Cholecystitis (ko-luh-sis-TIE-tis) is inflammation of the gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, beneath your liver. The gallbladder holds a digestive fluid that's released into your small intestine (bile).

In most cases, gallstones blocking the tube leading out of your gallbladder cause cholecystitis. This results in a bile buildup that can cause inflammation. Other causes of cholecystitis include bile duct problems and tumors.

If left untreated, cholecystitis can lead to serious, sometimes life-threatening complications, such as a gallbladder rupture. Treatment for cholecystitis often involves gallbladder removal.

Signs and symptoms of cholecystitis may include:

  • Severe pain in your upper right abdomen
  • Pain that radiates from to your right shoulder or back
  • Tenderness over your abdomen when it's touched
  • Nausea
  • Vomiting
  • Fever

Cholecystitis signs and symptoms often occur after a meal, particularly a large or fatty meal.

When to see a doctor

Make an appointment with your doctor if you have worrisome signs or symptoms. For abdominal pain so severe you can't sit still or get comfortable, have someone drive you to the emergency room.

Cholecystitis occurs when your gallbladder becomes inflamed. Gallbladder inflammation can be caused by:

  • Gallstones. Most cholecystitis is the result of hard particles that develop in your gallbladder  (gallstones) from imbalances in the substances in bile, such as cholesterol and bile salts. Gallstones can block the cystic duct — the tube through which bile flows when it leaves the gallbladder — causing bile to build up and resulting in inflammation.
  • Tumor. A tumor may prevent bile from draining out of your gallbladder properly, causing bile buildup that can lead to cholecystitis.
  • Bile duct blockage. Kinking or scarring of the bile ducts can cause blockages that lead to cholecystitis.

Having gallstones is the main risk factor for developing cholecystitis.

Cholecystitis can lead to a number of serious complications, including:

  • Infection within the gallbladder. If bile builds up within your gallbladder, causing cholecystitis, the bile may become infected.
  • Death of gallbladder tissue. Untreated cholecystitis can cause tissue in the gallbladder to die, which in turn can lead to a tear in the gallbladder, or it may cause your gallbladder to burst.
  • Torn gallbladder. A tear in your gallbladder may result from gallbladder enlargement or infection.

Make an appointment with your doctor if you have signs or symptoms that worry you. If your doctor suspects you have cholecystitis, he or she may either refer you to a doctor who specializes in the digestive system (gastroenterologist) or send you to a hospital.

Here's information to help you prepare for your appointment.

What you can do

  • Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
  • Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including major stresses or recent life changes.
  • Make a list of all medications, vitamins and supplements you're taking.
  • Take a family member or friend along, if possible. Someone who accompanies you can help you remember the information you get.
  • Write down questions to ask your doctor.

For cholecystitis, some basic questions to ask your doctor include:

  • Is cholecystitis the likely cause of my abdominal pain?
  • What are other possible causes for my symptoms?
  • What tests do I need?
  • Do I need gallbladder removal surgery?
  • How soon do I need surgery?
  • What are the risks of surgery?
  • How long does it take to recover from gallbladder surgery?
  • Are there other treatment options for cholecystitis?
  • Should I see a specialist?
  • Are there brochures or other printed material that I can take with me? What websites do you recommend?

Don't hesitate to ask other questions, as well.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • When did your symptoms begin?
  • Have you had pain similar to this before?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

Tests and procedures used to diagnose cholecystitis include:

  • Blood tests. Your doctor may order blood tests to look for signs of an infection or signs of gallbladder problems.
  • Imaging tests that show your gallbladder. Imaging tests, such as abdominal ultrasound or a computerized tomography (CT) scan, can be used to create pictures of your gallbladder that may reveal signs of cholecystitis.
  • A scan that shows the movement of bile through your body. A hepatobiliary iminodiacetic acid (HIDA) scan tracks the production and flow of bile from your liver to your small intestine and shows blockage. A HIDA scan involves injecting a radioactive dye into your body, which binds to the bile-producing cells so that it can be seen as it travels with the bile through the bile ducts.

Treatment for cholecystitis usually involves a hospital stay to stabilize the gallbladder inflammation and possible surgery.

Hospitalization

If you're diagnosed with cholecystitis, you'll likely be hospitalized. Your doctor will work to control your signs and symptoms and to control the inflammation in your gallbladder. Treatments may include:

  • Fasting. You may not be allowed to eat or drink at first in order to take stress off your inflamed gallbladder. So that you don't become dehydrated, you may receive fluids through a vein in your arm.
  • Antibiotics to fight infection. If your gallbladder is infected, your doctor likely will recommend antibiotics.
  • Pain medications. These can help control pain until the inflammation in your gallbladder is relieved.

Your symptoms are likely to subside in a day or two.

Surgery to remove the gallbladder

Because cholecystitis frequently recurs, most people with the condition eventually require gallbladder removal surgery (cholecystectomy). The timing of surgery will depend on the severity of your symptoms and your overall risk of problems during and after surgery. If you're at low surgical risk, you may have surgery within 48 hours or during your hospital stay.

Cholecystectomy is most commonly performed using a tiny video camera mounted at the end of a flexible tube. This allows your surgeon to see inside your abdomen and to use special surgical tools to remove the gallbladder (laparoscopic cholecystectomy). The tools and camera are inserted through four incisions in your abdomen, and the surgeon watches a monitor during surgery to guide the tools. An open procedure, in which a long incision is made in your abdomen, is rarely required.

A less invasive way to remove gallbladders is under study. Known as natural orifice transluminal endoscopic surgery (NOTES), the procedure is intended to lessen scarring and discomfort. While laparaoscopic cholecystectomy remains the standard of care for gallbladder removal, NOTES is being performed in a few centers worldwide and may eventually be an important alternative.

Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder. You don't need your gallbladder to live normally.

You can reduce your risk of cholecystitis by taking the following steps to prevent gallstones:

  • Lose weight slowly. Rapid weight loss can increase the risk of gallstones. If you need to lose weight, aim to lose 1 or 2 pounds (0.5 to about 1 kilogram) a week.
  • Maintain a healthy weight. Being overweight increase the risk of gallstones. To achieve a healthy weight, reduce calories and increase the physical activity. Maintain a healthy weight by continuing to eat well and exercise.
  • Choose a healthy diet. Diets high in fat and low in fiber may increase the risk of gallstones. To reduce your risk of gallstones, choose a diet high in fruits, vegetables and whole grains.
Aug. 28, 2014