Cholecystitis

Acute Cholecystitis is inflammation of the gallbladder.

90%-95% of cholecystitis is caused by gallstone blockage and bile buildup. Blockage occurs when gallstones block the duct that carries bile to the small intestines. This causes bile to accumulate in the gallbladder which swells the organ and causes inflammation.

10%-15% of people with gallstones develops acute cholecystitis at some time in their lives. Acute complicated cholecystitis is when the patient develops serious complications from cholecystitis.

Other causes may include infection, inflammation of the gallbladder wall, scarring of the bile ducts, and more. Risk factors for cholecystitis include female sex, obesity, high cholesterol levels, low fiber diets, certain medications (such as estrogen-containing drugs), a history of multiple pregnancies, family history of gallstones, and advanced age.

However, 5%-10% of people who develop acute cholecystitis do not have gallstones. This is called acalculous cholecystitis. Risk factors for acalculous cholecystitis include critical illness, diabetes, male sex, HIV infection, atherosclerosis and IV nutrition.

Gallbladder inflammation can lead to a variety of symptoms including upper right abdominal pain, fever, nausea, vomiting, jaundice (yellowing of the skin), and clay-colored stools.

Diagnosis is typically based on medical history, physical examination, and imaging studies. Your doctor may ask questions about your symptoms, such as when they began and if you have any other medical conditions. During the physical exam, they will check for tenderness in your abdomen and signs of inflammation. Right upper abdominal ultrasound is the first recommended imaging study to diagnose cholecystitis.

Surgical removal of the gallbladder is the first-line treatment. The procedure is called a cholecystectomy. It is a minimally invasive laparoscopic procedure performed with small incisions in the abdomen to remove the gallbladder. When this procedure is performed within three days after diagnosis, it is associated with improved patient outcomes including fewer postoperative complications and shorter hospitalization. Sometimes, patients may require a longer incision to remove the gallbladder.

Pregnant people are also at risk for developing gallstones. If they develop cholecystitis, the treatment is early laparoscopic cholecystectomy which may be recommended during all trimesters. It is safe and effective with low risk.

Critically ill and older patients with multiple comorbidities who are at risk for surgical complications may undergo a catheter placement into the gallbladder to drain it. This is called a percutaneous cholecystostomy.

Treatment of cholecystitis depends on the severity and cause of the condition, as well as other factors such as age and overall health. Treatment may include antibiotics to clear up any infection, pain medication, dietary changes, or possibly surgery to remove the gallbladder. Talk to your doctor about the best treatment options for you.

Untreated cholecystitis can lead to serious complications such as gangrene (tissue death), perforation of the gallbladder wall, or infection of other organs.