Cholecystitis is the inflammation of the gallbladder, the small organ behind the liver. The great majority of cases of cholecystitis result from the presence of gallstones, though the disorder may also occur because of another disease or, rarely, a tumor in the area. Normally, the gallbladder releases bile to the small intestine as needed, but when there is a blockage bile builds up in the gallbladder, resulting in pain, swelling and possible infection. While the gallbladder plays a part in the digestive process, it is not a vital organ and can be removed if necessary for the patient's health and well-being.
Causes of Cholecystitis
The cause of the formation of gallstones is unknown, although there seems to be a familial predisposition to their formation, and they are more common in Native Americans and Americans of Mexican descent. Gallstones are composed of substances found in bile, like cholesterol or bilirubin, and are more likely to form if the gallbladder does not empty completely. They may be as tiny as grains of sand or as large as golf balls, and may or may not cause symptoms. If gallstones are present in an asymptomatic patient, no action is necessary. The risk factors below may contribute to the formation of gallstones:
- Being female
- Being overweight or obese
- Losing weight suddenly
- Being pregnant
- Eating a diet high in fat or cholesterol and/or low in fiber
- Having diabetes
Taking certain medications, such as estrogen or some cholesterol-lowering medications, may also contribute to the formation of gallstones.
Symptoms of Cholecystitis
While it is possible to have gallstones without symptoms, when symptoms of gallbladder disease are present, they are difficult to ignore. If a gallstone lodges in a duct and causes a blockage, the result is sudden and rapidly intensifying pain. This is often referred to as a "gallbladder attack." Symptoms of a gallbladder attack may include:
- Pain in the upper right abdomen
- Pain in the right shoulder or upper back
- Nausea and vomiting
- Clay-colored stools
A gall bladder attack may last for several minutes or as much as an hour or more. It is more likely to occur after the ingestion of a meal heavy in fat content.
Diagnosis of Cholecystitis
While a doctor may suspect the presence of gallstones or other gallbladder disease, diagnostic tests are available to confirm this condition. There are also several tests to confirm the presence of gallstones, including:
- Abdominal ultrasound
- CT scan
- HIDA scan (hepatobiliary iminoacetic acid)
- Blood tests to check for infection or pancreatitis
An ERCP (endoscopic retrograde cholangiopancreatography) may also be performed. This is a type of endoscopy in which dye is used to illuminate the biliary tract.
Treatment of Cholecystitis
Mild cholecystitis is sometimes treated with a diet very low in fat. In most cases, however, surgery is necessary. Fortunately, in recent years a cholecystectomy has almost always been performed laparoscopically instead of as an open procedure. This results in less pain, less bleeding, less scarring and a much speedier recovery for the patient.
Risks of Cholecystitis
While there are minimal risks to a laparoscopic cholecystectomy, there are greater risks in allowing gallbladder disease to go untreated. Without treatment, the diseased gallbladder may become infected. The patient may also develop an infection of the bile duct, pancreatitis, a fistula, a bowel obstruction or even a malignancy in the area.