Cholecystitis is inflammation of the gallbladder, the pear-shaped muscular sac the lies below the liver. The gallbladder's main function is to store and concentrate bile and to expel bile through the bile duct into the intestine to assist with the digestion of fats. Bile is a greenish-brown liquid produced by the liver that helps to break down fats present in the small intestine during digestion. Cholecystitis may come on suddenly (acute) or may persist over a period of time (chronic).
Acute cholecystitis is usually caused by obstruction of the outlet of the gallbladder, which is often due to the development of a stone formed in the biliary tract (gallstone or biliary calculus). Repeated mild episodes of acute cholecystitis may result in chronic cholecystitis, which may be characterized by thickening and shrinking of the gallbladder walls and a resulting inability to store bile. Cholecystitis may cause a variety of symptoms including severe pain in the right side of the abdomen (right upper quadrant) and/or back, nausea, vomiting, indigestion, fever, and persistent yellowing of the skin, mucous membranes, and whites of the eyes (jaundice). In some cases, there may be additional symptoms.
The specific symptoms associated with cholecystitis may vary from one person to another. An episode of cholecystitis may be referred to as a “gallbladder attack”. Chronic cholecystitis is characterized by continued, recurrent attacks over time.
Upper abdominal pain is the most common symptom of cholecystitis. In acute cholecystitis, the pain is often sudden and intense. Pain can become excruciating. Upper abdominal pain usually lasts longer than six hours, often begins a few hours after a meal, can worsen when taking deep breaths and may radiate all the way to the right shoulder blade (scapula).
In addition to pain, affected individuals may experience nausea and vomiting. Shortness of breath when inhaling (due to pain) may also occur. Additional symptoms that may occur in individuals with cholecystitis include stiffening of the muscles on the right side of the abdomen, bloating of the abdomen, chills, a slight fever, and yellowing of the skin and whites of the eyes (jaundice).
Older individuals with cholecystitis may not develop pain or fever and their only symptom may be tenderness of the upper right portion of the abdomen.
Affected individuals may develop a bacterial infection preceding or during a gallbladder attack. In most cases a gallbladder attack lasts one to four days and then subsides. In rare cases, more serious complications can occur such as puncture (perforation) of the gallbladder or the presence of pus within the gallbladder (empyema). In these cases, surgery may be necessary.
Approximately 90 percent of cases of cholecystitis are associated with a stone causing obstruction of the cystic duct (calculous cholecystitis). The medical term for the presence of a gallstone is cholelithiasis. The cystic duct is a short tube that carries bile from the gallbladder to the common bile duct. Obstruction of the cystic duct causes widening (distention) and inflammation of the gallbladder, which, in turn, causes the symptoms of the cholecystitis.
The exact cause of cases not associated with a gallstone (acalculous cholecystitis) is unknown. Acalculous cholecystitis has been linked to a variety of different potential causative agents including bacterial infection in the bile duct system, trauma or injury, decreased blood supply to the gallbladder as may occur in individuals with diabetes, heart abnormalities, and tumors in the liver or pancreas. Additional conditions or disorders linked to acalculous cholecystitis include sickle cell anemia, the presence of infection or toxins in the bloodstream (sepsis), long-term total parenteral nutrition (feeding through the vein), and prolonged fasting.
Calculous cholecystitis, the more common form, occurs more often in females than males. Acalculous cholecystitis occurs most often in elderly men. Although an estimated 10-20 percent of individuals in the general population have gallstones, the exact incidence of cholecystitis is unknown. The incidence of cholecystitis increases with age. Acute acalculous cholecystitis is a rare disorder.
A diagnosis of cholecystitis is made based upon identification of characteristic symptoms, a detailed patient history, a thorough clinical evaluation and use of one or more of a variety of specialized tests including an abdominal ultrasound, a computed tomography (CT) scan, cholangiography, or hepatobiliary scintigraphy (HIDA scan). These tests can detect the presence of a gallstone or thickening of the gallbladder wall or indicate obstruction of the cystic duct.
During an abdominal ultrasound, reflected sound waves are used to create an image of internal structures of the abdomen. During CT scanning, a computer and x-rays are used to create a film showing cross-sectional images of certain tissue structures. During cholangiography, a contrast dye is injected into the bloodstream, which enables x-rays to create an image of the bile ducts.
During hepatobiliary scintigraphy, a specialized camera is used to obtain two-dimensional images of the gallbladder, liver and bile ducts. Individuals are injected with a radioactive chemical that travels everywhere bile goes. The specialized camera can sense the radioactive chemical thereby producing an image of the gallbladder and surrounding structures.
Blood tests may reveal elevated levels of white blood cells, which may indicate inflammation or infection or both.
The treatment of cholecystitis is directed toward the specific symptoms that are apparent in each individual. Specific therapeutic procedures and interventions may vary, depending upon numerous factors, such as the cause of gallbladder inflammation (e.g., whether a gallstone is present); the extent of the disease; individual's age and general health; individual responsiveness to certain medications or treatments; and/or other elements. Decisions concerning the use of particular interventions should be made by physicians and other members of the health care team in careful consultation with the patient, based upon the specifics of his or her case; a thorough discussion of the potential benefits and risks; patient preference; and other appropriate factors.
Treatment of acute cholecystitis often includes hospitalization along with bowel rest, intravenous hydration with fluids and electrolytes, and pain medications (analgesics). Antibiotics may be given to treat infection. An affected individual is not allowed to eat or drink during the early portion of hospitalization. More individuals with acute cholecystitis eventually have their gallbladder removed surgically, a procedure called a cholecystectomy. During this procedure, a small, thin tube called a laparoscope is passed through a small incision in the abdominal wall, allowing a surgeon to remove the diseased gallbladder.
Some mild cases of acute cholecystitis may be treated with antibiotics alone. Acalculous cholecystitis is usually treated by surgical removal of the gallbladder.
Affected individuals may also receive medications that preventing vomiting (antiemetics), medications that hinder the development of gallstones, medications that dissolve gallstones, and be encouraged to follow a low-fat diet.
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