What is cholecystitis and how does it affect the gallbladder. What are the common causes and risk factors for developing cholecystitis. How is cholecystitis diagnosed and what treatment options are available. What complications can arise from untreated cholecystitis.

The Anatomy and Function of the Gallbladder

The gallbladder is a small, pear-shaped organ located beneath the liver in the upper right quadrant of the abdomen. Its primary function is to store and concentrate bile, a digestive fluid produced by the liver. When we eat, especially foods high in fat, the gallbladder contracts and releases bile into the small intestine to aid in the digestion and absorption of fats.

Understanding the gallbladder’s anatomy is crucial for comprehending cholecystitis. The organ is connected to the liver and small intestine through a complex network of ducts:

• Hepatic ducts: Carry bile from the liver
• Cystic duct: Connects the gallbladder to the common bile duct
• Common bile duct: Transports bile to the small intestine

This intricate system allows for the storage, concentration, and timely release of bile. However, when this system is disrupted, it can lead to various gallbladder issues, including cholecystitis.

Cholecystitis: Inflammation of the Gallbladder

Cholecystitis is a condition characterized by inflammation of the gallbladder. It occurs when bile becomes trapped within the gallbladder, often due to an obstruction in the bile ducts. This trapped bile can lead to irritation and swelling of the gallbladder walls, potentially resulting in infection.

There are two main types of cholecystitis:

1. Acute cholecystitis: A sudden onset of inflammation, often accompanied by severe pain
2. Chronic cholecystitis: Long-term, recurrent inflammation that can lead to thickening of the gallbladder walls

Understanding the difference between these types is essential for proper diagnosis and treatment. Acute cholecystitis often requires immediate medical attention, while chronic cholecystitis may be managed with lifestyle changes and medication in some cases.

Common Causes and Risk Factors for Cholecystitis

The most common cause of cholecystitis is the presence of gallstones, which can obstruct the flow of bile from the gallbladder. However, other factors can also contribute to the development of this condition:

• Biliary sludge: A thick mixture of bile, cholesterol, and calcium salts
• Tumors: Growths that can block bile ducts
• Infections: Bacterial or viral infections affecting the gallbladder
• Reduced blood flow: Compromised blood supply to the gallbladder

Several risk factors increase the likelihood of developing cholecystitis:

• Age: Individuals over 40 are at higher risk
• Gender: Women are more susceptible, especially those who have been pregnant
• Obesity: Excess weight increases the risk of gallstone formation
• Rapid weight loss: Can lead to imbalances in bile composition
• Diabetes: Associated with higher rates of gallbladder issues
• Family history: Genetic factors can play a role
• Certain medications: Hormonal treatments and some cholesterol-lowering drugs

Identifying these risk factors can help individuals take preventive measures and seek early medical attention when necessary.

Recognizing the Symptoms of Cholecystitis

Identifying the symptoms of cholecystitis is crucial for early diagnosis and treatment. The most common signs include:

• Severe pain in the upper right or center abdomen
• Pain that radiates to the right shoulder or back
• Tenderness when touching the abdomen
• Nausea and vomiting
• Fever
• Chills
• Abdominal bloating

These symptoms can vary in intensity and duration. Acute cholecystitis typically presents with sudden, severe pain, while chronic cholecystitis may involve milder, recurrent discomfort. In some cases, individuals may experience what’s known as a “gallbladder attack,” characterized by intense pain that can last for several hours.

Is there a specific time when cholecystitis symptoms are more likely to occur? Often, symptoms worsen after eating fatty meals, as the gallbladder contracts to release bile, potentially exacerbating any blockages or inflammation.

Diagnostic Approaches for Cholecystitis

Accurately diagnosing cholecystitis involves a combination of physical examination, medical history review, and diagnostic tests. Healthcare providers typically employ the following methods:

1. Physical examination: Checking for abdominal tenderness and a positive Murphy’s sign (pain when pressing on the gallbladder area while the patient inhales)
2. Blood tests: To check for signs of infection, inflammation, or liver function abnormalities
3. Imaging studies:
   • Ultrasound: The primary imaging tool for gallbladder issues
   • CT scan: Provides detailed images of the abdomen
   • HIDA scan: Assesses gallbladder function and bile flow
4. Endoscopic retrograde cholangiopancreatography (ERCP): A procedure that can diagnose and treat bile duct blockages

How accurate are these diagnostic methods? While ultrasound is highly sensitive for detecting gallstones and inflammation, combining multiple diagnostic approaches provides the most comprehensive assessment. This multi-faceted approach helps healthcare providers differentiate cholecystitis from other conditions with similar symptoms, such as appendicitis or peptic ulcer disease.

Treatment Options and Management Strategies

The treatment of cholecystitis depends on the severity of the condition and the overall health of the patient. Common approaches include:

Conservative Management

• Fasting: To rest the gallbladder
• Intravenous fluids: To prevent dehydration
• Pain medication: To manage discomfort
• Antibiotics: If infection is present or suspected

Surgical Intervention

Cholecystectomy, the surgical removal of the gallbladder, is often the definitive treatment for recurrent or severe cholecystitis. This procedure can be performed in two ways:

1. Laparoscopic cholecystectomy: A minimally invasive approach using small incisions
2. Open cholecystectomy: Traditional surgery with a larger incision, typically reserved for complicated cases

When is surgery necessary for cholecystitis? Surgery is often recommended for severe acute cholecystitis, recurrent episodes, or when complications arise. In some cases, emergency surgery may be required to prevent life-threatening complications.

Alternative Treatments

For patients who are poor surgical candidates, alternative treatments may be considered:

• Percutaneous cholecystostomy: A drainage tube is inserted into the gallbladder to relieve pressure and inflammation
• Lithotripsy: Using shock waves to break up gallstones (rarely used for cholecystitis)
• Medications: Ursodeoxycholic acid to dissolve small gallstones (long-term treatment)

These alternatives are typically reserved for specific situations and are not as common as surgical intervention.

Potential Complications and Long-term Outlook

If left untreated, cholecystitis can lead to serious complications:

• Gallbladder perforation: A hole in the gallbladder wall
• Gangrene: Death of gallbladder tissue
• Abscess formation: Collection of pus near the gallbladder
• Biliary peritonitis: Inflammation of the abdominal lining due to bile leakage
• Sepsis: A life-threatening systemic infection

What is the prognosis for patients with cholecystitis? With prompt and appropriate treatment, the outlook for most patients is excellent. After gallbladder removal, most individuals can return to their normal activities within a few weeks. However, some may need to make dietary adjustments to manage digestion without a gallbladder.

Long-term effects of cholecystectomy are generally minimal, as the body adapts to the absence of the gallbladder. The liver continues to produce bile, which flows directly into the small intestine. Some patients may experience temporary digestive changes, but these typically resolve over time.

Preventive Measures and Lifestyle Modifications

While not all cases of cholecystitis can be prevented, certain lifestyle changes can reduce the risk of developing gallbladder issues:

• Maintain a healthy weight: Obesity is a significant risk factor for gallstones
• Adopt a balanced diet: Focus on fruits, vegetables, whole grains, and lean proteins
• Limit fat intake: Reduce consumption of saturated and trans fats
• Exercise regularly: Aim for at least 30 minutes of moderate activity daily
• Stay hydrated: Adequate water intake can help prevent bile concentration
• Avoid rapid weight loss: Gradual, steady weight loss is preferable

Can dietary changes alone prevent cholecystitis? While a healthy diet can reduce the risk of gallstone formation, it’s important to note that some risk factors, such as age and genetics, cannot be modified. Therefore, a comprehensive approach to health, including regular check-ups, is essential for early detection and prevention of gallbladder issues.

For individuals with a history of gallbladder problems or those at high risk, working closely with a healthcare provider to develop a personalized prevention plan is crucial. This may include regular screenings, dietary counseling, and lifestyle recommendations tailored to individual needs and risk factors.

The Role of Supplements and Alternative Therapies

Some studies suggest that certain supplements and alternative therapies may support gallbladder health:

• Vitamin C: May help reduce the risk of gallstone formation
• Lecithin: Could aid in the dissolution of cholesterol in bile
• Milk thistle: Traditionally used to support liver and gallbladder function
• Acupuncture: May help manage pain associated with gallbladder issues

However, it’s important to note that the effectiveness of these approaches in preventing or treating cholecystitis is not conclusively proven. Always consult with a healthcare provider before starting any new supplement or alternative therapy regimen, especially if you have a history of gallbladder problems.

Recent Advances in Cholecystitis Research and Treatment

The field of gallbladder health and cholecystitis treatment continues to evolve. Recent advancements include:

• Improved imaging techniques: Enhanced ultrasound and MRI technologies for more accurate diagnosis
• Robotic-assisted surgery: Offering greater precision in complex cases
• Biomarkers: Research into new blood tests for early detection of gallbladder inflammation
• Minimally invasive treatments: Development of novel approaches to treat gallstones without surgery

How are these advancements changing the landscape of cholecystitis treatment? These innovations are leading to earlier diagnosis, more personalized treatment plans, and potentially less invasive management options for some patients. As research continues, we may see further improvements in both the prevention and treatment of cholecystitis.

Staying informed about these developments and discussing them with healthcare providers can help patients make more informed decisions about their gallbladder health. It’s an exciting time in the field, with the potential for significant improvements in patient outcomes on the horizon.

Cholecystitis: Gallbladder Inflammation, Symptoms, Treatment

Overview

Anatomy of the gallbladder, featuring gallstones stuck in the cystic duct.

What is cholecystitis?

Cholecystitis is an inflammation of the gallbladder. Your gallbladder is a small pear-shaped organ tucked away under your liver in the upper right section of your abdomen. The gallbladder’s job is to store bile – a fat-digesting fluid made by the liver – and to release it after you eat a meal. Cholecystitis usually develops when the bile gets trapped in your gallbladder, and becomes infected with bacteria. Bile gets trapped when gallstones block the flow of bile out of your gallbladder.

What are gallstones and how do they block the flow of bile?

Gallstones are hardened deposits of the digestive fluids that form in your gallbladder, and can range in size from a tiny grain of sand (called sludge) to a golf ball. They are made up of either cholesterol or pigment stones. Gallstones made of cholesterol are yellow-greenish in color, and are more common. Pigment stones are mostly made of bilirubin, a substance that is created when the liver breaks down red blood cells.

Gallstones themselves are not necessarily a problem. It’s possible to have gallstones sitting in your gallbladder, never bothering you and, in that case, they don’t need to be treated. However, gallstones that leave the gallbladder can get stuck in your ducts (tubes). They block the flow of bile out of your gallbladder, which causes a buildup of bile. These events cause the walls of your gallbladder to become inflamed and swell, and that can lead to bacterial infection of the bile. Your life can even be in danger unless you seek prompt medical and surgical help.

How does the gallbladder work?

The gallbladder connects to your liver by a duct system (tubes) that look like a tree trunk with branches. There are many ducts, or “branches” inside your liver. These tree branches connect to two main tree limbs in your liver, called the right and left hepatic ducts. These two ducts merge (like the trunk of a tree) to form your common hepatic duct. One main “tree limb” coming off the common hepatic duct is called the cystic duct. It connects directly into your gallbladder. The common hepatic duct, the “tree trunk,” continues but its name changes to the common bile duct. Your common bile duct empties into the duodenum section of the small intestine.

Bile, a fat-dissolving liquid substance that is made continuously by your liver, travels through the duct system and enters your digestive system at the duodenum. When you are not eating, a valve structure at the common bile duct and duodenum connection, called the major duodenal papilla, is usually closed. This allows the bile to reflux back through the cystic duct into your gallbladder to be stored. During mealtime, your gallbladder contracts, and the valve opens, pushing the stored bile out of your gallbladder, through the cystic duct and down the common bile duct into your intestine. Bile mixes with the partially digested food, further helping the breakdown of the fat in your diet.

Gallstones, or even sludge, in the gallbladder can obstruct this normal flow of bile, leading to cholecystitis.

How common is cholecystitis?

Approximately 120,000 Americans are treated for acute cholecystitis every year. Women make up 60% of this number.

Who is at risk to get cholecystitis?

You are at greater risk of developing cholecystitis if you:

• Have a family history of gallstones.
• Are a woman age 50 or older.
• Are a man or woman age 60 or older.
• Eat a diet high in fat and cholesterol.
• Are overweight or obese.
• Have diabetes.
• Are of Native American, Scandinavian or Hispanic descent.
• Are currently pregnant or have had several pregnancies.
• Are a woman who takes estrogen replacement therapy or birth control pills.
• Have lost weight rapidly.

Symptoms and Causes

What causes cholecystitis?

Cholecystitis is commonly caused by gallstones that have blocked your cystic duct, which prevents bile from exiting your gallbladder. Your gallbladder becomes swollen and may become infected with bacteria. Less common causes include blocked bile ducts due to scarring, reduced blood flow to your gallbladder, tumors that block the flow of bile from your gallbladder, or viral infections that inflame your gallbladder.

Structure of the digestive anatomy showcasing the liver, stomach, pancreas and gallbladder.

What are the symptoms of cholecystitis?

Symptoms can be acute or chronic.

Acute cholecystitis comes on suddenly and causes severe, ongoing pain. More than 95% of people with acute cholecystitis have gallstones. Pain begins in your mid to upper right abdomen and may spread to your right shoulder blade or back. Pain is strongest 15 to 20 minutes after eating and it continues. Pain that remains severe is considered a medical emergency.

Chronic cholecystitis means you’ve had repeated attacks of inflammation and pain. Pain tends to be less severe and doesn’t last as long as acute cholecystitis. The repeated attacks are usually caused by gallstones blocking the cystic duct intermittently.

Other signs and symptoms of cholecystitis may include:

• Tenderness in your abdomen when it’s touched.
• Nausea and bloating.
• Vomiting.
• Fever above 100.4 F (38 C). Fever may not be present in older adults and usually doesn’t occur in people with chronic cholecystitis.
• Chills.
• Abdominal pain that gets worse when taking a deep breath.
• Abdominal pain and cramping after eating – especially fatty foods.
• Jaundice (a yellowing of skin and eyes).

Diagnosis and Tests

How is cholecystitis diagnosed?

Your healthcare professional will ask about your symptoms. They may order blood work to check your white blood cell count and how well your liver is working. A higher than normal white blood cell count is a sign of an infection, inflammation, or an abscess.

Imaging tests that could be ordered include:

• Abdominal ultrasound: This test uses sound waves to examine the gallbladder and the bile ducts. It helps identify signs of inflammation in your gallbladder, the presence of gallstones, and thickening or swelling of the gallbladder wall.
• Hepatobiliary nuclear imaging (HIDA scan): This is an imaging test that involves an injected radioactive substance. A gamma camera sees the radiation as it moves through the different tracts of the digestive system. If that substance doesn’t enter your gallbladder, then the healthcare provider knows the organ is blocked, indicating cholecystitis. This test can also detect the function of the gallbladder and its ability to eject the bile once stimulated. This is called the ejection fraction of the gallbladder, which is considered normal when it is above 30-35%.
• Magnetic Resonance Cholangiopancreatography (MRCP): This type of MRI shows details of your liver, gallbladder, bile ducts, structures and ducts of the pancreas as well. It can show gallstones, inflammation or blockage of the bile ducts and gallbladder and if there is any inflammation of the pancreas.
• Abdominal Computed Tomography (CT Scan): This X-ray test shows details of your liver, gallbladder and bile ducts. It shows inflammation of the gallbladder.

Management and Treatment

How can cholecystitis be treated?

Treatment of cholecystitis usually takes place in the hospital. Treatments may include:

• Fasting, to rest the gallbladder.
• IV fluids to prevent dehydration.
• Pain medication.
• Antibiotics to treat infection.
• Removing the gallbladder. This surgery, called a cholescystectomy, is usually performed by making tiny cuts (incisions) through the abdomen to insert a laparoscope (tiny camera) to see inside the abdomen and surgical instruments to remove the gallbladder. The gallbladder is usually removed within 24 to 48 hours of admission if you have a confirmed case of acute cholecystitis.
• Draining the gallbladder to treat and prevent the spread of infection. This procedure, called percutaneous cholecystostomy, is usually reserved for those who are too ill to undergo surgery.
• Removing gallstones in the area blocking the common bile duct. This procedure, done by an endoscopist, called endoscopic retrograde cholangiopancreatography (ERCP), is reserved for patients with a suspected or confirmed blocked common bile duct, and can clear the duct of stones and sludge.

What is it like to recover from gallbladder surgery?

Recovery from gallbladder surgery, when done laparoscopically, is usually uneventful. As with any surgery there can be minimal pain at the incision sites. Most patients are discharged from the hospital shortly after the surgery, and do not require additional testing or interventions. If the surgery is done through a larger wound (open surgery) then the recovery can be slower and require more days in the hospital.

Can I live without my gallbladder?

Yes, you can live a normal life without a gallbladder. Since the gallbladder’s main role is the storage of the bile, and bile is made continuously by the liver, you don’t need your gallbladder for normal digestion. Bile can still flow directly from your liver, through the common bile duct and into the small intestine.

What complications can occur if cholecystitis is not treated?

Complications can range from ongoing infection to possible death.

• Severely Infected gallbladder: A blocked gallbladder that is extremely uncomfortable and painful. Without treatment, it could lead to an overwhelming infection, or even gangrene of the gallbladder.
• Cholangitis: An acute infection of the main bile ducts and liver that can be extremely life-threating if not promptly treated.
• Inflamed pancreas (Pancreatitis): Your common bile duct and the pancreatic duct share the same “valve” into the duodenum. If a gallstone blocks that valve, the potent pancreatic enzyme juice excreted by the pancreases gets backed up causing pancreatitis, which can also be severe and life threatening.

What if I have cholecystitis during pregnancy?

During early and later pregnancy cholecystitis can be treated by antibiotics. Surgery is usually a safe option during the second trimester, but can also be performed safely at any time if antibiotics fail to treat the infection

Prevention

How can cholecystitis be prevented?

You can reduce your risk of developing cholecystitis by:

• Eating a healthy diet: Choose to eat a healthy diet – one high in fruits, vegetables whole grains and healthy fats – such as the Mediterranean diet. Stay away from foods high in fat and cholesterol.
• Exercising: Exercise reduces cholesterol, and the lower the cholesterol level the lower the chance of getting gallstones.
• Losing weight slowly: If you are making efforts to lose weight, don’t lose more than one to two pounds a week. Rapid weight loss increases your risk for developing gallstones.

Outlook / Prognosis

What is the outlook for patients with cholecystitis?

There is a higher rate of the symptoms recurring if cholecystitis is treated only with medications. There is a higher risk of death, as well, for patients who do not address the worsening conditions.

Surgery to remove the gallbladder (cholecystectomy) is usually the definitive treatment. The benefits of the surgery outweighs the risks in most cases, since the surgical treatment carries very low risk of complications in most cases. Your surgeon will assess your risks for the surgery and discuss all of your treatment options before the operation.

Living With

What’s the difference between cholecystitis and cholelithiasis?

Cholelithiasis is the formation of gallstones. Cholecystitis is the inflammation of the gallbladder.

How do I take care of myself if I have a diagnosis of cholecystitis?

Educate yourself about the symptoms of cholecystitis so that you and your healthcare provider can identify it and treat it as early as possible.

When should I see my healthcare provider?

Abdominal pain of any sort should always be an alarm. If you have sudden pain or bouts of pain in your upper right area of your abdomen or right shoulder or back, contact your healthcare provider.

When should I go to emergency room?

Don’t hesitate to go to the emergency room if you have severe abdominal pain that does not spontaneously resolve or that continues to worsen.

What questions should I ask my doctor?

• Is my pain cholecystitis, for sure, or could it be caused by something else?
• Should my cholecystitis be treated with medication or with surgery, or both?
• What do you think caused these symptoms?
• How quickly am I likely to recover from surgery?
• Keeping my other medical conditions in mind, are there any risks in getting surgery?
• Could I have any non-surgical treatments?
• How quickly should I have surgery?
• What specialist should I follow up with?
• What foods should I eat/avoid?

A note from Cleveland Clinic

If you have pain in the upper right quadrant of your abdomen, seek immediate answers from a healthcare provider. Gallbladder inflammation, whether it’s chronic or acute, requires swift and vigilant care!

Cholecystitis: Gallbladder Inflammation, Symptoms, Treatment

Overview

Anatomy of the gallbladder, featuring gallstones stuck in the cystic duct.

What is cholecystitis?

Cholecystitis is an inflammation of the gallbladder. Your gallbladder is a small pear-shaped organ tucked away under your liver in the upper right section of your abdomen. The gallbladder’s job is to store bile – a fat-digesting fluid made by the liver – and to release it after you eat a meal. Cholecystitis usually develops when the bile gets trapped in your gallbladder, and becomes infected with bacteria. Bile gets trapped when gallstones block the flow of bile out of your gallbladder.

What are gallstones and how do they block the flow of bile?

Gallstones are hardened deposits of the digestive fluids that form in your gallbladder, and can range in size from a tiny grain of sand (called sludge) to a golf ball. They are made up of either cholesterol or pigment stones. Gallstones made of cholesterol are yellow-greenish in color, and are more common. Pigment stones are mostly made of bilirubin, a substance that is created when the liver breaks down red blood cells.

Gallstones themselves are not necessarily a problem. It’s possible to have gallstones sitting in your gallbladder, never bothering you and, in that case, they don’t need to be treated. However, gallstones that leave the gallbladder can get stuck in your ducts (tubes). They block the flow of bile out of your gallbladder, which causes a buildup of bile. These events cause the walls of your gallbladder to become inflamed and swell, and that can lead to bacterial infection of the bile. Your life can even be in danger unless you seek prompt medical and surgical help.

How does the gallbladder work?

The gallbladder connects to your liver by a duct system (tubes) that look like a tree trunk with branches. There are many ducts, or “branches” inside your liver. These tree branches connect to two main tree limbs in your liver, called the right and left hepatic ducts. These two ducts merge (like the trunk of a tree) to form your common hepatic duct. One main “tree limb” coming off the common hepatic duct is called the cystic duct. It connects directly into your gallbladder. The common hepatic duct, the “tree trunk,” continues but its name changes to the common bile duct. Your common bile duct empties into the duodenum section of the small intestine.

Bile, a fat-dissolving liquid substance that is made continuously by your liver, travels through the duct system and enters your digestive system at the duodenum. When you are not eating, a valve structure at the common bile duct and duodenum connection, called the major duodenal papilla, is usually closed. This allows the bile to reflux back through the cystic duct into your gallbladder to be stored. During mealtime, your gallbladder contracts, and the valve opens, pushing the stored bile out of your gallbladder, through the cystic duct and down the common bile duct into your intestine. Bile mixes with the partially digested food, further helping the breakdown of the fat in your diet.

Gallstones, or even sludge, in the gallbladder can obstruct this normal flow of bile, leading to cholecystitis.

How common is cholecystitis?

Approximately 120,000 Americans are treated for acute cholecystitis every year. Women make up 60% of this number.

Who is at risk to get cholecystitis?

You are at greater risk of developing cholecystitis if you:

• Have a family history of gallstones.
• Are a woman age 50 or older.
• Are a man or woman age 60 or older.
• Eat a diet high in fat and cholesterol.
• Are overweight or obese.
• Have diabetes.
• Are of Native American, Scandinavian or Hispanic descent.
• Are currently pregnant or have had several pregnancies.
• Are a woman who takes estrogen replacement therapy or birth control pills.
• Have lost weight rapidly.

Symptoms and Causes

What causes cholecystitis?

Cholecystitis is commonly caused by gallstones that have blocked your cystic duct, which prevents bile from exiting your gallbladder. Your gallbladder becomes swollen and may become infected with bacteria. Less common causes include blocked bile ducts due to scarring, reduced blood flow to your gallbladder, tumors that block the flow of bile from your gallbladder, or viral infections that inflame your gallbladder.

Structure of the digestive anatomy showcasing the liver, stomach, pancreas and gallbladder.

What are the symptoms of cholecystitis?

Symptoms can be acute or chronic.

Acute cholecystitis comes on suddenly and causes severe, ongoing pain. More than 95% of people with acute cholecystitis have gallstones. Pain begins in your mid to upper right abdomen and may spread to your right shoulder blade or back. Pain is strongest 15 to 20 minutes after eating and it continues. Pain that remains severe is considered a medical emergency.

Chronic cholecystitis means you’ve had repeated attacks of inflammation and pain. Pain tends to be less severe and doesn’t last as long as acute cholecystitis. The repeated attacks are usually caused by gallstones blocking the cystic duct intermittently.

Other signs and symptoms of cholecystitis may include:

• Tenderness in your abdomen when it’s touched.
• Nausea and bloating.
• Vomiting.
• Fever above 100.4 F (38 C). Fever may not be present in older adults and usually doesn’t occur in people with chronic cholecystitis.
• Chills.
• Abdominal pain that gets worse when taking a deep breath.
• Abdominal pain and cramping after eating – especially fatty foods.
• Jaundice (a yellowing of skin and eyes).

Diagnosis and Tests

How is cholecystitis diagnosed?

Your healthcare professional will ask about your symptoms. They may order blood work to check your white blood cell count and how well your liver is working. A higher than normal white blood cell count is a sign of an infection, inflammation, or an abscess.

Imaging tests that could be ordered include:

• Abdominal ultrasound: This test uses sound waves to examine the gallbladder and the bile ducts. It helps identify signs of inflammation in your gallbladder, the presence of gallstones, and thickening or swelling of the gallbladder wall.
• Hepatobiliary nuclear imaging (HIDA scan): This is an imaging test that involves an injected radioactive substance. A gamma camera sees the radiation as it moves through the different tracts of the digestive system. If that substance doesn’t enter your gallbladder, then the healthcare provider knows the organ is blocked, indicating cholecystitis. This test can also detect the function of the gallbladder and its ability to eject the bile once stimulated. This is called the ejection fraction of the gallbladder, which is considered normal when it is above 30-35%.
• Magnetic Resonance Cholangiopancreatography (MRCP): This type of MRI shows details of your liver, gallbladder, bile ducts, structures and ducts of the pancreas as well. It can show gallstones, inflammation or blockage of the bile ducts and gallbladder and if there is any inflammation of the pancreas.
• Abdominal Computed Tomography (CT Scan): This X-ray test shows details of your liver, gallbladder and bile ducts. It shows inflammation of the gallbladder.

Management and Treatment

How can cholecystitis be treated?

Treatment of cholecystitis usually takes place in the hospital. Treatments may include:

• Fasting, to rest the gallbladder.
• IV fluids to prevent dehydration.
• Pain medication.
• Antibiotics to treat infection.
• Removing the gallbladder. This surgery, called a cholescystectomy, is usually performed by making tiny cuts (incisions) through the abdomen to insert a laparoscope (tiny camera) to see inside the abdomen and surgical instruments to remove the gallbladder. The gallbladder is usually removed within 24 to 48 hours of admission if you have a confirmed case of acute cholecystitis.
• Draining the gallbladder to treat and prevent the spread of infection. This procedure, called percutaneous cholecystostomy, is usually reserved for those who are too ill to undergo surgery.
• Removing gallstones in the area blocking the common bile duct. This procedure, done by an endoscopist, called endoscopic retrograde cholangiopancreatography (ERCP), is reserved for patients with a suspected or confirmed blocked common bile duct, and can clear the duct of stones and sludge.

What is it like to recover from gallbladder surgery?

Recovery from gallbladder surgery, when done laparoscopically, is usually uneventful. As with any surgery there can be minimal pain at the incision sites. Most patients are discharged from the hospital shortly after the surgery, and do not require additional testing or interventions. If the surgery is done through a larger wound (open surgery) then the recovery can be slower and require more days in the hospital.

Can I live without my gallbladder?

Yes, you can live a normal life without a gallbladder. Since the gallbladder’s main role is the storage of the bile, and bile is made continuously by the liver, you don’t need your gallbladder for normal digestion. Bile can still flow directly from your liver, through the common bile duct and into the small intestine.

What complications can occur if cholecystitis is not treated?

Complications can range from ongoing infection to possible death.

• Severely Infected gallbladder: A blocked gallbladder that is extremely uncomfortable and painful. Without treatment, it could lead to an overwhelming infection, or even gangrene of the gallbladder.
• Cholangitis: An acute infection of the main bile ducts and liver that can be extremely life-threating if not promptly treated.
• Inflamed pancreas (Pancreatitis): Your common bile duct and the pancreatic duct share the same “valve” into the duodenum. If a gallstone blocks that valve, the potent pancreatic enzyme juice excreted by the pancreases gets backed up causing pancreatitis, which can also be severe and life threatening.

What if I have cholecystitis during pregnancy?

During early and later pregnancy cholecystitis can be treated by antibiotics. Surgery is usually a safe option during the second trimester, but can also be performed safely at any time if antibiotics fail to treat the infection

Prevention

How can cholecystitis be prevented?

You can reduce your risk of developing cholecystitis by:

• Eating a healthy diet: Choose to eat a healthy diet – one high in fruits, vegetables whole grains and healthy fats – such as the Mediterranean diet. Stay away from foods high in fat and cholesterol.
• Exercising: Exercise reduces cholesterol, and the lower the cholesterol level the lower the chance of getting gallstones.
• Losing weight slowly: If you are making efforts to lose weight, don’t lose more than one to two pounds a week. Rapid weight loss increases your risk for developing gallstones.

Outlook / Prognosis

What is the outlook for patients with cholecystitis?

There is a higher rate of the symptoms recurring if cholecystitis is treated only with medications. There is a higher risk of death, as well, for patients who do not address the worsening conditions.

Surgery to remove the gallbladder (cholecystectomy) is usually the definitive treatment. The benefits of the surgery outweighs the risks in most cases, since the surgical treatment carries very low risk of complications in most cases. Your surgeon will assess your risks for the surgery and discuss all of your treatment options before the operation.

Living With

What’s the difference between cholecystitis and cholelithiasis?

Cholelithiasis is the formation of gallstones. Cholecystitis is the inflammation of the gallbladder.

How do I take care of myself if I have a diagnosis of cholecystitis?

Educate yourself about the symptoms of cholecystitis so that you and your healthcare provider can identify it and treat it as early as possible.

When should I see my healthcare provider?

Abdominal pain of any sort should always be an alarm. If you have sudden pain or bouts of pain in your upper right area of your abdomen or right shoulder or back, contact your healthcare provider.

When should I go to emergency room?

Don’t hesitate to go to the emergency room if you have severe abdominal pain that does not spontaneously resolve or that continues to worsen.

What questions should I ask my doctor?

• Is my pain cholecystitis, for sure, or could it be caused by something else?
• Should my cholecystitis be treated with medication or with surgery, or both?
• What do you think caused these symptoms?
• How quickly am I likely to recover from surgery?
• Keeping my other medical conditions in mind, are there any risks in getting surgery?
• Could I have any non-surgical treatments?
• How quickly should I have surgery?
• What specialist should I follow up with?
• What foods should I eat/avoid?

A note from Cleveland Clinic

If you have pain in the upper right quadrant of your abdomen, seek immediate answers from a healthcare provider. Gallbladder inflammation, whether it’s chronic or acute, requires swift and vigilant care!

Cholecystitis: Gallbladder Inflammation, Symptoms, Treatment

Overview

Anatomy of the gallbladder, featuring gallstones stuck in the cystic duct.

What is cholecystitis?

Cholecystitis is an inflammation of the gallbladder. Your gallbladder is a small pear-shaped organ tucked away under your liver in the upper right section of your abdomen. The gallbladder’s job is to store bile – a fat-digesting fluid made by the liver – and to release it after you eat a meal. Cholecystitis usually develops when the bile gets trapped in your gallbladder, and becomes infected with bacteria. Bile gets trapped when gallstones block the flow of bile out of your gallbladder.

What are gallstones and how do they block the flow of bile?

Gallstones are hardened deposits of the digestive fluids that form in your gallbladder, and can range in size from a tiny grain of sand (called sludge) to a golf ball. They are made up of either cholesterol or pigment stones. Gallstones made of cholesterol are yellow-greenish in color, and are more common. Pigment stones are mostly made of bilirubin, a substance that is created when the liver breaks down red blood cells.

Gallstones themselves are not necessarily a problem. It’s possible to have gallstones sitting in your gallbladder, never bothering you and, in that case, they don’t need to be treated. However, gallstones that leave the gallbladder can get stuck in your ducts (tubes). They block the flow of bile out of your gallbladder, which causes a buildup of bile. These events cause the walls of your gallbladder to become inflamed and swell, and that can lead to bacterial infection of the bile. Your life can even be in danger unless you seek prompt medical and surgical help.

How does the gallbladder work?

The gallbladder connects to your liver by a duct system (tubes) that look like a tree trunk with branches. There are many ducts, or “branches” inside your liver. These tree branches connect to two main tree limbs in your liver, called the right and left hepatic ducts. These two ducts merge (like the trunk of a tree) to form your common hepatic duct. One main “tree limb” coming off the common hepatic duct is called the cystic duct. It connects directly into your gallbladder. The common hepatic duct, the “tree trunk,” continues but its name changes to the common bile duct. Your common bile duct empties into the duodenum section of the small intestine.

Bile, a fat-dissolving liquid substance that is made continuously by your liver, travels through the duct system and enters your digestive system at the duodenum. When you are not eating, a valve structure at the common bile duct and duodenum connection, called the major duodenal papilla, is usually closed. This allows the bile to reflux back through the cystic duct into your gallbladder to be stored. During mealtime, your gallbladder contracts, and the valve opens, pushing the stored bile out of your gallbladder, through the cystic duct and down the common bile duct into your intestine. Bile mixes with the partially digested food, further helping the breakdown of the fat in your diet.

Gallstones, or even sludge, in the gallbladder can obstruct this normal flow of bile, leading to cholecystitis.

How common is cholecystitis?

Approximately 120,000 Americans are treated for acute cholecystitis every year. Women make up 60% of this number.

Who is at risk to get cholecystitis?

You are at greater risk of developing cholecystitis if you:

• Have a family history of gallstones.
• Are a woman age 50 or older.
• Are a man or woman age 60 or older.
• Eat a diet high in fat and cholesterol.
• Are overweight or obese.
• Have diabetes.
• Are of Native American, Scandinavian or Hispanic descent.
• Are currently pregnant or have had several pregnancies.
• Are a woman who takes estrogen replacement therapy or birth control pills.
• Have lost weight rapidly.

Symptoms and Causes

What causes cholecystitis?

Cholecystitis is commonly caused by gallstones that have blocked your cystic duct, which prevents bile from exiting your gallbladder. Your gallbladder becomes swollen and may become infected with bacteria. Less common causes include blocked bile ducts due to scarring, reduced blood flow to your gallbladder, tumors that block the flow of bile from your gallbladder, or viral infections that inflame your gallbladder.

Structure of the digestive anatomy showcasing the liver, stomach, pancreas and gallbladder.

What are the symptoms of cholecystitis?

Symptoms can be acute or chronic.

Acute cholecystitis comes on suddenly and causes severe, ongoing pain. More than 95% of people with acute cholecystitis have gallstones. Pain begins in your mid to upper right abdomen and may spread to your right shoulder blade or back. Pain is strongest 15 to 20 minutes after eating and it continues. Pain that remains severe is considered a medical emergency.

Chronic cholecystitis means you’ve had repeated attacks of inflammation and pain. Pain tends to be less severe and doesn’t last as long as acute cholecystitis. The repeated attacks are usually caused by gallstones blocking the cystic duct intermittently.

Other signs and symptoms of cholecystitis may include:

• Tenderness in your abdomen when it’s touched.
• Nausea and bloating.
• Vomiting.
• Fever above 100.4 F (38 C). Fever may not be present in older adults and usually doesn’t occur in people with chronic cholecystitis.
• Chills.
• Abdominal pain that gets worse when taking a deep breath.
• Abdominal pain and cramping after eating – especially fatty foods.
• Jaundice (a yellowing of skin and eyes).

Diagnosis and Tests

How is cholecystitis diagnosed?

Your healthcare professional will ask about your symptoms. They may order blood work to check your white blood cell count and how well your liver is working. A higher than normal white blood cell count is a sign of an infection, inflammation, or an abscess.

Imaging tests that could be ordered include:

• Abdominal ultrasound: This test uses sound waves to examine the gallbladder and the bile ducts. It helps identify signs of inflammation in your gallbladder, the presence of gallstones, and thickening or swelling of the gallbladder wall.
• Hepatobiliary nuclear imaging (HIDA scan): This is an imaging test that involves an injected radioactive substance. A gamma camera sees the radiation as it moves through the different tracts of the digestive system. If that substance doesn’t enter your gallbladder, then the healthcare provider knows the organ is blocked, indicating cholecystitis. This test can also detect the function of the gallbladder and its ability to eject the bile once stimulated. This is called the ejection fraction of the gallbladder, which is considered normal when it is above 30-35%.
• Magnetic Resonance Cholangiopancreatography (MRCP): This type of MRI shows details of your liver, gallbladder, bile ducts, structures and ducts of the pancreas as well. It can show gallstones, inflammation or blockage of the bile ducts and gallbladder and if there is any inflammation of the pancreas.
• Abdominal Computed Tomography (CT Scan): This X-ray test shows details of your liver, gallbladder and bile ducts. It shows inflammation of the gallbladder.

Management and Treatment

How can cholecystitis be treated?

Treatment of cholecystitis usually takes place in the hospital. Treatments may include:

• Fasting, to rest the gallbladder.
• IV fluids to prevent dehydration.
• Pain medication.
• Antibiotics to treat infection.
• Removing the gallbladder. This surgery, called a cholescystectomy, is usually performed by making tiny cuts (incisions) through the abdomen to insert a laparoscope (tiny camera) to see inside the abdomen and surgical instruments to remove the gallbladder. The gallbladder is usually removed within 24 to 48 hours of admission if you have a confirmed case of acute cholecystitis.
• Draining the gallbladder to treat and prevent the spread of infection. This procedure, called percutaneous cholecystostomy, is usually reserved for those who are too ill to undergo surgery.
• Removing gallstones in the area blocking the common bile duct. This procedure, done by an endoscopist, called endoscopic retrograde cholangiopancreatography (ERCP), is reserved for patients with a suspected or confirmed blocked common bile duct, and can clear the duct of stones and sludge.

What is it like to recover from gallbladder surgery?

Recovery from gallbladder surgery, when done laparoscopically, is usually uneventful. As with any surgery there can be minimal pain at the incision sites. Most patients are discharged from the hospital shortly after the surgery, and do not require additional testing or interventions. If the surgery is done through a larger wound (open surgery) then the recovery can be slower and require more days in the hospital.

Can I live without my gallbladder?

Yes, you can live a normal life without a gallbladder. Since the gallbladder’s main role is the storage of the bile, and bile is made continuously by the liver, you don’t need your gallbladder for normal digestion. Bile can still flow directly from your liver, through the common bile duct and into the small intestine.

What complications can occur if cholecystitis is not treated?

Complications can range from ongoing infection to possible death.

• Severely Infected gallbladder: A blocked gallbladder that is extremely uncomfortable and painful. Without treatment, it could lead to an overwhelming infection, or even gangrene of the gallbladder.
• Cholangitis: An acute infection of the main bile ducts and liver that can be extremely life-threating if not promptly treated.
• Inflamed pancreas (Pancreatitis): Your common bile duct and the pancreatic duct share the same “valve” into the duodenum. If a gallstone blocks that valve, the potent pancreatic enzyme juice excreted by the pancreases gets backed up causing pancreatitis, which can also be severe and life threatening.

What if I have cholecystitis during pregnancy?

During early and later pregnancy cholecystitis can be treated by antibiotics. Surgery is usually a safe option during the second trimester, but can also be performed safely at any time if antibiotics fail to treat the infection

Prevention

How can cholecystitis be prevented?

You can reduce your risk of developing cholecystitis by:

• Eating a healthy diet: Choose to eat a healthy diet – one high in fruits, vegetables whole grains and healthy fats – such as the Mediterranean diet. Stay away from foods high in fat and cholesterol.
• Exercising: Exercise reduces cholesterol, and the lower the cholesterol level the lower the chance of getting gallstones.
• Losing weight slowly: If you are making efforts to lose weight, don’t lose more than one to two pounds a week. Rapid weight loss increases your risk for developing gallstones.

Outlook / Prognosis

What is the outlook for patients with cholecystitis?

There is a higher rate of the symptoms recurring if cholecystitis is treated only with medications. There is a higher risk of death, as well, for patients who do not address the worsening conditions.

Surgery to remove the gallbladder (cholecystectomy) is usually the definitive treatment. The benefits of the surgery outweighs the risks in most cases, since the surgical treatment carries very low risk of complications in most cases. Your surgeon will assess your risks for the surgery and discuss all of your treatment options before the operation.

Living With

What’s the difference between cholecystitis and cholelithiasis?

Cholelithiasis is the formation of gallstones. Cholecystitis is the inflammation of the gallbladder.

How do I take care of myself if I have a diagnosis of cholecystitis?

Educate yourself about the symptoms of cholecystitis so that you and your healthcare provider can identify it and treat it as early as possible.

When should I see my healthcare provider?

Abdominal pain of any sort should always be an alarm. If you have sudden pain or bouts of pain in your upper right area of your abdomen or right shoulder or back, contact your healthcare provider.

When should I go to emergency room?

Don’t hesitate to go to the emergency room if you have severe abdominal pain that does not spontaneously resolve or that continues to worsen.

What questions should I ask my doctor?

• Is my pain cholecystitis, for sure, or could it be caused by something else?
• Should my cholecystitis be treated with medication or with surgery, or both?
• What do you think caused these symptoms?
• How quickly am I likely to recover from surgery?
• Keeping my other medical conditions in mind, are there any risks in getting surgery?
• Could I have any non-surgical treatments?
• How quickly should I have surgery?
• What specialist should I follow up with?
• What foods should I eat/avoid?

A note from Cleveland Clinic

If you have pain in the upper right quadrant of your abdomen, seek immediate answers from a healthcare provider. Gallbladder inflammation, whether it’s chronic or acute, requires swift and vigilant care!

Acute cholecystitis – Illnesses & conditions

Acute cholecystitis is swelling (inflammation) of the gallbladder. It is a potentially serious condition that usually needs to be treated in hospital.

The main symptom of acute cholecystitis is a sudden sharp pain in the upper right side of your tummy (abdomen) that spreads towards your right shoulder.

The affected part of the abdomen is usually extremely tender, and breathing deeply can make the pain worse.

Unlike some others types of abdominal pain, the pain associated with acute cholecystitis is usually persistent, and doesn’t go away within a few hours.

Some people may additional symptoms, such as:

• a high temperature (fever)
• nausea and vomiting
• sweating
• loss of appetite
• yellowing of the skin and the whites of the eyes (jaundice)
• a bulge in the abdomen

When to seek medical advice

You should see your GP as soon as possible if you develop sudden and severe abdominal pain, particularly if the pain lasts longer than a few hours or is accompanied by other symptoms, such as jaundice and a fever.

If it’s not possible to contact your GP immediately, phone your local out-of-hours service or call the NHS 24 111 service for advice.

It’s important for acute cholecystitis to be diagnosed as soon as possible, because there is a risk that serious complications could develop if the condition is not treated promptly (see below).  

What causes acute cholecystitis?

The causes of acute cholecystitis can be grouped into 2 main categories: calculous cholecystitis and acalculous cholecystitis.

Calculous cholecystitis

Calculous cholecystitis is the most common, and usually less serious, type of acute cholecystitis. It accounts for around 95% of all cases.

Calculous cholecystitis develops when the main opening to the gallbladder, called the cystic duct, gets blocked by a gallstone or by a substance known as biliary sludge.

Biliary sludge is a mixture of bile (a liquid produced by the liver that helps digest fats) and small crystals of cholesterol and salt.

The blockage in the cystic duct results in a build-up of bile in the gallbladder, increasing the pressure inside it and causing it to become inflamed. In around 1 in every 5 cases, the inflamed gallbladder also becomes infected by bacteria.

Acalculous cholecystitis

Acalculous cholecystitis is a less common, but usually more serious, type of acute cholecystitis. It usually develops as a complication of a serious illness, infection or injury that damages the gallbladder.

Acalculous cholecystitis is often associated with problems such as accidental damage to the gallbladder during major surgery, serious injuries or burns, blood poisoning (sepsis), severe malnutrition or AIDS.

Who is affected

Acute cholecystitis is a relatively common complication of gallstones.

It is estimated that around 10-15% of adults in the UK have gallstones. These don’t usually cause any symptoms, but in a small proportion of people they can cause infrequent episodes of pain (known as biliary colic) or acute cholecystitis.

Diagnosing cholecystitis

To diagnose acute cholecystitis, your GP will examine your abdomen.

They will probably carry out a simple test called Murphy’s sign. You will be asked to breathe in deeply with your GP’s hand pressed on your tummy, just below your rib cage.

Your gallbladder will move downwards as your breathe in and, if you have cholecystitis, you will experience sudden pain as your gallbladder reaches your doctor’s hand.

If your symptoms suggest you have acute cholecystitis, your GP will refer you to hospital immediately for further tests and treatment.

Tests you may have in hospital include:

• blood tests to check for signs of inflammation in your body
• an ultrasound scan of your abdomen to check for gallstones or other signs of a problem with your gallbladder

Other scans – such as an X-ray, a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan – may also be carried out to examine your gallbladder in more detail if there is any uncertainty about your diagnosis.

Treating acute cholecystitis

If you are diagnosed with acute cholecystitis, you will probably need to be admitted to hospital for treatment.

Initial treatment

Initial treatment will usually involve:

• fasting (not eating or drinking) to take the strain off your gallbladder
• receiving fluids through a drip directly into a vein (intravenously) to prevent dehydration
• taking medication to relieve your pain

If you have a suspected infection, you will also be given antibiotics. These often need to be continued for up to a week, during which time you may need to stay in hospital or you may be able to go home.

With this initial treatment, any gallstones that may have caused the condition usually fall back into the gallbladder and the inflammation often settles down.

Surgery

In order to prevent acute cholecystitis recurring, and reduce your risk of developing potentially serious complications, the removal of your gallbladder will often be recommended at some point after the initial treatment. This type of surgery is known as a cholecystectomy.

Although uncommon, an alternative procedure called a percutaneous cholecystostomy may be carried out if you are too unwell to have surgery. This is where a needle is inserted through your abdomen to drain away the fluid that has built up in the gallbladder.

If you are fit enough to have surgery, your doctors will need to decide when the best time to remove your gallbladder may be. In some cases, you may need to have surgery immediately or in the next day or 2, while in other cases you may be advised to wait for the inflammation to fully resolve over the next few weeks.

Surgery can be carried out in two main ways:

• laparoscopic cholecystectomy – a type of keyhole surgery where the gallbladder is removed using special surgical instruments inserted through a number of small cuts (incisions) in your abdomen
• open cholecystectomy – where the gallbladder is removed through a single, larger incision in your abdomen

Although some people who have had their gallbladder removed have reported symptoms of bloating and diarrhoea after eating certain foods, you can lead a perfectly normal life without a gallbladder.

The organ can be useful but it’s not essential, as your liver will still produce bile to digest food.

Possible complications

Without appropriate treatment, acute cholecystitis can sometimes lead to potentially life-threatening complications.

The main complications of acute cholecystitis are:

• the death of the tissue of the gallbladder, called gangrenous cholecystitis, which can cause a serious infection that could spread throughout the body
• the gallbladder splitting open, known as a perforated gallbladder, which can spread the infection within your abdomen (peritonitis) or lead to a build-up of pus (abscess)

In about 1 in every 5 cases of acute cholecystitis, emergency surgery to remove the gallbladder is needed to treat these complications.

Preventing acute cholecystitis

It’s not always possible to prevent acute cholecystitis, but you can reduce your risk of developing the condition by cutting your risk of gallstones.

One of the main steps you can take to help lower your chances of developing gallstones is adopting a healthy, balanced diet and reducing the number of high-cholesterol foods you eat, as cholesterol is thought to contribute to the formation of gallstones.

Being overweight, particularly being obese, also increases your risk of developing gallstones. You should therefore control your weight by eating a healthy diet and exercising regularly.

However, low-calorie, rapid weight loss diets should be avoided, because there is evidence they can disrupt your bile chemistry and actually increase your risk of developing gallstones. A more gradual weight loss plan is best. 

Read more about preventing gallstones.

Gallbladder inflammation symptoms: Signs, complications, and causes

The gallbladder is a pear-shaped digestive organ located on the right side of the abdomen. Its role is to store and release bile for fat digestion.

When inflamed, it can cause abdominal pain, vomiting, and fever.

It connects to the liver by a duct. If a stone blocks this duct, bile backs up, causing the gallbladder to become inflamed. This is known as acute cholecystitis.

The gallbladder swells and becomes red during a bout of inflammation, and the buildup of fluid in the organ can develop a secondary infection.

This article identifies the symptoms of a gallbladder infection and how to treat the condition.

The most common symptoms of gallbladder inflammation are:

• Upper-right quadrant pain: This pain often has a sudden onset, often occurring shortly after a high-fat meal. It may start just above the bellybutton but will eventually settle under the edge of the ribcage on the right side of the abdomen, around the location of the gallbladder.
• Nausea and vomiting: Fats cannot be broken down for digestion due to the obstructed bile duct, resulting in a lack of appetite, feelings of nausea, and vomiting.
• Fever: A fever over 100 °Fahrenheit (37.8 °Celsius) occurs in about one-half of individuals with cholecystitis.
• Malaise: A person with an inflamed gallbladder may experience a general feeling of discomfort, illness, and uneasiness. Malaise is a common complaint with many illnesses and is often the first indication of inflammation or infection.

Additional gallbladder inflammation symptoms may vary based on age and overall state of health.

Gallbladder pain first presents in the form of spasmodic pains in the abdomen but over time will change to a steady, severe pain that resting, changing position, or using other measures does not resolve. Pain may also occur in the right shoulder or upper-right region of the back.

The pain will intensify over time, especially when taking a deep breath or with any kind of movement. Most people call their doctor within 4 of 6 hours of experiencing this type of pain.

In children and older adults, gallbladder symptoms may be vague. They may not experience pain or fever and complain only of malaise, lack of appetite, and weakness. Some people with gallbladder inflammation encounter a yellow tinge to the skin, known as jaundice. However, this is rare.

In an emergency room, a person with an acutely inflamed gallbladder will usually lie perfectly still on the examining table because the slightest movement can aggravate their pain.

The individual might also tense the abdominal muscles, which will feel similar to a spasm. Tensing these muscles, or guarding, helps protect the inflamed organ from the potential pain of examination.

In some cases, an inflamed gallbladder can rupture and progress to a life-threatening infection called sepsis.

Any individual experiencing symptoms of gallbladder inflammation must seek immediate medical attention to avoid any potentially serious or life-threatening complications.

A surgeon will often remove the gallbladder to prevent the progression of cholecystitis into more severe conditions.

Many gallbladder inflammation cases occur as a result of gallstones. These are small crystal-like masses made up of bile pigments, cholesterol, and calcium salts.

Roughly 10 to 15 percent of Americans have gallstones, and as many as one-third of these people will develop inflammation. Gallstones do not usually cause symptoms on their own.

The risk of gallbladder inflammation increases with age. Other risk factors include:

• being female
• pregnancy
• obesity
• diabetes
• a history of gallstones
• rapid weight loss

Tackling gallbladder inflammation is vital for preventing the development of any potentially fatal complications.

Symptoms, causes, diagnosis, and treatment

Cholecystitis is an inflammation of the gallbladder. It normally happens because a gallstone gets stuck at the opening of the gallbladder. It can lead to fever, pain, nausea, and severe complications.

Untreated, it can result in perforation of the gallbladder, tissue death and gangrene, fibrosis and shrinking of the gallbladder, or secondary bacterial infections.

Gallstones are involved in 95 percent of cholecystitis cases. These may be formed from cholesterol, a pigment known as bilirubin, or a mix of the two. It can also be triggered by biliary sludge when bile collects in the biliary ducts.

Other causes include trauma, critical illness, immunodeficiency, or certain medications. Some chronic medical conditions, like kidney failure, coronary heart disease, or certain types of cancer also increase the risk of cholecystitis.

In the United States, there were 215,995 hospital admissions for cholecystitis in 2012, and the average hospital stay was 3.9 days.

Acute cholecystitis starts suddenly. Chronic cholecystitis develops slowly over time.

Share on PinterestA healthy diet can help prevent gallstones, a common cause of cholecystitis.

A patient with cholecystitis will be hospitalized, and they will probably not be allowed to consume any solid or liquid foods for some time. They will be given liquids intravenously while fasting. Pain medications and antibiotics may also be given.

Surgery is recommended for acute cholecystitis because there is a high rate of recurrence from inflammation related to gallstones. However, if there is a low risk of complications, surgery can be done as an outpatient procedure.

If there are complications, such as gangrene or perforation of the gallbladder, the patient will need immediate surgery to remove the gallbladder. If the patient has an infection, a tube may be inserted through the skin into the gallbladder to drain the infection.

Removal of the gallbladder, or cholecystectomy, can be performed by open abdominal excision or laparoscopically.

Laparoscopic cholecystectomy involves several small incisions in the skin. A camera is inserted into one incision to help the surgeon see inside the abdomen, and tools for removing the gallbladder and inserted through the other incisions.

The benefit of laparoscopy is that the incisions are small, so patients usually have less pain after the procedure and less scarring.

After surgically removing the gallbladder, the bile will flow directly into the small intestine from the liver. This does not normally affect the patient’s overall health and digestive system. Some patients may have more frequent episodes of diarrhea.

Upon recovery from the condition, it is important to make dietary adjustments that help bring bile production back to normal.

Be sure to eat smaller meals more frequently and avoid large servings or portions. These can upset the system and produce a gallbladder or bile duct spasm.

Avoid high-fat and fried foods, including whole milk products, and stick to lean proteins.

The gallbladder is a small, pear-shaped organ connected to the liver, on the right side of the abdomen. It stores bile and releases it into the small intestine to help in the digestion of fat.

The gallbladder holds bile, a fluid that is released after we eat, especially after a meal that is high in fat, and this bile aids digestion. The bile travels out of the gallbladder through the cystic duct, a small tube that leads to the common bile duct, and from there into the small intestine.

The main cause of cholecystitis is gallstones or biliary sludge getting trapped at the gallbladder’s opening. This is sometimes called a pseudolith, or “fake stone.”

Other causes include:

• injury to the abdomen from burns, sepsis or trauma, or because of surgery
• shock
• immune deficiency
• prolonged fasting
• vasculitis

An infection in the bile can lead to inflammation of the gallbladder.

A tumor may stop the bile from draining out of the gallbladder properly, resulting in an accumulation of bile. This can lead to cholecystitis.

Signs and symptoms of cholecystitis include right upper quadrant pain, fever, and a high white blood cell count.

Pain generally occurs around the gallbladder, in the right upper quadrant of the abdomen.

In cases of acute cholecystitis, the pain starts suddenly, it does not go away, and it is intense. Left untreated, it will usually get worse, and breathing in deeply will make it feel more intense. The pain may radiate from the abdomen to the right shoulder or back.

Other symptoms may include:

• abdominal bloating
• tenderness on the upper-right hand side of the abdomen
• little or no appetite
• nausea
• vomiting
• sweating

A slight fever and chills may be present with acute cholecystitis.

After a meal, especially one that is high in fat, symptoms will worsen. A blood test may reveal a high white blood cell count.

A doctor will normally ask if a patient has a history of cholecystitis because it often recurs. A physical examination will reveal how tender the gallbladder is.

The following tests may also be ordered:

• Ultrasound: This can highlight any gallstones and may show the condition of the gallbladder.
• Blood test: A high white blood cell count may indicate an infection. High levels of bilirubin, alkaline phosphatase, and serum aminotransferase may also help the doctor make a diagnosis.
• Computerized tomography (CT) or ultrasound scans: Images of the gallbladder may reveal signs of cholecystitis.
• Hepatobiliary iminodiacetic acid (HIDA) scan: Also known as a cholescintigraphy, hepatobiliary scintigraphy or hepatobiliary scan, this scan creates pictures of the liver, gallbladder, biliary tract and small intestine.

This allows the doctor to track the production and flow of bile from the liver to the small intestine and determine whether there is a blockage, and where any blockage is.

The following factors may increase the risk of developing gallstones:

• a family history of gallstones on the mother’s side of the family
• Crohn’s disease
• diabetes
• coronary artery disease
• end-stage kidney disease
• hyperlipidemia
• losing weight rapidly
• obesity
• older age
• pregnancy

Long labor during childbirth can damage the gallbladder, raising the risk of cholecystitis during the following weeks.

Untreated acute cholecystitis can lead to:

• A fistula, a kind of tube or channel, can develop if a large stone erodes the wall of the gallbladder. This can link the gallbladder and the duodenum, and the stone may pass through.
• Gallbladder distention: If the gallbladder is inflamed because of bile accumulation, it may stretch and swell, causing pain. There is then a much greater risk of a perforation, or tear, in the gallbladder, as well as infection and tissue death.
• Tissue death: Gallbladder tissue can die, and gangrene develops, leading to perforation, or the bursting of the bladder. Without treatment, 10 percent of patients with acute cholecystitis will experience localized perforation, and 1 percent will develop free perforation and peritonitis.

If a gallstone becomes impacted in the cystic duct, it can compress and block the common bile duct, and this can lead to cholestasis. This is rare.

Gallstones can sometimes pass from the gallbladder into the biliary tract, leading to an obstruction of the pancreatic duct. This may cause pancreatitis.

In 3 percent to 19 percent of cases, acute cholecystitis can lead to a pericholecystic abscess. Symptoms include nausea, vomiting, and abdominal pain.

Some measures can reduce the risk of developing gallstones, and this can decrease the chance of developing cholecystitis:

• avoiding saturated fats
• keeping to a regular breakfast, lunch and dinner times and not skipping meals
• exercising 5 days per week for at least 30 minutes each time
• losing weight, because obesity increases the risk of gallstones
• avoiding rapid weight loss as this increases the risk of developing gallstones

A healthy weight loss is generally around 1 to 2 pounds, or 0.5 to 1 kilograms, of body weight per week.

The nearer a person is to their ideal body weight, the lower the risk will be of developing gallstones. Gallstones are more prevalent in people with obesity, compared with those who have an appropriate body weight for their age, height, and body frame.

Cholecystitis (Gallbladder inflammation), Diagnosis & Treatment

Cholecystitis (ko-luh-sis-TIE-tis) is inflammation of the gallbladder. It usually occurs when drainage from the gallbladder becomes blocked (often from a gallstone). It may be acute (come on suddenly) and cause severe pain in the upper abdomen. Or it may be chronic (multiple recurrent episodes) with swelling and irritation that occurs over time.

Your doctor may use abdominal ultrasound, abdominal CT, magnetic resonance cholangiopancreatography (MRCP) or nuclear imaging to help diagnose your condition. Treatment may include fasting, antibiotic medication and having a drainage tube placed in the gallbladder. However, because it can often reoccur, the most common treatment is to have surgery to remove your gallbladder.

What is cholecystitis?

Cholecystitis means inflammation of the gallbladder. The gallbladder is a pear-shaped organ that sits beneath your liver and stores bile. If your gallbladder is inflamed, you may have pain in the upper right or mid-portion of the abdomen and you may be tender to the touch there.

Bile is made in the liver. The gallbladder stores bile and pushes it into the small intestine where it is used to help digest food. When the drainage pathway for the bile stored in the gallbladder (called the cystic duct) becomes blocked, usually by a gallstone, the gallbladder becomes swollen and may become infected. This results in cholecystitis. The cystic duct drains into the common bile duct, which carries the bile into the small intestine. A gallstone may also become stuck in the common bile duct. This condition (choledocholithiasis) requires a procedure to remove or bypass the blockage.

Cholecystitis may be:

• Acute (occur suddenly) – This inflammation often causes severe pain in the mid or right upper abdomen. Pain can also spread between the shoulder blades. In severe cases, the gallbladder may tear or burst and release bile into the abdomen, causing severe pain. This can be a life-threatening situation that requires immediate attention.
• Chronic (multiple episodes of inflammation) – Recurrent bouts of mild swelling and irritation/inflammation will often damage the wall of the gallbladder causing it to thicken, shrink and lose proper function

Other symptoms include:

• nausea
• vomiting
• fever
• abdominal pain that gets worse when taking a deep breath
• abdominal pain and cramping after meals (especially fatty foods)

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How is cholecystitis diagnosed and evaluated?

Your doctor may order blood tests to see if you have a gallbladder infection. Often, the white blood cell count in our blood may become elevated as a sign of the infection. One or more of the following radiology tests also may be done:

• Abdominal ultrasound: This is often the first test done to evaluate for cholecystitis. Ultrasound uses sound waves to produce pictures of the gallbladder and the bile ducts. It is used to identify signs of inflammation involving the gallbladder and is very good at showing gallstones.
• Abdominal CT: Computed tomography (CT) uses x-rays to produce detailed pictures of the abdomen, liver, gallbladder, bile ducts and intestine to help identify inflammation of the gallbladder or blocked bile flow. Sometimes (but not always) it can also show gallstones. See the Radiation Dose page for more information about CT.
• Magnetic resonance cholangiopancreatography (MRCP): MRCP is a type of MRI exam that makes detailed images of the liver, gallbladder, bile ducts, pancreas and pancreatic duct. It is very good at showing gallstones, gallbladder or bile duct inflammation, and blocked bile flow. See the MRI Safety page for more information.
• Hepatobiliary nuclear imaging: This nuclear medicine test uses an injected radiotracer to help evaluate disorders of the liver, gallbladder and bile duct (biliary system). In acute cholecystitis, it can detect blockage of the cystic duct (the duct that is always blocked with acute cholecystitis).

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How is cholecystitis treated?

Your doctor may suggest:

• fasting to rest the gallbladder
• a special, low-fat diet
• pain medication
• antibiotics to treat infection

However, because the condition may come back often, your doctor may recommend you have your gallbladder removed using either:

• laparoscopic surgery. The surgeon uses the belly button and several small cuts to insert a laparoscope to see inside the abdomen and remove the gallbladder. You will be asleep for the surgery.
• open surgery. The surgeon makes a cut in the abdomen and removes the gallbladder. You will be asleep for the surgery. See the Anesthesia Safety page for more information.

If you cannot have surgery, your doctor may drain bile from the gallbladder. This may be done by:

• Percutaneous cholecystostomy: This procedure is done by a radiologist. It places a tube through the skin directly into the gallbladder using ultrasound or CT guidance. Blocked or infected bile is removed to reduce inflammation. This procedure is typically done in patients who are too sick to have their gallbladder removed. You will be sedated for this procedure. The tube typically has to stay in for at least a few weeks.
• Endoscopic retrograde cholangiopancreatography (ERCP): This procedure is typically done by a doctor who specializes in abdominal disorders (a gastroenterologist). A camera on a flexible tube is passed from the mouth through the stomach and into the beginning of the small bowel. This is where the common bile duct meets the small intestine. The valve mechanism (called the sphincter) at the end of the bile duct can be examined and opened to clear blocked bile and stones, if necessary. Doctors can also insert a small tube into the main bile duct and inject contrast material to better see the duct. They also may use a laser fiber to destroy small gallstones or use a basket or balloon to retrieve stones or stone fragments. All of this may be done without making any incisions in the abdomen. This procedure poses a small, but real risk of pancreas inflammation or injury. You will be sedated for this procedure.
• Percutaneous transhepatic cholangiography (PTC): This procedure is done by a radiologist. A needle is placed in the bile ducts within the liver using imaging guidance. Contrast material is injected to help locate gallstones that may be blocking bile flow. Some stones can be removed during a PTC. Others may be bypassed by leaving a small stent in place to allow bile to get around the area of blockage. This helps reduce inflammation. You will be sedated for this procedure. See the Biliary Interventions page for more information.

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Which test, procedure or treatment is best for me?

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This page was reviewed on January, 15, 2019

Cholecystitis – inflammation of the gallbladder

Cholecystitis is an inflammation of the walls of the gallbladder. It can occur both in the presence of gallstone disease and in the absence of stones in the gallbladder.

Classification

According to the severity and duration of symptoms, acute and chronic forms of cholecystitis can be distinguished.

Acute cholecystitis

It is characterized by a sudden onset – within a few hours after blockage of the cystic duct, severe pain in the right half of the abdomen, fever, changes in laboratory parameters (a significant increase in leukocytes, C-reactive protein).It is most often associated with a violation of the diet, excessive consumption of spicy and fatty foods, as well as sometimes with driving on uneven roads, stress, taking choleretic drugs

In 90% of cases, this occurs in patients with cholelithiasis, and only 5-10% occurs in patients with acalculous (non-stone) cholecystitis. Gangrene and rupture of the gallbladder can be severe and sometimes dangerous complications of acute cholecystitis.

Chronic cholecystitis

Chronic cholecystitis, as a rule, is caused by repeated attacks of biliary colic, which cause thickening of the walls of the gallbladder as a result of inflammation and impaired motor activity.Over time, chronic bile stasis occurs in the gallbladder, leading to an increase in its concentration and precipitation of cholesterol / bilirubin, followed by the formation of stones.

Reasons

With prolonged stagnation of bile in the gallbladder, the components of bile (most often cholesterol) begin to crystallize and precipitate. Microscopic crystals grow in size over time, merge with each other and form stones.

The gallbladder is normally pear-shaped.Its length is 7-10 cm, width – 3-4 cm, capacity – 40-70 ml (in women, the gallbladder in a state of functional rest has a slightly larger volume than in men, but it contracts faster). It distinguishes between the bottom, the body and the neck, passing into the cystic duct. The outflow of bile from the gallbladder is regulated by the sphincter of Lutkens, and from the common bile duct – by the sphincter of Oddi.

On average, up to 1.5 liters of bile are formed in the human body per day. However, its entry into the intestine normally occurs mainly during digestion.This is provided by the reservoir function of the gallbladder and its rhythmic contractions with successive relaxation of the said sphincter of Lutkens and then the sphincter of Oddi, located at the confluence of the common bile duct into the intestine. In the gallbladder, bile is concentrated 5-10 times.

Risk factors for gallstones:

1. Genetic predisposition.

2. Age from 40 to 70 years.

3. Female gender: blood estrogen levels, oral contraceptive use, pregnancy significantly increase the risk.

4. Improper diet and sudden weight change:

   • eating food with a high cholesterol content;

   • increase in consumption of fats, refined carbohydrates;

   • unbalanced diet, lack of diet;

   • long-term parenteral nutrition;

   • fasting, fast weight loss: loss of more than 24% of weight, weight loss of more than 1.5 kg per week, low-calorie diets by reducing the amount of fat.

5. Metabolic disorders (metabolic syndrome, diabetes mellitus).

6. Crohn’s disease (inflammatory bowel disease leading to impaired absorption of bile salts from the intestine), certain blood diseases, cirrhosis of the liver.

Signs and symptoms

For cholecystitis, pain in the right hypochondrium or in the epigastric region, radiating to the right scapula, shoulder or collarbone, is typical.They are dull or paroxysmal in nature, varying in intensity and duration.

In biliary colic, the intensity of pain often increases for an hour, then the pain becomes constant for several hours, after which it gradually decreases and disappears when the mobile stone returns to the cavity of the gallbladder. There is no pain between attacks.

Complications

If an attack lasts more than 6 hours, is accompanied by vomiting and fever, there is a high probability of developing acute calculous cholecystitis (inflammation of the gallbladder), obstructive jaundice associated with blockage of the bile duct, or pancreatitis (acute inflammation of the pancreas).All of these conditions require urgent hospitalization and emergency surgical care.

Long-term carriage of stones is accompanied by secondary infection and the development of chronic cholecystitis, which entails various diseases of the liver and pancreas. In addition, long-term inflammation increases the risk of developing gallbladder cancer.

Diagnostics

When seeking medical help, the patient must be examined by a surgeon, and even before carrying out instrumental diagnostic methods, the doctor checks some specific symptoms indicating the presence of acute cholecystitis:

1. Ortner’s symptom – pain that appears in the gallbladder area with light tapping with the edge of the palm along the right costal arch;

2. Murphy’s symptom – an increase in pain that occurs at the time of palpation of the gallbladder with a deep breath of the patient.If the patient’s deep breath is interrupted, not reaching height, due to acute pain in the right hypochondrium under the thumb, then Murphy’s symptom is positive;

3. Courvoisier’s symptom – an increase in the gallbladder is determined by palpation of the elongated part of its bottom, which quite clearly protrudes from under the edge of the liver;

4. Mussey symptom (frenicus symptom) – pain on palpation in the area above the collarbone.

After examination, the patient undergoes a weight range of instrumental diagnostic measures (the volume of which may vary depending on the severity and duration of symptoms):

• ultrasound examination of the abdominal organs,

• MSCT of the abdominal organs, in some cases MRCP (magnetic resonance cholangiopancreatography),

• laboratory tests: general blood test with leukocyte formula, C-reactive protein, biochemical blood test.

Treatment of cholecystitis

Treatment of patients with acute cholecystitis is aimed at reducing the severity of inflammation and, in most cases, subsequent removal of the gallbladder (cholecystectomy).

Conservative treatment

Within the framework of conservative (non-surgical) treatment, infusion (replenishment of fluid balance, correction of water-electrolyte disturbances) and antibiotic therapy are carried out. Antibiotics are used in almost all cases of cholecystitis (with the exception of a mild course and in the absence of stones).The duration of admission is determined by the rate of regression of clinical symptoms, as well as by the laboratory picture.

The following bacterial agents are most commonly detected in bile: Escherichia coli (41%), Enterococcus (12%), Klebsiella (11%) and Enterobacter (9%). An ideal antibiotic regimen should be effective against all bacterial agents. The most commonly used amoxicillin with clavulonic acid is at least 5 days.

It is imperative to provide adequate pain relief and thereby reduce the suffering of the patient.The most commonly used drugs from the group of non-steroidal anti-inflammatory drugs (ibuprofen), but sometimes you have to resort to opioid analgesics. The latter are rarely used due to the fact that they can increase the pressure in the area of ​​the sphincter of Oddi and thereby further aggravate the patient’s condition.

We do not recommend for cholelithiasis the use of drugs that affect the rheology of bile, contribute to the dissolution of stones in the gallbladder, due to their potential danger – they can provoke choledocholithiasis (“loss” of small stones in the bile duct and blockage of the latter with the occurrence of severe and potentially life-threatening condition – obstructive jaundice).

Surgical treatment

With large stones and in the presence of certain concomitant diseases (for example, diabetes mellitus), with pathological changes in the gallbladder itself, the doctor may recommend removing the gallbladder.

Removal of the gallbladder – the “gold standard” in the treatment of calculous cholecystitis against the background of cholelithiasis. Patients who do not require emergency surgery (non-calculous cholecystitis, mild inflammation) should be risk stratified to determine whether they require early or delayed gallbladder surgery.

If the patient is concerned about biliary colic attacks, surgeons recommend elective cholecystectomy. Each subsequent attack can cause the development of acute cholecystitis with severe complications from the liver and pancreas.

Benefits of Cholecystectomy with EMC

Doctors of the surgical clinic perform surgical interventions for cholecystitis around the clock. In the clinic, removal of the gallbladder is performed by laparoscopic access (through several small punctures, or through one – a promising technique of single-puncture laparoscopic surgery), which is the “gold standard” for cholecystectomy all over the world.Cholecystectomy improves the patient’s condition and does not affect the digestive function.

In the postoperative period, the patient continues to be monitored at regular intervals by the EMC gastroenterologist, who corrects possible (but rather rare) side effects of surgical treatment.

Diet and Nutrition

Of course, adherence to a strict diet (and in some cases fasting is possible) is important in the presence of acute inflammation. The patient is recommended a diet with the exception of spicy, fried and fatty foods, 4-6 meals a day in small portions (in the presence of vomiting, food through a nasogastric tube).

Prevention

EMC doctors recommend that patients who have problems with the gallbladder, and when a small stone is discovered for the first time, should be regularly observed by a gastroenterologist and undergo an ultrasound examination of the abdominal organs once every six months. Active monitoring will allow you to find and eliminate the causes of stone formation and other complications without surgery.

There is no data indicating the effectiveness of adherence to a strict diet in the prevention of gallstone disease.All dietary recommendations are general in nature and ultimately come down to moderation in the use of potentially unhealthy foods (fast food, fatty and fried foods, overeating).

Cholecystitis | Ministry of Health of the Astrakhan region

Cholecystitis is an inflammation of the gallbladder. This small, pear-shaped organ sits on the underside of the liver on the right side of the abdomen. The gallbladder collects and secretes bile, which is involved in the digestion of fats, through a special duct into the duodenum.

If cholecystitis occurs suddenly, it is called acute. If it develops over a long period of time, it is chronic.

What causes cholecystitis?

1. Approximately 95 percent of cholecystitis cases are caused by gallstones formed by cholesterol, thickened mucus, and calcium and bilirubin compounds. These stones block the gallbladder duct – it becomes full and inflamed.

2. Injury to the gallbladder. The inflammation can cause a blow to the abdomen – to the liver area.Cholecystitis can also be a consequence of surgery.

3. Infection. If the bile gets infected, it can cause inflammation of the gallbladder.

4. Tumor. The growth of a malignant or benign tumor can block the gallbladder duct. As a result of the accumulation of bile, inflammation develops.

Risk factors for the development of cholecystitis:

• Development of gallstone disease in close relatives
• Diabetes of the first and second types
• Elevated blood lipids
• Weight loss too fast as a result of an unbalanced diet
• Obesity
• Older age
• Pregnancy

Main signs of cholecystitis

• Pain in the upper right abdomen
• Bloating
• Slight temperature rise
• Chills
• Sweating
• Decreased or no appetite
• Nausea
• Vomiting

These symptoms are usually worse after eating, especially oily food.

In the case of acute cholecystitis, pain in the right upper abdomen occurs suddenly, is very intense and does not go away on its own. It can also increase with deep breathing and be given to the right shoulder and back.

Attention! The onset of one or more of the above symptoms require urgent medical attention.

As a rule, when gallstones form, surgical treatment is required. Without it, serious complications can develop – up to rupture of the gallbladder and peritonitis.

How to reduce the risk of cholecystitis?

Prevention of cholecystitis usually consists in reducing the risk of developing gallstones:

1. Follow your diet, trying to adhere to your usual breakfast, lunch and dinner times. Do not skip meals and switch to fractional meals. It will avoid disruption of the gallbladder.

2. Avoid fatty foods. Frequent consumption of saturated fat leads to disruption of the gallbladder and the development of stones in it.

3. Be physically active to reduce the risk of developing gallstones. Exercise at least five times a week, for at least 30 minutes every day.

4. Maintain a healthy body weight. The closer your weight is to your ideal body mass index, the lower your risk of developing cholecystitis.

5. If you have extra pounds and you want to lose weight – reduce weight at a reasonable pace. Rapid weight loss increases your risk of developing gallstones. Remember that healthy weight loss does not exceed 0.5-1 kg per week.

An unhealthy lifestyle leads not only to the appearance of stones in the bile ducts, but also to dysfunction of the liver itself. Remember, alcohol, smoking and the liver are not friends!

Fasting and sudden weight loss lead to stagnation of bile in the ducts and can provoke the formation of insoluble gallstones.

Most important

Most often, cholecystitis is caused by the formation of stones in the gallbladder. To reduce your risk of gallbladder inflammation, eat right, stay physically active, and don’t try to lose weight too quickly.

Source: takzdorovo.ru

90,000 what is it, causes, signs, symptoms, treatment – MEDSI

Table of Contents

Cholecystitis is an inflammatory process in the gallbladder that can lead to complications such as gallstone disease. It makes itself felt with severe pain and discomfort in the right side.

According to statistics, its prevalence reaches 20%, and women over 50 are most susceptible to its appearance.

Classification

Several approaches are used to classify cholecystitis:

Chronic cholecystitis manifests itself gradually, accompanied by episodic discomfort in the right side (including chronic calculous cholecystitis).

• By the nature of the neoplasms:
• No calculus (stones) in the gallbladder (more likely for patients under 30 years of age)
• With the formation of stones in the bubble
• By development type:
• Chronic
• Acute – may occur during the formation of stones against the background of the development of gallstone disease
• By degree of inflammation:
• Purulent
• Catarrhal – accompanied by severe pain on the right side, which can also be felt in the lower back, right side of the neck, right shoulder blade
• Phlegmonous – accompanied by pain when coughing, changing the position of the body in space, etc.
• Gangrenous – cholecystitis develops into it at the phlegmonous stage
• Mixed

Reasons

Causes of occurrence:

• Diseases of the ENT organs and respiratory tract (sinusitis, bronchitis, sinusitis, pneumonia, etc.)
• Emergence of chronic or acute inflammatory processes in the gastrointestinal tract (dysbiosis, colitis, appendicitis, etc.)
• The emergence of parasites in the gallbladder ducts (giardiasis, etc.)n.)
• Development of infections of the reproductive or urinary systems (cystitis, pyelonephritis, oophoritis, prostatitis, etc.)

One of the risk factors is the overuse of spicy, fatty or fried foods .

Risk Factors:

• Presence of biliary dyskinesia (violation of muscle tone, can provoke problems with bile outflow)
• Incorrect composition of bile (occurs due to improper nutrition)
• Ingestion of the contents of the duodenum into the bile ducts and into the gallbladder
• Autoimmune processes
• Pathology of development of the gallbladder
• Violation of the blood supply to the organ (due to arterial hypertension or diabetes mellitus)
• Changes in hormonal levels due to menstrual irregularities, pregnancy, etc.
• Obesity
• Excessive consumption of spicy, fatty or fried foods
• Abuse of alcoholic beverages and tobacco products
• Genetic predisposition
• Allergic reactions

Cholecystitis in adults – symptoms

The first sign of the disease is the appearance of pain on the right side (under the ribs).This symptom can be relieved by pain relievers, but then the discomfort in this area will return again.

The first sign of the disease is the appearance of pains on the right side (under the ribs) .

Cholecystitis – signs of the disease:

• Indigestion
• Presence of pain on the right (can be projected into the area of ​​the right arm or shoulder blade)
• Constant nausea, belching
• Chills
• Yellowing of the skin
• Disturbed appetite
• Excessive gassing

Similar symptoms can occur simultaneously or separately.Signs of acute and chronic forms of the disease can differ.

Chronic cholecystitis – symptoms:

• Heaviness and pain in the right side, under the ribs, in the scapula
• Regular belching and bitterness in the mouth
• Persistent digestive problems (lack of appetite, nausea and vomiting, etc.)
• Manifestation of icteric signs

With an acute attack of cholecystitis, the following symptoms will appear:

• Sudden weakness and bitterness in the mouth
• A person is not comfortable in any position, while the pulse has increased and the pressure has dropped
• Vomiting occurs immediately after a meal
• Skin yellowed
• Acute pain appeared on the right

How to remove an attack of cholecystitis?

When cholecystitis and its acute symptoms appear, treatment is necessary.Therefore, the first step is to call an ambulance doctor.

While waiting for the doctor’s arrival, follow:

• Provide a state of rest for the patient
• Give pain reliever (antispasmodic)
• Apply cold compress

While waiting for the doctor’s arrival, the patient should be given mineral water without gas (sodium chloride) to drink, especially after vomiting.

What should not be used for an attack of cholecystitis and its symptoms before treatment:

• Apply heating pad
• Use narcotic painkillers or analgesics
• Take alcoholic drinks
• Give an enema
• Use any medication other than antispasmodics

Complications

If any disease is not treated promptly, its development can lead to serious consequences.In the case of cholecystitis, complications such as:

• Termination of the gallbladder
• Reactive hepatitis
• The appearance of a fistula in the organs of the gastrointestinal tract
• Development of cholangitis – inflammation of the bile ducts
• The appearance of empyema of the gallbladder – accompanied by inflammation and accumulation of pus
• Onset of gangrene and peritonitis
• Ruptured gallbladder
• Pericholedocheal lymphadenitis – inflammation of the lymph nodes
• Intestinal obstruction

The emergence of all complications can be avoided if you consult a doctor in time.

Diagnostics

When making a diagnosis, the gastroenterologist interviews the patient, takes anamnesis and examines.

For more than an accurate diagnosis of , it is necessary to conduct a number of laboratory tests.

Laboratory research:

• General urinalysis
• Blood tests:
• For sugar, cholesterol and pancreatic amylase (for the detection of concomitant diseases)
• General (to detect signs of inflammation)
• For antibodies to parasites (for the detection of lamblia)
• Biochemical (to determine the increase in the activity of transaminases AST, ALT, GGTP, alkaline phosphatase and bilirubin, which appear in chronic cholecystitis)
• Stool tests:
• For antibodies to parasites (detection of lamblia)
• Coprogram

To clarify the diagnosis or identify concomitant pathologies, the doctor may prescribe a number of procedures such as:

• ECG
• Abdominal ultrasound
• CT or MRI with contrast
• Ultrasound scan with choleretic breakfast (to detect dyskinesia)
• Bilioscintigraphy (radioisotope research)
• ERPHG (endoscopic retrograde cholangiopancreatography)
• Bile culture
• X-ray of the abdominal organs
• Duodenal intubation
• Endoscopic ultrasound (endoscopy)

Cholecystitis – treatment in adults

Like other diseases, cholecystitis requires timely treatment.General principles of cholecystitis therapy:

• Antibiotic use
• Diet appointment
• Treatment of symptoms
• Physiotherapy Application

In chronic cholecystitis, treatment can be either medication or surgical .

The following types of drugs are used for complex drug therapy:

• Antibiotics
• Enzymes to facilitate digestion
• Antispasmodics
• Anti-inflammatory drugs (non-steroidal)
• Prokinetics (to ensure the correct functioning of the gastrointestinal tract)
• Products containing bifido and lactobacilli
• Choleretic preparations

It is also recommended to use physiotherapy procedures and undergo spa treatment.

In case of cholecystitis, treatment of exacerbation can be surgical if it is impossible to remove acute inflammation with medications. In such a situation, the affected part of the gallbladder is removed.

Diet

You can eat such dishes and products as:

For cholecystitis, an important part of the treatment is nutrition .

• Vegetable and milk soups
• Steamed or oven dishes (meat, lean fish)
• Low-fat dairy products
• Eggs in the form of protein omelets
• Non-acidic fruits and vegetables
• Cereals and pasta
• Not sour jam
• Unsweetened biscuits, bread, rusks
• Greens (parsley, dill)
• Cinnamon, vanilla
• Mild sauces (including soy)
• Marmalade, dried fruits, sweets without cocoa and chocolate

In case of cholecystitis during treatment, the diet should exclude:

• Fried, spicy, salty, sour, fatty
• Hot spices (mayonnaise, adjika, ketchup, etc.)
• Fatty dairy products
• Legumes, mushrooms
• Eggs with yolks
• Coffee, alcohol, cocoa, carbonated drinks
• Chocolate-containing products (pastries, sweets)
• Sour or spicy vegetables and herbs

Advantages of the procedure in MEDSI

• MEDSI clinics have modern expert equipment for accurate and fast diagnostics
• When diagnosing cholecystitis, its symptoms and treatment in adults, MEDSI specialists use only innovative treatment methods
• Patients are offered a comfortable hospital stay
• There are no queues in clinics and the need for long waiting times
• When a complex diagnosis is made, a medical council can be assembled
• There is a possibility of an operative appointment by phone 8 (495) 7-800-500

MEDSI clinics have modern expert equipment for accurate and fast diagnostics

Cholecystitis: signs, symptoms, treatment – MedCom

Causes of the disease

Cholecystitis can be triggered by factors of infectious and non-infectious origin.Cases of cholecystitis have become widespread during the penetration and multiplication of colonies in the gallbladder of pathogenic microorganisms – here E. coli, streptococci, staphylococci, enterococci are active. The infection can enter the organ through the blood or lymph from other foci of chronic inflammation. In this case, the treatment of cholecystitis is carried out using antibiotics.

The reasons for the development of cholecystitis that are not associated with infection include:

• Penetration of pancreatic enzymes into the gallbladder.
• Hormonal disorders.
• Formation of stones in the bile ducts.
• Congenital pathologies.
• Obesity.
• Diabetes mellitus.
• Helminthic invasions.
• Hypertension, which contributes to the deterioration of the blood supply to the organ.
• Stretching the walls of the bladder.

Non-observance of a healthy lifestyle can become the main provoking factor. Violations in the diet or the predominance of spicy, fatty, spicy foods in the diet leads to a change in the qualitative composition of bile and an increase in the likelihood of symptoms of cholecystitis.A provoking factor can be pregnancy, during which the enlarging uterus compresses the gallbladder, as well as organ injuries.

Symptoms of cholecystitis

Signs of cholecystitis in most cases begin to appear already at the earliest stages. The first symptoms of cholecystitis may appear after a sharp change in the usual diet, drinking a lot of alcohol or severe stress. Initially, a person begins to worry about pain in the upper abdomen, which spreads to the area under the right rib.The severity of pain can be different, with a sharp change from paroxysmal sensations to pulling and gradually increasing. With cholecystitis, a very sharp pain resembles biliary colic.

A bitter or metallic taste appears in the oral cavity, excessive dryness, nausea, flatulence, unpleasant belching. The skin and sclera gradually acquire a yellowish tint, and with the development of the pathological process, the body temperature rises. The acute period with cholecystitis can last from 5-10 days to a month.In the absence of stones and localized purulent foci, cholecystitis can be treated quite quickly.

If symptoms are ignored, the disease flows into a chronic process. It is characterized by periods of exacerbation and remission, during which the symptoms do not bother the person. The frequency of acute manifestations of the disease will depend on adherence to diet and treatment recommendations.

Diagnostic Methods

After the first signs of the disease appear, you should seek help from a gastroenterologist.A preliminary diagnosis is made by the attending physician based on the patient’s complaints, taking into account the nature of the described pain, the frequency of their manifestation and other symptoms.

It is possible to reliably confirm the diagnosis and determine the methods of treatment after a complete diagnosis:

• Investigation of a blood test in a laboratory. With cholecystitis, especially in the acute period, the ESR level will be increased, and neutrophilic leukocytosis will also be detected.
• ultrasound. The examination allows you to visually assess the changes in the organ.The doctor establishes the shape of the organ, the thickness of the walls and its dimensions, assesses the contractile function and the number of dense formations, if any. At advanced stages with cholecystitis, you can notice the deformation of the organ and thickening of the walls.
• Probing, during which three portions of bile are taken. With the help of further microscopic examination, the bile consistency and color are assessed. At this stage, the pathogen that is the cause of the infectious process is also determined.This will determine how to treat cholecystitis and which drugs will be more effective.
• X-ray contrast method – allows you to assess the degree of impairment of the motor function of an organ.

In doubtful cases, the patient may be assigned additional diagnostic examinations.

Treatment of pathology

The treatment of cholecystitis is based on an integrated approach based on adherence to a specially selected diet, taking medications, flushing the ducts and physiotherapeutic measures.Diet therapy is indicated for cholecystitis at all stages of the disease and consists in fractional nutrition, as well as the use of products baked, boiled or stewed. During treatment, it is necessary to observe the intervals between meals, avoiding large gaps in time.

For the treatment of pain attacks with cholecystitis, the doctor prescribes the use of antispasmodics and pain relievers. If, according to the results of the diagnosis, it was possible to identify the presence of infectious agents-pathogens, then an antibacterial drug will be selected based on their type.After the relief of the acute condition with cholecystitis, the patient is prescribed drugs to stimulate the process of bile formation and its outflow from the organ.

Physiotherapy can be prescribed to restore the tone of the gallbladder: UHF, electrophoresis. Forced release of the gallbladder with cholecystitis is performed by flushing, for which the probe and probeless method is used. With the ineffectiveness of conservative treatment methods that do not allow to eliminate acute symptoms, the patient is asked about the need for surgical intervention.

A favorable prognosis after the treatment of cholecystitis awaits those patients who responsibly followed the recommendations of the attending physician and supported the diet.

90,000 prices for treatment, symptoms and diagnosis of chronic and acute cholecystitis in the “CM-Clinic”

Egiev Valery Nikolaevich

Surgeon, oncologist, doctor of medical sciences, professor

“CM-Clinic” on the street.Novocheremushkinskaya (metro station “Novye Cheryomushki”)

“CM-Clinic” on Volgogradsky prospect (metro “Tekstilshchiki”)

Komrakov Vladimir Evgenievich

Surgeon doctor, cardiovascular surgeon, phlebologist, lymphologist, doctor of the highest category, Ph.MD, professor

“CM-Clinic” on the street. Novocheremushkinskaya (metro station “Novye Cheryomushki”)

Nurpisov Aglam Muratbekovich

Surgeon, phlebologist, Ph.D.

“CM-Clinic” on the street.Novocheremushkinskaya (metro station “Novye Cheryomushki”)

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“CM-Clinic” on the street.Novocheremushkinskaya (metro station “Novye Cheryomushki”)

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Ophthalmologist, ophthalmologist of the highest category, microsurgeon, Ph.MD, professor of RAE, head of the department of ophthalmology at the “CM-Clinic” on the street. Yaroslavl

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Blue-eyed Maria Sergeevna

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Shipilov Ilya Gennadievich

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“SM-Clinic” in Staropetrovsky proezd (metro station “Voykovskaya”)

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Surgeon, phlebologist, Dr.M.Sc. Deputy Chief Physician for Surgery at SM-Clinic in Staropetrovsky Proezd

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Short Valentin Igorevich

Coloproctologist, surgeon, Ph.M.Sc.

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90,000 Treatment of chronic cholecystitis | # 06/06

Diseases of the gallbladder and biliary tract constitute one of the most important medical and social problems, since there is a constant increase in the incidence worldwide. From year to year, the number of operations on the biliary tract is growing, as well as the number of postoperative complications, which force the resort to repeated surgical interventions and often lead to permanent disability of the patient.

Chronic acalculous cholecystitis is considered by most authors as the initial stage of cholelithiasis, since the inflammatory process in the gallbladder changes the biochemical structure of bile, and bile acquires lithogenic properties. Therefore, early detection and treatment of chronic non-calculous cholecystitis can prevent the formation of gallstones.

The main role in the development of chronic acalculous cholecystitis is played by the infection, which enters the gallbladder by the hematogenous route through the hepatic artery and portal vein, by the lymphogenous route or by the ascending route from the intestine.Any chronic focus of infection in the body (chronic tonsillitis, chronic salpingo-oophoritis, sinusitis), as well as a chronic inflammatory process in the gastrointestinal tract (GIT), can be a source of infection in the bile. In bacteriological examination of bile, Escherichia coli, staphylococci, enterococci, Klebsiella, Clostridia, typhoid and dysentery bacteria, Proteus are more often found. However, only in 30–40% of patients microflora is detected in the biliary tract, since sensitization of the organism and a decrease in the immunological reactivity of the macroorganism are of decisive importance in the occurrence of inflammation in the biliary tract.

The etiological role of viral hepatitis in the occurrence of chronic cholecystitis is currently beyond doubt and, according to the literature, this variant of the development of the disease is noted in 30% of cases. The role of parasitic invasion in the duodenum and biliary tract (opisthorchiasis, amebiasis, fascioliasis, clonorchiasis, giardiasis), which can promote the activation of infection in the gallbladder, is described. Cholecystitis also occurs due to dysfunction of the biliary tract.

The biliary tract is a complex system of bile excretion, including the common hepatic duct, formed from the fusion of the right and left hepatic ducts, the gallbladder with the Lutkens sphincter, the common bile duct, starting from the junction of the hepatic and cystic ducts and the ampulla of the large duodenal papilla.

With each meal, the gallbladder contracts 1-2 times. At the same time, bile enters the intestines, where it is involved in digestion. The gallbladder on an empty stomach contains 30–80 ml of bile, but with stagnation, its amount may increase.

In women, the gallbladder in a state of functional rest has a slightly larger volume than in men, but it contracts faster. With age, the contractile function of the gallbladder decreases.

The leading role in the occurrence of dysfunctional disorders of the biliary tract belongs to psychoemotional factors – psychoemotional overload, stressful situations.Dysfunctions of the gallbladder and the sphincter of Oddi can be manifestations of neurotic conditions.

The influence of psychogenic factors on the function of the gallbladder and biliary tract is realized with the participation of cortical and subcortical formations, nerve centers of the medulla oblongata, hypothalamus, and also the endocrine system.

Disorders of synchrony in the work of the gallbladder and the sphincter apparatus underlie dysfunctional disorders of the biliary tract and are the cause of the formation of clinical symptoms.

Disorders of the motor function of the biliary tract play a significant role in the formation of not only pain, but also dyspeptic disorders (feeling of heaviness in the epigastrium and right hypochondrium, vomiting, heartburn, belching, bitter taste in the mouth, flatulence, stool disorders). The wall of the gallbladder is easily extensible, which is due to the presence of both smooth muscle and elastic fibers in its middle shell. Due to the similar structure of the gallbladder wall, the entire organ and its individual parts contract.

The contraction of smooth muscles of the gastrointestinal tract occurs when acetylcholine stimulates muscarinic receptors on the surface of the muscle cell, which is accompanied by the interaction of the Ca ²⁺ , Na ⁺ , and K ⁺ cell membrane channels. These processes determine the contraction and relaxation of smooth muscle cells and, therefore, a change in muscle tone.

The motor activity of the biliary tract is regulated with the participation of central reflexes, local (gastroduodenal) reflexes caused by mechanical stretching and exposure to food components, and humoral influences.Under the action of these regulatory links, the gallbladder contracts, and the sphincter of Oddi relaxes.

An important place in the regulation of the functions of the biliary system is occupied by gastrointestinal hormones. In this case, the leading role belongs to cholecystokinin, gastrin, secretin, motilin, glucagon.

The most important humoral stimulant providing synchronous contraction of the gallbladder and relaxation of the sphincter apparatus of the biliary tract in response to food intake is cholecystokinin.It is now known that there is a direct connection through nerve fibers between the duodenum, on the one hand, and the gallbladder and the sphincter of Oddi, on the other, conducting cholinergic excitation to the nerve ganglia of the gallbladder and the sphincter of Oddi.

Secretin, produced in the duodenum, stimulates the secretion of water, electrolytes and bicarbonates by the epithelium of the biliary and pancreatic ducts and potentiates the effects of cholecystokinin.

Motilin is an important hormone that regulates gastrointestinal motility.The introduction of motilin causes a decrease in the volume of the gallbladder and an increase in the contractility of the antrum.

The neurotransmitters that cause relaxation of smooth muscle cells of the biliary tract include vasoactive intestinal peptide (VIP) and nitric oxide (NO), produced by the enzyme NO synthetase. VIP inside muscle cells stimulates an increase in the level of cyclic adenosine monophosphoric acid, and NO – increases the level of cyclic guanidine monophosphoric acid.VIP and NO mutually reinforce each other’s production.

In the regulation of the contraction of the smooth muscles of the gallbladder, a certain role is played by norepinephrine, which is secreted by sympathetic postganglionic fibers and, acting presynaptically on the vagal nerve endings in the gallbladder ganglia, reduces the release of acetylcholine from the vagal nerve endings.

Currently, the term “dysfunctional disorders of the biliary tract”, according to the classification of functional disorders of the digestive system, includes all diseases associated with impaired motility of the biliary tract, regardless of their etiology.According to the classification of functional disorders of the gastrointestinal tract, dysfunction of the gallbladder and dysfunction of the sphincter of Oddi are distinguished.

Eating large amounts of fatty and fried foods can cause spasm of the sphincter of Oddi and Lutkens, as well as impaired metabolism of cholesterol and bile acids, which predisposes to the development of cholecystitis.

Dysfunction of the biliary tract, the development of hypotension and atony of the sphincter of Oddi, contributing to the reflux of the contents of the duodenum into the biliary tract, leads to prolonged use of anticholinergics and antispasmodics with the formation of “pharmacological” cholestasis, as well as duodenostasis.Therefore, in case of peptic ulcer with the localization of the process in the duodenal bulb, changes in the biliary tract are often observed. In addition to motor secretory disorders in the gallbladder and biliary tract system, infections and metabolic disorders in the body, some other factors are also important in the genesis of the development of cholecystitis: genetic predisposition, occupational hazards (work with vibration, sedentary work) and repeated pregnancies.

Changes in the chemical composition of bile (discrinia) in the form of an increase in the concentration of bile salts can cause aseptic inflammation of the gallbladder.The value of reflux of pancreatic juice, which is a consequence of a violation of the physiological mechanisms of the Vater papilla with a common ampoule for the excretory ducts of the liver and pancreas, in the biliary tract in the genesis of cholecystitis has been proved. With a free outflow of pancreatic juice into the duodenum, changes in the gallbladder are not detected, but with a violation of the outflow and an increase in hypertension in the biliary system, stretching of the gallbladder leads to a change in the normal capillary blood flow in the wall of the bladder.This causes disruption of tissue metabolism, damage to cellular elements and the release of cytokinase, which converts trypsinogen into trypsin, which leads to the development of enzymatic cholecystitis.

Gallstone disease is a multifactorial and multistage disease characterized by impaired metabolism of cholesterol, bile acids and / or bilirubin with the formation of stones in the gallbladder and / or bile ducts.

In the above classification of gallstone disease, four stages of the disease are distinguished (A.A. Ilchenko, 2002).

I, initial stage or pre-stone stage:

a) thick heterogeneous bile;

b) the formation of biliary sludge

– with the presence of microliths;

– with the presence of putty bile;

– a combination of putty bile with microliths.

II, stage of formation of gallstones:

a) by localization

– in the gallbladder;

– in the common bile duct;

– in the hepatic ducts;

b) by the number of calculi

– single;

– multiple;

c) by composition

– cholesterol;

– pigmented;

– mixed;

d) according to the clinical course

– latent course;

– with the presence of clinical symptoms:

• painful form with typical biliary colic;
• dyspeptic form;
• under the guise of other diseases.

III, stage of chronic recurrent calculous cholecystitis.

IV, stage of complications.

Thus, the mechanism of development of cholecystitis is complex, diverse, often several factors act, leading to a disease of the biliary tract.

Pathogenetic therapy of cholecystitis sets itself the task of removing the inflammatory process in the wall of the gallbladder, normalizing the processes of bile formation and bile secretion, and preventing the formation of stones.Given the important role of the nutritional factor in this process, treatment primarily involves frequent, fractional nutrition. Taking a small amount of food at the same hours normalizes choleresis, promotes better outflow of bile into the intestines and prevents the development of cholestasis. A single meal in large quantities can lead to intense contraction of the gallbladder and the development of biliary colic. Therefore, it is advisable to consider eating in small portions 4-5 times a day.

Due to the fact that during the inflammatory process in the gallbladder there is a shift in pH towards the acidic side (acidosis of bile), which contributes to the loss of cholesterol in the form of crystals and a change in the ratio of bile acids towards cholesterol (cholato-cholesterol ratio), in the diet should be sharply limited or exclude products containing acidic valencies.These are primarily flour, spicy dishes, meat, fish, brains, etc.

The content of proteins in the diet of patients with cholecystitis should correspond to the physiological norm of 80–90 g per day. Protein-rich foods – cottage cheese, milk and cheese – cause the bile reaction to shift towards the alkaline side. It should be borne in mind that food, poor in proteins, leads to the development of fatty degeneration of the liver, disruption of the process of repair and regeneration, disruption of the synthesis of many enzymes and hormones. All this indicates that long-term restriction of protein intake in patients with chronic cholecystitis is not justified.

Fats stimulate bile secretion, and the majority of patients do not need to limit them. However, animal fats are rich in cholesterol and should be limited to those with chronic cholecystitis. With insufficient flow of bile into the intestine, fats are poorly broken down, which leads to irritation of the intestinal mucosa and the appearance of diarrhea. It has been shown that diets with an increased amount of fat due to vegetable oil have a positive effect on the lipid complex of bile, bile formation and bile secretion.A lipotropic fat diet with a 1: 1 ratio of animal and vegetable fats is recommended. It should also be remembered that vegetable oils (corn, sunflower, olive), due to the content of unsaturated fatty acids – arachidonic, linoleic, linolenic – improve cholesterol metabolism, participate in the synthesis of prostaglandins (arachidonic acid), and affect gallbladder motility. Fats increase the metabolism of fat-soluble vitamins, especially vitamin A.

Carbohydrates, especially easily digestible ones (sugar, glucose, honey, jam), which were previously recommended to increase liver glycogenization, should be limited, especially if you are overweight.It has been proven that glycogen stores only decrease with massive liver necrosis. The inclusion of large amounts of easily digestible carbohydrates can enhance lipogenesis and thereby increase the likelihood of gallstone formation. Therefore, the use of flour and sweet foods should be limited. The diet should be rich in plant fiber, which eliminates constipation, and this reflexively improves the emptying of the gallbladder. The diet should include carrots, pumpkin, watermelons, melons, grapes, wheat and rye bran.With oxalaturia and phosphaturia, tomatoes, sorrel, spinach, and radishes should be limited. The carbohydrate content in the first week of exacerbation of cholecystitis should be 250-300 g, from the second week it should increase to 350 g, but the proportion of simple sugars should be no more than 50-100 g per day.

Thus, with an exacerbation of chronic cholecystitis in the first week, the calorie content of food is 2000 calories, later, when the inflammatory process subsides, the calorie content can be increased to 2500 calories.

A complete vitamin composition of food is a prerequisite for the diet therapy of chronic cholecystitis. Products containing lipotropic factors should be included in the diet: oat and buckwheat groats, cottage cheese, cheese, cod, soy products. Cooking food is of great importance. During the period of exacerbation, a gentle diet option is prescribed – table number 5a, which provides for the limitation of mechanical and chemical irritants. During the period of remission, the main dietary regimen is diet No. 5, which excludes foods rich in cholesterol and extractives, spicy snacks, salty, smoked and fried foods.The total calorie content of the diet corresponds to the physiological norm – 2500 calories (90 g of protein, 85 g of fat, 350 g of carbohydrates).

The basis of drug treatment for chronic cholecystitis is anti-inflammatory therapy. Antibiotics are widely used to suppress infection in the biliary tract. The choice of an antibacterial drug depends on individual tolerance and on the sensitivity of the bile microflora to the antibiotic. The most effective are antimicrobial drugs of the fluoroquinolone group – norfloxacin (nolicin, norbactin, girablok) 0.4 g 2 times a day, ofloxacin (tarivid, zanocin) 0.2 g 2 times a day, ciprofloxacin (tsiprobai, tsiprolet, tsifran) 0.5 g 2 times a day, levofloxacin (tavanic, lefokcin) 0.5 g 2 times a day; macrolides – erythromycin 0.25 g 4 times a day, azithromycin (sumamed, azitrox, azitral) 0.5 g once a day, clarithromycin (klacid, clubax, clerimed) 0.5 g 2 times a day, roxithromycin (rulid, roxid, roxolid) 0.1 g 2 times a day, midecamycin (macropen) 0.4 g 2 times a day and semi-synthetic tetracyclines – doxacyclin (vibramycin, unidox solutab, medomycin) 0.1 g 2 times per day, metacyclin 0.15 g 4 times a day.You can use semi-synthetic penicillins: ampicillin 0.5 g 4 times a day, oxacillin 0.5 g 4 times a day, ampiox 0.5 g 4 times a day – although they are less active. In severe cases, cephalosporins (ketocef, cephobid, claforan, cefepime, rocefin). The oral route of taking the antibiotic is preferable, the usual therapeutic doses, the course of treatment is 7–8 days, it is possible to repeat the course with other antibiotics after 3-4 days. Correction of antibiotic therapy is carried out after obtaining a sowing of bile on the microflora and determining its sensitivity to the antibiotic.

In the absence of sensitivity of the microflora of bile to antibiotics or the presence of allergies to them, co-trimaxozole (biseptol, bactrim) is recommended 2 tablets 2 times a day, although its effectiveness is much lower than that of antibiotics, and the adverse effect on the liver is higher. A good effect is provided by the use of nitrofuran drugs – furazolidone, furadonin, as well as metronidazole (0.5 g 3 times a day for 7-10 days).

With severe pain syndrome in order to reduce the spasm of the sphincter of Oddi and the sphincter of Lutkens, with dysfunctions of the gallbladder in the hypermotor type, antispasmodics are indicated.There are several groups of antispasmodics that differ in their mechanism of action.

As antispasmodics, both selective (metacin, gastrocepin) and non-selective M-anticholinergics (buscopan, platifillin) are used. However, when taking this group of drugs, a number of side effects can be observed (dry mouth, urinary retention, visual impairment, tachycardia, constipation). The combination of the rather low effectiveness of this group of drugs with a wide range of side effects limits the use of this group of drugs.

Direct antispasmodics such as papaverine, drotaverine (no-shpa) are effective in relieving spasms. However, they are not characterized by selectivity of action, since they affect all tissues where smooth muscles are present, including the vascular wall, and cause vasodilation.

Mebeverine hydrochloride (duspatalin) has a much more pronounced antispastic activity, which also has a direct myotropic effect, but it has a number of advantages over other antispasmodic agents.It almost selectively relaxes the smooth muscles of the digestive tract, does not affect the smooth muscle wall of blood vessels and does not have systemic effects inherent in anticholinergics. By the mechanism of action, duspatalin is a sodium channel blocker. The drug has a prolonged effect, and it should be taken no more than 2 times a day in the form of 200 mg capsules.

Myotropic antispasmodics include pinaveria bromide (dicetel). The main mechanism of its action is the selective blockade of calcium channels located in the cells of smooth muscles of the intestine, biliary tract and peripheral nerve endings.Dicetel is prescribed 100 mg 3 times a day for pain.

The drug that has a selective spasmolytic effect on the sphincter of Oddi and the sphincter of the gallbladder is gimecromone (odeston). This drug combines antispasmodic and choleretic properties, provides harmonious emptying of the intra- and extrahepatic biliary tract. Odeston does not have a direct choleretic effect, but facilitates the flow of bile into the digestive tract, thereby increasing enterohepatic recirculation of bile acids.The advantage of odeston is that it practically does not affect other smooth muscles, in particular the circulatory system and intestinal muscles. Odeston is used 200-400 mg 3 times a day 30 minutes before meals.

All antispasmodics are prescribed in a course of 2-3 weeks.

In the future, they can be used if necessary or repeated courses. In acute pain syndrome, drugs can be used once or in short courses.

In the relief of pain syndrome, a special role is given to drugs that affect visceral sensitivity and nociceptive mechanisms.Currently, the possibility of prescribing antidepressants, 5-HT3 receptor antagonists, k-opioid receptor agonists, somatostatin analogues for pain of a similar genesis is being discussed.

Antidepressants (amitriptyline, mianserin, etc.) are used in medium doses, the duration of their administration should be at least 4-6 weeks.

In case of gallbladder dysfunction caused by hypomotor dyskinesia, prokinetics are used to increase contractile function for 10-14 days: domperidone (motilium, motonium, motilac) or metoclopramide (cerucal) 10 mg 3 times a day 20 minutes before meals.

Prescribing choleretic agents requires a differentiated approach depending on the presence of inflammation and the type of dysfunction. They are shown only after the inflammatory process subsides. All choleretic drugs are divided into two large groups: choleretics – drugs that stimulate bile formation, and hologoga – drugs that stimulate bile secretion.

Choleretics include drugs that increase the secretion of bile and stimulate the formation of bile acids (true choleretics), which are subdivided:

• for preparations containing bile acids – decholin, allochol, cholenzyme, hologon;
• herbal preparations – chophytol, tanacehol, cholagol, livamin (liv.52), hepabene, hepatofalk, silymar;
• drugs that increase the secretion of bile due to the water component (hydrocholeresis) – mineral waters.

The second group of drugs that stimulate bile secretion include:

• cholekinetics – drugs that increase the tone of the sphincters of the biliary tract and gallbladder – magnesium sulfate, Karlovy Vary salt, sorbitol, xylitol, holagogum, olimetin, rovachol, preparations containing oil solutions – pumpkin;
• drugs that relax the biliary tract (cholespasmolytics) – platifillin, no-shpa, duspatalin, odeston, dicetel.

The drugs of these groups should be prescribed differentially, depending on the type of dyskinesia accompanying chronic cholecystitis.

During the period of exacerbation of chronic acalculous cholecystitis, physiotherapeutic procedures are shown: electrophoresis with antispasmodics for hypermotor-type dysfunctions and with magnesium sulfate for hypomotor dysfunction. Diathermy, inductothermy, paraffin, ozokerite, UHF therapy on the gallbladder area are prescribed.Recently, works have appeared on the effectiveness of laser therapy for chronic acalculous cholecystitis. During the onset of remission, physical therapy can be used to help empty the gallbladder.

In the treatment of chronic acalculous cholecystitis, treatment with medicinal herbs – phytotherapy, which allows you to prolong the therapeutic effect of medications, is becoming increasingly important. Medicinal plants are also divided into two groups: choleretics and cholekinetics, although many of them have both effects.The first group includes: sandy immortelle flowers (flamin), corn stigmas, peppermint, tansy, common barberry fruits, elecampane root, centaury grass, dandelion root, yarrow, black radish juice.

The second group includes: hawthorn flowers, valerian root, dandelion root, fruits and bark of common barberry, smoky grass, flowers of blue cornflower, calendula, wild chicory root, rose hips, caraway seed, dill seed, tansy, sandy immortelle, lavender, lemon balm.Medicinal plants are used in the form of infusions and decoctions. Collections from choleretic herbs with various mechanisms of action are widely used.

Infusions and decoctions of herbs are used for half a glass 30 minutes before meals 2-3 times a day, for a long time, for several months (2-3 months). It is advisable to cook them daily or for 2 days. It is necessary to follow the principle of gradually expanding the spectrum and adding herbs to the collection (but not more than 5 herbs), taking into account the individual tolerance of individual herbs and associated diseases.Phytotherapy courses must be repeated 3-4 times a year.

Mineral waters have long been widely used in the treatment of chronic cholecystitis, since most of them have choleretic and cholekinetic effects, affect the chemistry of bile, increasing the cholato-cholesterol coefficient. Oral use of mineral waters can be combined with intraduodenal lavage, as well as blind probing (tubing without a probe). Tubage is performed on an empty stomach in the morning. The patient drinks in sips for 40-50 minutes 0.5 liters of degassed warm mineral water (Essentuki, Smirnovskaya, Slavyanovskaya) with the addition of 15-20 g of xylitol or 1/3 teaspoon of Karlovy Vary salt.With cholecystitis with hypomotor dysfunction of the gallbladder, the patient is recommended to moderate physical activity 1–1.5 hours before meals. Bottled mineral waters are widely used. It is also shown stay at the resorts: Essentuki, Zheleznovodsk, Krainka, Monino, Dorokhovo, Karlovy Vary, etc. When prescribing mineral waters, the state of the secretory function of the stomach is taken into account. In addition, balneological factors have a beneficial effect on the state of the nervous system and the neuro-humoral regulatory mechanisms of bile secretion.

The presence of biliary sludge in the gallbladder as a pre-stone stage of cholelithiasis requires correction in the treatment of patients with chronic cholecystitis. Prescribed drugs that enhance choleresis, cholecystokinetics, as well as drugs ursodeoxycholic and chenodeoxycholic acids: ursofalk, ursosan – at the rate of 10 mg / kg of body weight once per night or henofalk, litofalk at the rate of 15 mg / kg of body weight once per night. The duration of litholytic therapy is 3 months, after which an ultrasound examination (ultrasound) is performed.

Treatment of gallstone disease at the stage of formed stones requires a different approach to the management of patients. The only non-invasive treatment is oral bile acid litholytic therapy.

Litolytic therapy is carried out in case of contraindications to surgical treatment and if the patient refuses the operation. However, there are certain contraindications to the appointment of litholytic therapy: pigmented and mixed stones, stones more than 10-15 mm in diameter, the number of stones occupying more than 1/3 of the gallbladder, impaired contractile function of the gallbladder, the presence of active hepatitis, biliary cirrhosis and peptic ulcer disease in the stage exacerbation.Ursodeoxycholic or chenodeoxycholic acid is prescribed at a dose of 15 mg / kg of the patient’s body weight in two doses (in the morning and at night). It is possible to combine these drugs in half the dose each (8 mg / kg body weight). The therapy is carried out for a long time – for 1 year or longer. An ultrasound scan is performed every 3 months. If there is no effect after 6 months, the treatment is discontinued, and the patient must be warned about this in advance. Side effects of therapy in the form of diarrhea and a transient increase in aminotransferases are possible, and therefore it is necessary to monitor the biochemical blood profile every 3 months.

With successful therapy, drugs are subsequently prescribed that enhance choleresis and normalize the motor-evacuation function of the gallbladder and biliary tract. In order to prevent recurrence of cholelithiasis after 1.5–2 years, repeated courses of bile acid preparations in half doses are recommended for 2–3 months.

Other non-surgical treatments include extracorporeal shock wave lithotripsy and contact endoscopic lithotripsy.

Thus, eliminating the factors that cause the development of chronic cholecystitis, and adopting the principle of rational therapeutic nutrition, pharmacological agents, herbal medicine, spa treatment, it is possible to influence the complex pathogenetic mechanisms of the development of chronic acalculous cholecystitis and prevent the development of cholelithiasis. Remediation of chronic foci of infection, treatment of major diseases are mandatory components of therapy and prevent the development of chronic cholecystitis or its exacerbation.However, given the variety of factors and complex mechanisms for the development of pathology of the biliary tract, treatment that requires patience from both the doctor and the patient should be long-term, prolonged (drug therapy, herbal medicine, mineral waters) and be carried out consistently.

Literature

1. Belousov A.S., Vodolagin V.D., Zhakov V.P. Diagnostics, differential diagnosis and treatment of diseases of the digestive system. M .: Medicine, 2002.424 p.
2. Ilchenko A.A. Cholelithiasis. M .: Anakharsis, 2004.200 s.
3. Kalinin A. V. Functional disorders of the biliary tract and their treatment // Clinical perspectives of gastroenterology, hepatology. 2002. No. 3. P. 25–34.
4. Leishner U. Practical guide to diseases of the biliary tract. M .: GEOTAR-MED, 2001.264 p.
5. Loranskaya I.D., Mosharova E.V. Biliary dysfunctions: diagnosis, treatment: textbook. M., 2004.20 s.
6. Shulpekova Yu. O., Drapkina O. M., Ivashkin V. T. Abdominal pain syndrome // Russian journal of gastroenterology, hepatology, coloproctology. 2002. T. 12. No. 4. P. 8–15.
7. Yakovenko E.P., Agafonova N.A., Kalnov S. B. Odeston in the treatment of diseases of the biliary tract // Practicing doctor. 2001. No. 19. P. 33–35.
8. Drossman D. A. The functional gastrointestinal disorders. Second edition. 2000.764 s.

I.D. Loranskaya , Doctor of Medical Sciences, Professor
L.G. Rakitskaya , Candidate of Medical Sciences, Associate Professor
E.V. Malakhova , Candidate of Medical Sciences
L.D. Mamedova , Candidate of Medical Sciences, Associate Professor
RMAPO, Moscow

90,000 diagnostics and treatment of cholecystitis in St. Petersburg, price

Chronic cholecystitis is a disease characterized by inflammation of the gallbladder wall.Women suffer from this disease 3-4 times more often than men, it is most often found in overweight people, however, in persons with asthenic physique, it is not an exceptional rarity.

Cholecystitis can be caused by bacteria (E. coli, streptococcus, staphylococcus, etc.), helminths, lamblia, fungi; there are cholecystitis of a toxic and allergic nature. The microbial flora enters the gallbladder by the ascending (from the intestines), hematogenous (through the blood) or lymphogenous (through the lymph) pathway.

It predisposes to the development of cholecystitis stagnation of bile in the gallbladder, which can lead to gallstones, compression and kinks of the bile ducts, dyskinesia of the gallbladder and biliary tract (i.e., a violation of their tone and motor function under the influence of stress, endocrine and autonomic disorders, reflexes from pathologically altered organs of the digestive system), prolapse of the viscera, pregnancy, sedentary lifestyle, rare meals, throwing pancreatic juice into the biliary tract with their dyskinesia with its damaging effect on the mucous membrane of the bile ducts and gallbladder.

Overeating, especially the consumption of fatty and spicy foods, the intake of alcoholic beverages, an acute inflammatory process in another organ (tonsillitis, pneumonia, adnexitis, etc.), is often an immediate impetus to an outbreak of the inflammatory process in the gallbladder. Chronic cholecystitis can occur after acute, but more often develops independently and gradually, against the background of cholelithiasis, gastritis with secretory insufficiency, chronic pancreatitis and other diseases of the digestive system, obesity.

Chronic cholecystitis symptoms

For chronic cholecystitis, a dull, aching (sometimes sharp) pain in the right hypochondrium of a constant nature or arising 1-3 hours after an abundant meal, especially fatty and fried, is typical. The pain radiates upward to the area of ​​the right shoulder and neck, right shoulder blade. Dyspeptic symptoms are not uncommon: a feeling of bitterness and a metallic taste in the mouth, belching with air, nausea, flatulence, impaired bowel movements (constipation and diarrhea may alternate), as well as irritability, insomnia.Jaundice is uncommon.

Signs of chronic cholecystitis are determined by ultrasound. The course in most cases is long, with alternating periods of remission and exacerbations; the latter often result from malnutrition, alcohol intake, hard physical work, acute intestinal infections, hypothermia. The prognosis is favorable in most cases. However, inflammation often contributes to the formation of gallstones.

Diagnostics of the chronic cholecystitis

The diagnosis of chronic cholecystitis begins with the identification of the main complaints and external signs of the disease, prompting the doctor for a further diagnostic algorithm. To clarify the diagnosis of chronic cholecystitis, the following diagnostic methods are used:

• Ultrasound of the abdominal organs, in particular of the gallbladder can detect the presence of stones or signs of inflammation in the gallbladder.
• Cholegraphy – X-ray examination method to detect signs of inflammation of the gallbladder. Cholegraphy is not performed during an exacerbation of the disease, as well as during pregnancy (in these cases, ultrasound is preferred).
• General and biochemical blood test – allows you to identify signs of inflammation and other signs characteristic of liver and gallbladder diseases
• Analysis of feces for parasites (roundworm, lamblia) – mandatory for all patients with cholecystitis.

Treatment of chronic cholecystitis

With exacerbations of chronic cholecystitis, hospitalization in a surgical or therapeutic hospital is necessary; therapy is the same as for acute cholecystitis. In mild cases, outpatient treatment is possible: bed rest, dietary food – restriction of fatty foods and their calorie content (diet No. 5a), food intake 4–6 times a day. In the phase of exacerbation of the process, antibiotics of a wide spectrum of action are used, which accumulate in the bile in a sufficiently high concentration, in usual therapeutic doses for 7-10 days.With giardiasis, antiparasitic drugs are effective. To eliminate biliary dyskinesia and spastic pain, symptomatic treatment is prescribed with one of the antispasmodic drugs (no-shpa, motilium, etc.). Violation of the outflow of bile in patients with chronic cholecystitis is corrected by choleretic agents (synthetic and plant origin), stimulating the formation and secretion of bile by the liver, as well as enhancing the muscular contraction of the gallbladder and the flow of bile into the duodenum.It is advisable to use enzyme preparations containing bile acids.

In patients with non-calculous cholecystitis, therapeutic duodenal intubation is effective. To normalize the bile-forming function of the liver, reduce the viscosity of bile, eliminate its stagnation, prevent the formation of stones, improve blood circulation, achieve an anti-inflammatory, antispasmodic and analgesic effect, physiotherapy is used (electrophoresis on the liver area with novocaine, magnesium, papaverine, no-spa; UHF on the liver area ; ultrasound; electrical stimulation of the gallbladder).Many mineral waters (“Moskovskaya”, “Smirnovskaya”, “Slavyanovskaya”, “Dzhemruk”, “Arzni”, “Borzhomi”, “Essentuki”, “Naftusya”), general baths (sodium chloride, carbonic) have a beneficial effect.
One of the most effective remedies is mud therapy. It has a positive effect on the functional state of the gallbladder, liver, pancreas, improves the immunological reactivity of the body, stimulates the glucocorticoid function of the adrenal glands, has an analgesic, anti-inflammatory, desensitizing effect.Remedial gymnastics using a special technique is advisable. With the failure of conservative therapy and frequent exacerbations, surgical treatment is indicated.

Removal of gallstone (cholecystectomy)

When there are obvious symptoms of gallstones, treatment is necessary, which consists in removing the gallbladder (cholecystectomy) or stones that cause obstruction of the biliary tract. Nowadays, more and more often, cholecystectomy is performed without opening the anterior abdominal wall, using the endoscopic method.If the symptoms are not very pronounced and the stones are small, then you can try to dissolve them with certain medications. An endoscope, a fiberglass optical instrument, is inserted into the abdominal cavity through a small incision in the anterior abdominal wall near the navel. The gallbladder is isolated, freed from its connections and adhesions with other tissues, and removed through a small additional opening.

Gallstones can be removed through the common bile duct using a flexible endoscope.The device is inserted through the mouth into the esophagus, then through the stomach into the duodenum. A thin instrument is inserted through the tube of the device, which is passed into the common bile duct. The location of the stone is determined using radiography. If the stone turns out to be too large, then it is crushed and removed in parts.

Need to see a doctor

• In the presence of pain in the right hypochondrium (abdominal pain). In chronic cholecystitis, the pain is dull, aching, lasting from several hours and days to several weeks.A characteristic feature of pain in chronic cholecystitis is their occurrence or intensification after taking fatty or fried foods. In chronic cholecystitis, pain from the right hypochondrium extends upward to the right shoulder and neck. Often, against the background of dull aching pain, the patient notes short bouts of acute cutting pain characteristic of an exacerbation of chronic cholecystitis.
• With vomiting, which is a less permanent symptom of chronic cholecystitis and, like pain, occurs mainly after the patient’s violation of the dietary regimen.In addition to vomiting, patients with chronic cholecystitis may notice prolonged nausea, a bitter or metallic taste in the mouth, and a deterioration in appetite.
• If you are concerned about bloating, constipation and diarrhea – these are quite common symptoms of chronic cholecystitis, indicating a gradual deterioration in its function and upset digestion. Bloating, diarrhea, or constipation are rarely caused by chronic cholecystitis alone.