Cholecystitis

What is Cholecystitis?

Cholecystitis is an inflammatory condition of the gallbladder. The gallbladder is a small, pear-shaped organ on the right side of the abdomen beneath the liver. The gallbladder stores a digestive fluid known as bile that is released into the small intestine after you eat a meal. 

Causes of Cholecystitis 

The causes of cholecystitis include:

• Gallstones- The accumulation of cholesterol particles in your gallbladder results in the development of gallstones. These gallstones can block the tube (cystic duct) through which bile flows leading to a build-up of bile in the gallbladder causing inflammation.
• Tumor growth- A tumor mass in and around the gallbladder may block bile from draining out properly. This may also cause bile build up that can lead to inflammation.
• Bile sludge- Altered concentration or thickening of the bile if the gallbladder is not emptied regularly, certain medications, or changes in diet can block the bile duct causing inflammation.
• Infection- Some viral infections such as AIDS can trigger gallbladder inflammation.

Risk Factors for Cholecystitis

There are several risk factors than can lead to cholecystitis including:

• Family history
• Age above 50 or older
• Excess alcohol consumption
• High fat diet (oily and junk food)
• Obesity
• Diabetes
• Pregnancy 
• Hormonal therapy or birth control pills
• Rapid weight loss

Symptoms of Cholecystitis

Symptoms of cholecystitis may include:

• Severe pain in your upper right or center abdomen
• Pain that spreads to your right shoulder or back
• Tenderness over your abdomen when it's touched
• Nausea and vomiting
• High grade fever with chills
• Abdominal pain that worsens when taking a deep breath.
• Abdominal pain and cramping typically starts after eating meals especially fatty foods
• Jaundice

Diagnosis of Cholecystitis 

For diagnosing cholecystitis, your health care provider will do a physical examination and discuss your symptoms and medical history. To confirm the diagnosis your health care provider may order tests that include:

• Blood tests: Liver function test to look for liver enzyme and protein impairment, complete blood count to look for increase in white blood count and platelet count that might indicate infection, serum amylase and lipase to analyse liver and pancreas abnormalities.
• Imaging tests that visualize your gallbladder: Abdominal ultrasound scan, endoscopic ultrasound, computerized tomography (CT) scan or magnetic resonance cholangiopancreatography (MRCP) can be used to see the images of your gallbladder and bile ducts that may show signs of cholecystitis or stones in the bile ducts and gallbladder.
• Hepatobiliary iminodiacetic acid (HIDA) scan: This is a scan that is used to trace the movement of bile through your body. It helps in tracking the production and flow of bile from your liver to your small intestine. A HIDA scan involves injecting a radioactive dye into your body, which attaches to bile-producing cells. During the scan, the dye can be seen as it travels with the bile through the bile ducts, so your healthcare provider may easily locate blockages.

Differential Diagnosis

Cholecystitis symptoms can also mimic other problems in the abdomen such as:

• Liver infections
• Appendicitis (inflammation and infection of appendix)
• Pancreatitis (inflammation and infection of pancreas)

Management of Cholecystitis 

Cholecystitis can be managed by hospitalization for 2-3 days for pain management and observation. There are several treatment options available for the management of cholecystitis including:

• Fasting- You may be advised not to eat or drink for some time to avoid stress on your inflamed gallbladder by limiting the digestion process.
• Fluid balancing- You will be given IV fluids through a vein in your arm that helps to prevent dehydration and weakness.
• Medications-Antibiotics may be prescribed to fight infection and anti-inflammatory medications to control pain until the inflammation in your gallbladder is relieved.
• ERCP (Endoscopic retrograde cholangiopancreatography)- This procedure is usually used to remove gall stones blocking the CBD (common bile duct) and also to diagnose and treat problems in the liver, gallbladder, bile ducts and pancreas. During this procedure an endoscopist will insert a long flexible lighted tube called an endoscope through your mouth up to the duodenum (first part of small intestine). A dye is also used to highlight the bile ducts under X ray guidance.  Special instruments can be inserted through the endoscope to remove stones blocking the bile ducts or cystic duct.
• Laparoscopic cholecystectomy (Gallbladder removal surgery)-This is a procedure to remove the gallbladder completely. Usually, this is a minimally invasive procedure.  A small incision is made in your abdomen and laparoscope is introduced inside to visualize the gall bladder and remove it. The duration of the procedure depends on the severity of your condition. Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder. 
• Gallbladder drainage- This is done in some cases, such as when surgical removal of the gallbladder is not a good option, gallbladder drainage may be done just to reduce inflammation and infection. Drainage is done through the skin on the abdomen (percutaneous) or by passing a scope through the mouth (endoscopic).

Your symptoms are likely to decrease in 2 to 3 days after treatment. However, gallbladder inflammation often returns. Most people with cholecystitis eventually need surgery to remove the gallbladder.

Complications of Cholecystitis 

Untreated cholecystitis can lead to severe complications such as includes:

• Gangrene of the gallbladder- A blocked and severely infected gallbladder can lead to 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.
• Pancreatitis- The common bile duct and the pancreatic duct share the same valve to pass through into the duodenum. If a gallstone blocks that valve, the activated pancreatic enzymes secreted by the pancreases will get backed up causing pancreatitis (inflammation and infection in the pancreas), which can also be severe and life threatening.

Prevention of Cholecystitis 

You can reduce your risk of developing cholecystitis by following these preventive measures:

• Eating a healthy diet- Choose to eat a healthy diet that includes high fiber and protein such as fresh fruits, vegetables whole grains and healthy fats. Stay away from foods high in fat and cholesterol.
• Exercising- Physical activities and exercise reduces fat and cholesterol in your body lowering the chance of formation of gallstones.
• Plan for slow weight loss: If you are thinking to lose weight, consult an expert dietician and fitness coach for the proper guidance. Do not lose more than one to two pounds of weight per week because, rapid weight loss increases your risk for developing gallstones.