What are the common symptoms of biliary colic. How is biliary colic diagnosed and treated. What are the risk factors for developing gallstones and biliary colic. When should you seek medical attention for gallbladder pain.

Understanding Biliary Colic: A Common Gallbladder Condition

Biliary colic is a frequent medical condition characterized by abdominal pain caused by the obstruction of the biliary tree, typically due to gallstones. Despite its name, which suggests intermittent pain, biliary colic often presents as constant discomfort. This condition occurs when gallstones temporarily block the cystic duct or common bile duct, usually following the consumption of a large, fatty meal that triggers gallbladder contraction.

Can biliary colic resolve on its own? In many cases, yes. The pain may subside when the obstructing stone either passes through the common bile duct into the duodenum or falls back into the gallbladder. However, if the obstruction persists, it can lead to more severe conditions such as cholecystitis or cholangitis, requiring prompt medical intervention.

The Underlying Causes of Biliary Colic

The primary cause of biliary colic is the presence of gallstones, which can be composed of either cholesterol or bilirubin. These stones form within the gallbladder and may remain asymptomatic for years. However, when they move into the cystic duct or common bile duct, they can cause obstruction and pain.

Why do some people develop gallstones while others don’t? Several risk factors contribute to gallstone formation:

• Female gender (due to estrogen’s influence)
• Obesity
• Elevated cholesterol levels
• Rapid weight loss
• Certain medications (e.g., oral contraceptives)
• Family history of gallstones
• Age (risk increases with age)

In the United States, cholesterol-based stones are most common, while in developing countries, pigmented stones derived from bilirubin are more prevalent. These pigmented stones are often associated with hematologic disorders and biliary tree infections.

Recognizing the Symptoms of Biliary Colic

The hallmark symptom of biliary colic is pain, typically located in the right upper quadrant (RUQ) of the abdomen. This pain may radiate to the right shoulder or back. Other common symptoms include:

• Nausea and vomiting
• Bloating
• Indigestion
• Intolerance to fatty foods

How long does a biliary colic attack typically last? Pain episodes can persist for 15 minutes to several hours, often occurring after meals, particularly those high in fat content. It’s important to note that while the term “colic” suggests intermittent pain, many patients experience constant discomfort during an attack.

Diagnosing Biliary Colic: Medical Evaluation and Tests

Diagnosing biliary colic involves a combination of clinical assessment and diagnostic tests. The process typically includes:

1. Physical examination: The doctor will palpate the abdomen, checking for tenderness in the RUQ.
2. Medical history: Information about pain patterns, dietary habits, and risk factors is crucial.
3. Blood tests: These can help rule out other conditions and check for signs of inflammation or infection.
4. Imaging studies: Ultrasound is the primary diagnostic tool for detecting gallstones and assessing the biliary system.

In some cases, additional imaging techniques such as CT scans, MRCP (Magnetic Resonance Cholangiopancreatography), or ERCP (Endoscopic Retrograde Cholangiopancreatography) may be necessary to obtain a more detailed view of the biliary tree.

The Murphy’s Sign: A Key Physical Examination Technique

During the physical examination, the healthcare provider may perform Murphy’s sign test. This involves asking the patient to take a deep breath while the doctor’s hand is placed on the right upper quadrant of the abdomen. A positive Murphy’s sign occurs when the patient experiences pain and stops breathing mid-inspiration. While this sign is more commonly associated with acute cholecystitis, it can sometimes be present in severe cases of biliary colic.

Treatment Options for Biliary Colic

The management of biliary colic depends on the severity and frequency of symptoms. Treatment options include:

1. Conservative Management

For mild, infrequent episodes, conservative measures may be sufficient:

• Pain management with over-the-counter or prescription analgesics
• Dietary modifications to reduce fat intake
• Weight loss for overweight patients

2. Surgical Intervention

For recurrent or severe symptoms, surgical removal of the gallbladder (cholecystectomy) is often recommended. Laparoscopic cholecystectomy is the gold standard treatment, offering shorter recovery times and fewer complications compared to open surgery.

Is cholecystectomy always necessary for biliary colic? Not always. The decision to perform surgery depends on the frequency and severity of symptoms, as well as the patient’s overall health and preferences. However, for most patients with symptomatic gallstones, cholecystectomy provides the most effective long-term relief.

3. Non-Surgical Alternatives

In some cases where surgery is not an option, alternative treatments may be considered:

• Oral dissolution therapy: Medications like ursodeoxycholic acid can help dissolve small cholesterol stones over time.
• Lithotripsy: Using shock waves to break up gallstones (less commonly used).

These alternatives are generally less effective than surgery and are typically reserved for patients who cannot undergo cholecystectomy due to other health issues.

Preventing Biliary Colic and Gallstone Formation

While not all cases of biliary colic can be prevented, certain lifestyle modifications may help reduce the risk of developing gallstones:

• Maintaining a healthy weight
• Eating a balanced diet rich in fiber and low in saturated fats
• Regular exercise
• Staying hydrated
• Avoiding rapid weight loss or extreme dieting

Can dietary changes alone prevent gallstone formation? While a healthy diet can reduce the risk, it’s important to note that some risk factors, such as age and genetic predisposition, cannot be modified. However, adopting a healthy lifestyle can contribute to overall well-being and may help prevent various gastrointestinal issues, including biliary colic.

Complications and When to Seek Medical Attention

While biliary colic itself is not typically life-threatening, it can lead to more serious complications if left untreated. These complications may include:

• Acute cholecystitis (inflammation of the gallbladder)
• Cholangitis (infection of the bile ducts)
• Pancreatitis (inflammation of the pancreas)
• Gallbladder perforation

When should you seek immediate medical attention for gallbladder pain? It’s crucial to consult a healthcare provider if you experience:

• Severe abdominal pain that doesn’t subside with over-the-counter pain relievers
• Fever or chills accompanying the pain
• Jaundice (yellowing of the skin or eyes)
• Persistent nausea and vomiting
• Dark urine or clay-colored stools

These symptoms may indicate a more severe condition requiring immediate medical intervention.

Living with Biliary Colic: Management and Lifestyle Adjustments

For individuals diagnosed with biliary colic who have not yet undergone cholecystectomy or are not candidates for surgery, certain lifestyle adjustments can help manage symptoms:

Dietary Modifications

Adopting a gallbladder-friendly diet can help reduce the frequency and severity of biliary colic attacks. Key dietary recommendations include:

• Limiting fatty and fried foods
• Increasing fiber intake through fruits, vegetables, and whole grains
• Avoiding large meals and opting for smaller, more frequent meals throughout the day
• Reducing caffeine and alcohol consumption

Stress Management

Stress can exacerbate digestive issues, including biliary colic. Incorporating stress-reduction techniques into daily life can be beneficial:

• Regular exercise
• Meditation or mindfulness practices
• Yoga or tai chi
• Adequate sleep

Pain Management Techniques

During a biliary colic attack, certain strategies may help alleviate discomfort:

• Applying a heating pad to the abdominal area
• Practicing deep breathing exercises
• Taking prescribed pain medications as directed by a healthcare provider

Can alternative therapies help manage biliary colic symptoms? While scientific evidence is limited, some patients report relief from complementary approaches such as acupuncture or herbal remedies. However, it’s crucial to consult with a healthcare provider before trying any alternative treatments, as they may interact with conventional medications or have unintended effects.

The Role of Interprofessional Care in Managing Biliary Colic

Effective management of biliary colic often requires a collaborative approach involving various healthcare professionals:

• Primary care physicians: For initial diagnosis and ongoing management
• Gastroenterologists: To provide specialized care and perform diagnostic procedures
• Surgeons: For surgical evaluation and cholecystectomy when necessary
• Radiologists: To interpret imaging studies and assist in diagnosis
• Nutritionists: To provide dietary guidance and support
• Nurses: For patient education and perioperative care

This interprofessional approach ensures comprehensive care, from accurate diagnosis to effective treatment and long-term management of biliary colic.

Future Directions in Biliary Colic Research and Treatment

As medical science advances, new approaches to diagnosing and treating biliary colic are being explored:

Improved Diagnostic Techniques

Researchers are working on developing more accurate and less invasive diagnostic tools for detecting gallstones and assessing biliary function. These may include:

• Advanced imaging techniques with higher resolution and sensitivity
• Biomarkers for early detection of gallstone formation
• Artificial intelligence algorithms to improve diagnostic accuracy

Novel Treatment Approaches

While cholecystectomy remains the gold standard for treating symptomatic gallstones, scientists are investigating alternative treatments:

• Targeted drug therapies to prevent gallstone formation or promote dissolution
• Minimally invasive techniques for stone removal without gallbladder removal
• Gene therapy approaches to address underlying genetic factors contributing to gallstone formation

What potential impact could these advancements have on biliary colic management? These innovations could lead to earlier detection, more personalized treatment plans, and potentially non-surgical options for managing biliary colic and related gallbladder conditions. However, it’s important to note that many of these approaches are still in the research phase and may take years to become clinically available.

As our understanding of biliary colic and gallbladder disease continues to evolve, patients can expect more targeted and effective treatments in the future. In the meantime, awareness of risk factors, recognition of symptoms, and prompt medical attention remain crucial in managing this common condition.

Biliary Colic – StatPearls – NCBI Bookshelf

Continuing Education Activity

Biliary colic is defined as pain in the abdomen, due to obstruction usually by stones in the cystic duct or common bile duct of the biliary tree. It typically occurs after eating a large, fatty meal that causes contraction of the gallbladder. Treatment of this disease is primarily surgical, involving removal of the gallbladder, typically using a laparoscopic technique. This activity describes the risk factors, evaluation, and management of biliary colic and stresses the importance of the interprofessional team in caring for affected patients.

Objectives:

• Describe the risk factors, pathophysiology, and clinical features of patients with biliary colic.

• Outline the evaluation in patients with biliary colic.

• Explain the treatment strategies in patients with biliary colic.

• Outline an interprofessional team approach to enhance care coordination for prompt diagnosis and management in patients with biliary colic.

Access free multiple choice questions on this topic.

Introduction

Biliary colic is a common presentation of a stone in the cystic duct or common bile duct of the biliary tree. Colic refers to the type of pain that “comes and goes,” typically after eating a large, fatty meal which causes contraction of the gallbladder. However, the pain is usually constant and not colicky. Treatment of this disease is primarily surgical, involving removal of the gallbladder, typically using a laparoscopic technique. This medical condition does not typically require hospital admission.[1][2] Biliary colic generally refers to the pain that occurs from a temporary obstruction of the biliary tree which resolves on its own. Prolonged obstruction of the biliary tree or complete impaction of a stone within the biliary tree will eventually lead to cholecystitis or cholangitis, at which pain the pain will constant and increasing.

Etiology

Gallstones are formed within the gallbladder and may be composed of either cholesterol or bilirubin.  These stones may stay in the gallbladder and remain asymptomatic or may enter the cystic duct or common bile duct where they may become lodged and cause pain when the gallbladder contracts. The pain typically arises after fatty meals, when the gallbladder contracts to release bile into the duodenum to aid in digestion by emulsifying fats. Stones commonly exist within the gallbladder without symptoms, referred to as asymptomatic cholelithiasis. Asymptomatic cholelithiasis typically requires no medical or surgical treatment and may be managed expectantly and does not require further follow up. However, if pain, nausea, or vomiting do present, most commonly as right upper quadrant (RUQ) abdominal pain, the patient may be diagnosed with symptomatic cholelithiasis and will require surgical evaluation.[3][4] If the pain resolves on its own, typically by the stone either passing through the common bile duct and into the duodenum or by falling back into the gallbladder after obstructing the cystic duct, then it is termed biliary colic.

Epidemiology

It is estimated that somewhere between 10% to 20% of adults have gallstones, of which 1% to 3% of patients are symptomatic. In the United States, approximately 500,000 people require cholecystectomy due to all types of biliary disease. Biliary colic has a female predominance due to the influence of estrogen on the formation of gallstones. Obesity and elevated cholesterol are also strongly correlated to biliary colic and gallbladder disease because in the United States most gallstones are cholesterol-based.[5][6] In the developing world, the so-called pigmented stones derived from bilirubin are more common and are associated with hematologic disorders as well as biliary tree infections. Any type of stone may cause biliary colic, potentially progressing to cholecystitis or cholangitis, if it obstructs the cystic duct or the common bile duct.

Pathophysiology

Gallstones are formed in the gallbladder and can be composed of cholesterol or bilirubin. Fatty meals cause the release of cholecystokinin (CCK) from the duodenum, which subsequently causes contraction of the gallbladder. This contraction can expel stones from the gallbladder into the cystic duct or common bile duct. Less commonly, stones may also be formed within the common bile duct (CBD) and are referred to as primary CBD stones. These stones irritate the lining of the ducts, causing pain, which notably is present during times of gallbladder and duct contraction.[7][8] The stones may also become impacted in the cystic duct or common bile duct, with pain resulting when the gallbladder contracts against the obstruction.

History and Physical

Patients typically present with postprandial pain that “comes and goes,” hence the term colic. The pain is usually in the RUQ of the abdomen and may have radiation into the back. With uncomplicated biliary colic, patients will likely present only with pain. However, some may also report nausea and/or vomiting. These symptoms are accentuated after meals.

Biliary colic patients are afebrile and will commonly have no abnormal vitals in contrast to acute cholecystitis or cholangitis, which may present with fevers, tachycardia, or even hypotension if they progress to septic shock.

Patients with biliary colic will generally only have right upper quadrant (RUQ) or epigastric tenderness on physical exam. Abdominal distension and rebound tenderness are less common. Jaundice is not seen with blockage of the cystic duct; however, it is common with blockage of the common bile duct due to an elevation of direct bilirubin. This finding would suggest a more serious obstruction of the biliary tree and should raise suspicion for potential cholangitis rather than biliary colic.

Risk factors to ascertain for biliary colic:

Evaluation

Laboratory tests to be ordered include a complete blood count (CBC) and a metabolic panel with liver function tests. It is important to have these tests to rule out more serious gallbladder pathology such as acute cholecystitis or cholangitis. With an elevated white blood cell (WBC) count, the suspicion of acute cholecystitis or cholangitis rises. Elevated liver enzymes such as direct bilirubin, AST, ALT, ALP, and GGT suggest a stone or blockage in the common bile duct. Stones within the gallbladder or cystic duct typically do not produce any laboratory abnormalities unless it has progressed from biliary colic to cholecystitis in which case leukocytosis may be seen.[2][9]

RUQ abdominal ultrasound is the first radiologic test to evaluate suspected biliary pathology. HIDA scans are useful in evaluating acute or chronic cholecystitis and biliary dyskinesia. Abdominal CT is less sensitive than ultrasound at evaluating stones within the gallbladder. However, CT scans are a common modality used by emergency room physicians for nonspecific severe abdominal pain, which may find gallstones present. MRCP may be used for better visualization of the biliary tree, especially when evaluating for choledocholithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) can be used to evaluate for common bile duct stones if all other imaging is equivocal. ERCP is also a therapeutic intervention for choledocholithiasis.

Classic findings on RUQ ultrasound for biliary colic include stones (size may vary) or stone shadow. Findings of pericholecystic fluid, thickened wall (greater than 0.4 cm), and distended gallbladder are more indicative of acute cholecystitis.

Treatment / Management

Management of biliary colic is primarily surgical. Medical management of biliary colic involves strict maintenance of a low-fat diet and supportive management with antiemetics and pain control, however since patients typically have multiple stones the risk for recurrence of their biliary colic is high. There is no role for antibiotics in biliary colic as there is no infectious etiology, such as in acute cholecystitis or cholangitis. Oral ursodeoxycholic acid has also been used to help dissolve gallstones. Surgical intervention with laparoscopic cholecystectomy remains the gold standard. In patients who are poor surgical candidates, extracorporeal shockwave lithotripsy may be considered, but there is a considerable chance of stone recurrence. Open cholecystectomy is a less common approach, used in patients who are not candidates for laparoscopic surgery. [10][11]

Endoscopic retrograde cholangiopancreatography (ERCP) is both diagnostic and therapeutic for common bile duct stones. Sphincterotomy of the ampulla of Vater can assist in removing stones after ERCP and prevent future stones from becoming lodged in the common bile duct.

Patients with biliary colic do not necessarily require hospital admission. They may be treated symptomatically with a low-fat diet, pain control, and anti-emetics, and follow up for a laparoscopic cholecystectomy as an outpatient within a reasonable time-frame. However, if the patient has severe or intractable abdominal pain, hospital admission, and more urgent surgical management are warranted for symptomatic relief. Other considerations for possible admission include large gallstones. Stones greater than 1 cm in size have a greater propensity to obstruct the cystic duct and may predispose to acute cholecystitis, so they should be treated with surgical management more urgently. If the patient is unable to tolerate anything by mouth (even liquid), admission should be considered.

Differential Diagnosis

Complications

Postoperative and Rehabilitation Care

Cholecystectomy for biliary colic is an elective procedure and thus has a very favorable postoperative course. Since biliary colic by definition precedes the more serious inflammation that accompanies cholecystitis the dissection and removal of the gallbladder is typically much easier. Patients can often be discharged the same day or after a single day in the hospital provided they can tolerate appropriate oral intake of hydration and nutrition and their pain is well controlled.

Consultations

Biliary colic can be handled by a general surgery service without consultation of other services. However, if there is a concern for potential gallstones in the common bile duct then gastroenterology may be contacted for possible ERCP.

Deterrence and Patient Education

If a patient with biliary colic chooses nonoperative management of their condition then it is imperative to educate them on the warning signs of cholecystitis. They should be told to present to the hospital promptly if their abdominal pain persists longer than a few hours, becomes much greater than usual, or if they develop an accompanying fever. These patients should be made aware they are at high risk for developing an impacted stone which can lead to dangerous infectious processes such as cholecystitis or cholangitis. They should also be educated that fatty meals cause gallbladder contraction and can precipitate their symptoms.

Pearls and Other Issues

Aside from symptomatic cholelithiasis, complications of gallstones include acute cholecystitis, cholangitis, and pancreatitis depending on the location of the stone in the biliary tree. These diseases are more serious and do require hospital admission and medical management.

Enhancing Healthcare Team Outcomes

Patients with biliary colic often present to the emergency department with vague complaints. Besides blood work, imaging studies are necessary. The diagnosis and management of this disorder require an interprofessional team, including emergency department personnel, gastroenterologists, specialty care nurses, and dieticians. While the treatment of cholelithiasis and choledocholithiasis is established, there is also some evidence indicating that the condition can be prevented by changing diet and lifestyle. Anecdotal reports indicate that lowering the amount of fat in the diet may reduce biliary colic. Reducing body weight gradually has also been shown to lower the risk of biliary colic- hence the patient should be educated on the importance of a low-fat diet and regular exercise. These patients should be educated on the signs and symptoms of acute cholecystitis and when to seek medical help. For patients treated with surgery, the majority have an excellent outcome.[12][13] [Level 5]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

ERCP in CBD stones. Contributed by Sunil Munakomi, MD

References

1.

Baiu I, Hawn MT. Gallstones and Biliary Colic. JAMA. 2018 Oct 16;320(15):1612. [PubMed: 30326127]

2.

Naim H, Hasan SA, Khalid S, Abbass A, DSouza J. Clinical Cholecystitis in the Absence of the Gallbladder. Cureus. 2017 Nov 10;9(11):e1834. [PMC free article: PMC5762187] [PubMed: 29340256]

3.

Saurabh S, Green B. Is hyperkinetic gallbladder an indication for cholecystectomy? Surg Endosc. 2019 May;33(5):1613-1617. [PubMed: 30209609]

4.

Wilkins T, Agabin E, Varghese J, Talukder A. Gallbladder Dysfunction: Cholecystitis, Choledocholithiasis, Cholangitis, and Biliary Dyskinesia. Prim Care. 2017 Dec;44(4):575-597. [PubMed: 29132521]

5.

Hedström J, Nilsson J, Andersson R, Andersson B. Changing management of gallstone-related disease in pregnancy – a retrospective cohort analysis. Scand J Gastroenterol. 2017 Sep;52(9):1016-1021. [PubMed: 28599581]

6.

Cervellin G, Mora R, Ticinesi A, Meschi T, Comelli I, Catena F, Lippi G. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases. Ann Transl Med. 2016 Oct;4(19):362. [PMC free article: PMC5075866] [PubMed: 27826565]

7.

Tsai TJ, Chan HH, Lai KH, Shih CA, Kao SS, Sun WC, Wang EM, Tsai WL, Lin KH, Yu HC, Chen WC, Wang HM, Tsay FW, Lin HS, Cheng JS, Hsu PI. Gallbladder function predicts subsequent biliary complications in patients with common bile duct stones after endoscopic treatment? BMC Gastroenterol. 2018 Feb 27;18(1):32. [PMC free article: PMC6389262] [PubMed: 29486713]

8.

Wybourn CA, Kitsis RM, Baker TA, Degner B, Sarker S, Luchette FA. Laparoscopic cholecystectomy for biliary dyskinesia: Which patients have long term benefit? Surgery. 2013 Oct;154(4):761-7; discussion 767-8. [PubMed: 24074413]

9.

Değerli V, Korkmaz T, Mollamehmetoğlu H, Ertan C. The importance of routine bedside biliary ultrasonography in the management of patients admitted to the emergency department with isolated acute epigastric pain. Turk J Med Sci. 2017 Aug 23;47(4):1137-1143. [PubMed: 29156853]

10.

Demehri FR, Alam HB. Evidence-Based Management of Common Gallstone-Related Emergencies. J Intensive Care Med. 2016 Jan;31(1):3-13. [PubMed: 25320159]

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Bani Hani MN. Laparoscopic surgery for symptomatic cholelithiasis during pregnancy. Surg Laparosc Endosc Percutan Tech. 2007 Dec;17(6):482-6. [PubMed: 18097304]

12.

Altieri MS, Yang J, Zhu C, Sbayi S, Spaniolas K, Talamini M, Pryor A. What happens to biliary colic patients in New York State? 10-year follow-up from emergency department visits. Surg Endosc. 2018 Apr;32(4):2058-2066. [PubMed: 29063306]

13.

Santucci NR, Hyman PE, Harmon CM, Schiavo JH, Hussain SZ. Biliary Dyskinesia in Children: A Systematic Review. J Pediatr Gastroenterol Nutr. 2017 Feb;64(2):186-193. [PubMed: 27472474]

Disclosure: David Sigmon declares no relevant financial relationships with ineligible companies.

Disclosure: Nalin Dayal declares no relevant financial relationships with ineligible companies.

Disclosure: Marcelle Meseeha declares no relevant financial relationships with ineligible companies.

What Is Cholecystitis? | Everyday Health

Cholecystitis is a big word for the simple — but potentially painful — problem of gallbladder inflammation.

By Diana RodriguezMedically Reviewed by Jane Yoon Scott, MD

Reviewed: November 14, 2022

Medically Reviewed

Cholecystitis is often diagnosed using ultrasound imaging tests.James Cavallini/Alamy

The gallbladder is a small organ that holds bile from the liver and releases it into the small intestine to help with digestion. (1)

When a gallstone forms, it can wedge itself in the ducts that release bile — causing bile buildup and a painful condition called cholecystitis. (2)

Cholecystitis, or gallbladder inflammation, occurs when bile can’t circulate out of the gallbladder as it normally does.

When bile builds up, it causes the gallbladder to thicken, harden, swell, and become irritated.

The abdomen becomes painful, and infection can occur if bile can’t flow properly. (3)

Common Symptoms of Cholecystitis

The most common symptoms of cholecystitis are:

• Severe and sudden pain in the upper right part of the abdomen
• Pain that spreads to your right shoulder or back
• Pain after eating a meal
• An abdomen that’s tender to the touch
• Nausea
• Vomiting
• Fever
• Chills
• Bloated belly (2,3)

Symptoms of cholecystitis often occur after a large or fatty meal.

Although it’s easy to mistake the symptoms of cholecystitis for some other simple problem, it’s important to get a proper medical diagnosis.

Untreated cholecystitis can lead to complications, so don’t brush off these symptoms as just a little indigestion or a stomach bug. (3)

Acute vs. Chronic Cholecystitis

Cholecystitis can be chronic — persistent and long-lasting swelling and damage to the gallbladder — or acute, a sudden “attack” that causes swelling and irritation of the gallbladder.

Acute cholecystitis involves pain that begins suddenly and usually lasts for more than six hours. It’s caused by gallstones in 95 percent of cases. (4)

Acute cholecystitis can lead to a number of relatively serious complications, so it’s important to seek medical attention quickly. It usually needs to be treated in a hospital, typically with intravenous (IV) fluids, antibiotics, or even surgery. (5)

Acute cholecystitis can develop into chronic cholecystitis.

Chronic cholecystitis is defined by repeated attacks of pain caused by blockages in the biliary ducts, almost always due to gallstones.

Pain in chronic cholecystitis tends to be less severe than in acute cholecystitis and doesn’t tend to last as long. Fever is also rare in chronic cholecystitis.

If you have chronic cholecystitis, your gallbladder may become scarred and small, with a thick outer wall. It may also contain sludge (a thick substance that pollutes the gallbladder and can’t be absorbed) or calcium deposits, which can harden and further damage the organ. (4)

Common Causes of Cholecystitis

Some of the most common causes of cholecystitis include:

• Gallstones becoming lodged in the ducts of the gallbladder, preventing bile from emptying
• Scarring in the bile ducts leading to blockage, which can rarely happen without gallstones
• A tumor in the liver or pancreas
• Reduced blood flow to the gallbladder, sometimes due to damaged blood vessels from a severe illness
• A bacterial or viral infection that strikes the bile duct system, which empties bile from the gallbladder (this may be a complication of AIDS) (3)

A rare form of acute cholecystitis that isn’t due to gallstones — called acalculous cholecystitis — tends to occur after the following events and conditions:

• Major surgery
• Serious illness, infection, or injury
• Long-term intravenous (IV) feeding
• Extended fasting
• Immune system deficiency (4)

Diagnosing Cholecystitis

Cholecystitis can be easily diagnosed through a physical exam, medical history, and an ultrasound or other imaging test.

In most cases, an ultrasound can detect gallstones, in addition to fluid around the gallbladder and thickening of its walls. The procedure can also reveal tenderness in the area.

More in Gallbladder

Diagnostic Tests for Gallbladder Disease

A computed tomography (CT) scan may be used if an ultrasound doesn’t produce adequate images.

If acute cholecystitis isn’t seen on other imaging tests, another procedure called a hepatobiliary iminodiacetic acid (HIDA) scan may be used.

This imaging test involves injecting a small amount of a harmless radioactive substance into your arm. A device called a gamma camera is then used to create images as this substance travels from your bloodstream to your liver, gallbladder, bile ducts, and small intestine. (3)

Treatment for Cholecystitis

Once diagnosed, cholecystitis can be treated with:

• Cholecystectomy, or surgical removal of the gallbladder — the most common treatment
• Fasting to take the stress off your gallbladder
• Medications to manage pain
• Medications to dissolve gallstones
• Medications to keep gallstones from forming
• Antibiotics and, if warranted, IV fluids

People with mild cholecystitis may have to adjust their diet, take antibiotics if an infection is present, and drink plenty of fluids to allow the inflammation to subside.

More serious cases of cholecystitis generally require a stay in the hospital, as well as IV antibiotics to treat infection and intravenous (IV) fluids to help prevent dehydration.

Once you start on treatment, your symptoms will probably begin to resolve over two to three days.

Related

Dehydration: A Complication That May Arise From Diarrhea

The right treatment for you will depend on your symptoms, your age, how well you can tolerate the treatment, and your general health.

Even if your symptoms are resolved in the short term, your gallbladder may become inflamed again if it’s not removed. Most people with cholecystitis eventually require surgery to remove the organ. (3)

Additional reporting by Quinn Phillips

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Editorial Sources and Fact-Checking

1. Gallbladder Diseases. MedlinePlus. July 14, 2016.
2. Definition and Facts for Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases.  November 2017.
3. Cholecystitis: Symptoms and Causes. Mayo Clinic. September 9, 2022.
4. Cholecystitis. Merck Manual. September 2022.
5. Acute Cholecystitis. NHS. August 7, 2019.

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Cholelithiasis (cholelithiasis) – Gastroenterology

Methods of treatment

What is cholelithiasis?

Gallstone disease (Cholelithiasis) is a general term for diseases in which stones form in the gallbladder and bile ducts and can cause various symptoms such as pain, discomfort, etc., and in severe cases lead to blockage of the bile duct . Usually, gallstones that form in the gallbladder are called gallstones.

See in this material: What is cholelithiasis? Methods of treatment of gallstone disease in Japan Is gallstone disease curable? Intrahepatic lithiasis

Methods of treatment of gallstone disease in Japan 9 Surgical treatment

In case of asymptomatic course of the disease, treatment of cholelithiasis is not required, the patient is observed. Surgical treatment of cholelithiasis in Japan is generally used in the presence of abdominal pain and other symptoms. Even if only gallstones are removed, in most cases they reappear, requiring a second operation. Therefore, with cholelithiasis, the main method of treatment is cholecystectomy – removal of the gallbladder.

The operation is performed under general anesthesia. Traditionally, a laparotomy was performed – an open operation on the peritoneum. However, since 1990, after the introduction of laparoscopic cholecystectomy, minimally invasive endoscopic intervention has been preferred. A feature of this method is a quick return to normal life due to a small wound, and minor postoperative pain. However, if laparoscopy is difficult, for example, with adhesions of the gallbladder as a result of inflammation, if gallbladder cancer is suspected, etc., laparotomy is used. Despite the larger size of the wound, the surgeon has direct access to the organ, which allows for the safest operation.

• Drug treatment

Depending on the condition of the gallstones, there are other treatments in Japan besides surgery.

Cholesterol stones (comprising almost 80% of all gallstones), for example, are soluble by drugs containing bile and bile acids (ursodeoxycholic acid). The drug is used for cholesterol gallstones without calcification, 15 mm in size or less, provided that the gallbladder functions normally (reduction function).

When taking the drug for resorption of gallstones during the year, in 24-38% of patients, gallstones resolve. However, they reappear in 60% of cases. Therefore, it is necessary to continue taking the drugs even after the dissolution of the stones (in the photo: various types of gallstones).

• Extracorporeal shock wave lithotripsy (ESWL)

Remote crushing of stones using a shock wave. It is used in Japan for a single cholesterol stone without calcification, no larger than 20 mm in diameter and with preserved gallbladder function.

As a result of treatment, in 60-90% of cases, the stone disappears after a year. However, in 60% of patients, the disease recurs within the next 10 years.

Another problem with ESWL is that in some cases long-term treatment is required.

• Endoscopic removal of bile duct stones

When gallstones enter the bile ducts, the exit of the bile duct (duodenal papilla area) is blocked, causing cholangitis.

Symptoms include severe abdominal pain, fever with chills, jaundice. Since the attack can become severe, bile duct stones are treated even if the disease is asymptomatic. Treatment methods are divided into endoscopic and surgical.

If you feel unwell as a result of cholangitis, a sparing endoscopic tube stent placement is used to normalize the outflow of bile. To remove bile duct stones, an incision in the duodenal papilla is used, or its expansion with a balloon, followed by the installation of a basket catheter (a special device for extracting gallstones).

Surgical treatments for gallstones include laparotomy and laparoscopy. In addition, with severe inflammation, a drain is installed in the gallbladder to remove infected bile. Which of the methods of treatment is applicable, the attending physician decides based on the size and number of stones, the presence or absence of stones in the gallbladder, the general condition of the patient, etc.

Is gallstone disease curable?

Removal of the gallbladder usually cures gallstones. However, after surgery, preoperative symptoms may persist, or abdominal symptoms may appear that were not present before surgery. This condition is called postcholecystectomy syndrome and is caused by dysfunction of the sphincter of Oddi as a result of the removal of the gallbladder. In addition, stones may remain in the bile duct, or new ones may form.

Without treatment, gallstones can enter the bile duct or recur, causing inflammation of the bile ducts (cholangitis), accompanied by fever, jaundice, and pain.