When a gallstone forms, it can wedge itself in the ducts that release bile — causing bile buildup and a painful condition called cholecystitis. (2) Cholecystitis, or gallbladder inflammation, occurs when bile can’t circulate out of the gallbladder as it normally does. When bile builds up, it causes the gallbladder to thicken, harden, swell, and become irritated. The abdomen becomes painful, and infection can occur if bile can’t flow properly. (3)
Common Symptoms of Cholecystitis
The most common symptoms of cholecystitis are:
Severe and sudden pain in the upper right part of the abdomenPain that spreads to your right shoulder or backPain after eating a mealAn abdomen that’s tender to the touchNauseaVomitingFeverChillsBloated belly (2,3)
Symptoms of cholecystitis often occur after a large or fatty meal. Although it’s easy to mistake the symptoms of cholecystitis for some other simple problem, it’s important to get a proper medical diagnosis. Untreated cholecystitis can lead to complications, so don’t brush off these symptoms as just a little indigestion or a stomach bug. (3)
Acute vs. Chronic Cholecystitis
Cholecystitis can be chronic — persistent and long-lasting swelling and damage to the gallbladder — or acute, a sudden “attack” that causes swelling and irritation of the gallbladder. Acute cholecystitis involves pain that begins suddenly and usually lasts for more than six hours. It’s caused by gallstones in 95 percent of cases. (4) Acute cholecystitis can lead to a number of relatively serious complications, so it’s important to seek medical attention quickly. It usually needs to be treated in a hospital, typically with intravenous (IV) fluids, antibiotics, or even surgery. (5) Acute cholecystitis can develop into chronic cholecystitis. Chronic cholecystitis is defined by repeated attacks of pain caused by blockages in the biliary ducts, almost always due to gallstones. Pain in chronic cholecystitis tends to be less severe than in acute cholecystitis and doesn’t tend to last as long. Fever is also rare in chronic cholecystitis. If you have chronic cholecystitis, your gallbladder may become scarred and small, with a thick outer wall. It may also contain sludge (a thick substance that pollutes the gallbladder and can’t be absorbed) or calcium deposits, which can harden and further damage the organ. (4)
Common Causes of Cholecystitis
Some of the most common causes of cholecystitis include:
Gallstones becoming lodged in the ducts of the gallbladder, preventing bile from emptyingScarring in the bile ducts leading to blockage, which can rarely happen without gallstonesA tumor in the liver or pancreasReduced blood flow to the gallbladder, sometimes due to damaged blood vessels from a severe illnessA bacterial or viral infection that strikes the bile duct system, which empties bile from the gallbladder (this may be a complication of AIDS) (3)
A rare form of acute cholecystitis that isn’t due to gallstones — called acalculous cholecystitis — tends to occur after the following events and conditions:
Major surgerySerious illness, infection, or injuryLong-term intravenous (IV) feedingExtended fastingImmune system deficiency (4)
Diagnosing Cholecystitis
Cholecystitis can be easily diagnosed through a physical exam, medical history, and an ultrasound or other imaging test. In most cases, an ultrasound can detect gallstones, in addition to fluid around the gallbladder and thickening of its walls. The procedure can also reveal tenderness in the area. A computed tomography (CT) scan may be used if an ultrasound doesn’t produce adequate images. If acute cholecystitis isn’t seen on other imaging tests, another procedure called a hepatobiliary iminodiacetic acid (HIDA) scan may be used. This imaging test involves injecting a small amount of a harmless radioactive substance into your arm. A device called a gamma camera is then used to create images as this substance travels from your bloodstream to your liver, gallbladder, bile ducts, and small intestine. (3)
Cholecystectomy, or surgical removal of the gallbladder — the most common treatmentFasting to take the stress off your gallbladderMedications to manage painMedications to dissolve gallstonesMedications to keep gallstones from formingAntibiotics and, if warranted, IV fluids
People with mild cholecystitis may have to adjust their diet, take antibiotics if an infection is present, and drink plenty of fluids to allow the inflammation to subside. More serious cases of cholecystitis generally require a stay in the hospital, as well as IV antibiotics to treat infection and intravenous (IV) fluids to help prevent dehydration. Once you start on treatment, your symptoms will probably begin to resolve over two to three days. The right treatment for you will depend on your symptoms, your age, how well you can tolerate the treatment, and your general health. Even if your symptoms are resolved in the short term, your gallbladder may become inflamed again if it’s not removed. Most people with cholecystitis eventually require surgery to remove the organ. (3) Additional reporting by Quinn Phillips
