is made, the animal is given a complex treatment.

If the disease is in the acute phase, then to begin with, the dog can be assigned a therapeutic fast for 2-3 days or a strict diet in compliance with a certain diet.

Treatment with medications, which implies cholecystitis in dogs, is aimed at reducing pain, relieving spasm, eliminating the source of infection and parasites in the body.

To begin with, the veterinarian will prescribe ascorbic acid, salicylic acid and calcium, which will help relieve inflammation.Then, with the help of antispasmodics, spasm of the bile ducts and the gallbladder itself is eliminated.

Allochol, magnesium sulfate have a disinfecting effect and help to normalize the outflow of bile, and antibiotics and anthelmintic drugs are used to eliminate infections and parasites in the dog’s body.

If the disease is detected in the late stages, therapy does not give the desired result and symptoms of ascites in the dog appear, then a surgical operation can be performed to remove the gallbladder, after which, with a diet and a healthy lifestyle, the animal can live for a long time.