Cholecystitis: Symptoms and Causes

What Is Cholecystitis?

Cholecystitis is a condition in which the gallbladder, a small, pear-shaped organ underneath your liver, gets inflamed. The gallbladder’s primary function is storing bile, a digestive fluid produced by the liver. The inflammation usually results from a blockage in the bile duct, typically caused by gallstones. This condition can be acute, emerging suddenly, or chronic, developing over time.

In India, cholecystitis is quite common among all age groups due to the high prevalence of gallstones and unhealthy dietary patterns. Patients often delay seeking medical help due to a lack of awareness about the symptoms and severity of this condition. Hence, it is important to consult with a seasoned family physician or surgeon if you experience any symptoms of cholecystitis.

Types Of Cholecystitis

Cholecystitis has two main types: acute and chronic. They are characterised as follows:

• Acute Cholecystitis: This condition causes sudden inflammation, often due to gallstones obstructing the cystic duct. Its symptoms include severe abdominal pain (particularly in the upper right abdomen), nausea, vomiting, fever, and tenderness. If left untreated, it can lead to various complications, such as gallbladder perforation, gangrene, or infection.

It can be further classified as Calculous Cholecystitis which is the most common type, caused by gallstones obstructing the cystic duct. Another is Acalculous Cholecystitis which occurs without gallstones and is often associated with serious conditions such as trauma or infections.

• Chronic Cholecystitis: This type refers to long-standing inflammation that develops over time, often due to repeated episodes of acute cholecystitis. Symptoms are less severe and intermittent, including recurrent abdominal pain after eating fatty meals, bloating, and nausea. Over time, chronic cholecystitis can lead to gallbladder dysfunction and scarring.

Understanding these types of cholecystitis can aid in the timely diagnosis and determination of appropriate treatment strategies.

What Causes Cholecystitis?

Cholecystitis, or gallbladder inflammation, often arises due to various underlying conditions or influences. The most common contributors are:

• Gallstones: The leading cause of cholecystitis is the presence of gallstones, which are hardened deposits that can block the cystic duct, preventing bile from draining properly. This blockage leads to bile accumulation, swelling, and irritation of the gallbladder.
• Biliary sludge: A mixture of bile and small particles, known as biliary sludge, can also obstruct the cystic duct. This condition is often associated with rapid weight loss or pregnancy.
• Tumours: Tumours in the pancreas or liver can obstruct bile flow, backing it up in the gallbladder, and leading to cholecystitis.
• Infection: Bacterial infections can lead to inflammation and swelling of the gallbladder. In some cases, an inflamed gallbladder may become infected after a blockage occurs.
• Acalculous cholecystitis: This type occurs without gallstones and is often linked to severe illnesses or injuries that compromise blood flow to the gallbladder, such as sepsis or trauma.
• Other factors: Conditions that affect the blood supply to the gallbladder, prolonged fasting, hormonal changes, or immune deficiencies may also contribute to cholecystitis.
• Chronic conditions: Diseases such as diabetes or Crohn’s disease may increase the risk of developing cholecystitis due to their effects on digestion and metabolism.

Symptoms Of Cholecystitis

If you are suffering from cholecystitis, you are likely to experience the following symptoms:

• Severe pain: You might experience a sudden, sharp pain in the upper right abdomen that sometimes radiates to the right shoulder or back.
• Tenderness: The abdomen may become very tender to touch, particularly in the upper right quadrant.
• Nausea and vomiting: These symptoms often accompany the pain, particularly after eating a fatty meal.
• Fever: A low-grade fever may indicate inflammation or infection.
• Jaundice: Yellowing of the skin and eyes can occur if bile flow is obstructed.
• Bloating: Abdominal bloating and discomfort accompanying the pain.
• Loss of appetite: You may have little or no appetite due to discomfort.

In the case of chronic cholecystitis, the symptoms include:

• Intermittent pain: This is a dull, cramping pain in the upper right abdomen that comes and goes.
• Biliary colic: There might be episodes of severe abdominal pain lasting a few minutes to several hours.
• Nausea and indigestion: These might occur after eating rich or fatty foods.

Diagnosis And Evaluation Of Cholecystitis

The diagnosis of cholecystitis involves a combination of clinical evaluation, laboratory tests, and imaging. 

• Clinical examination: The doctor will look for signs such as severe pain in the upper right abdomen, nausea or vomiting, fever and chills, and tenderness in the abdomen. A positive Murphy sign (pain during inhalation when the gallbladder is palpated) indicates acute cholecystitis.
• Physical examination: The doctors might also observe tenderness in the right upper quadrant, guarding or rebound tenderness, and possible jaundice if there’s an associated bile duct obstruction.
• Laboratory tests: To measure inflammation markers, tests such as a Complete Blood Count (CBC), liver function tests, and C-reactive protein (CRP) might be performed.  
• Imaging studies: Imaging studies, including ultrasound, HIDA scan (Hepatobiliary Iminodiacetic Acid Scan), CT scan, and MRI/MRCP (Magnetic Resonance Cholangiopancreatography), help identify gallstones, inflammation signs, or any complications like perforation or abscess formation.

How Can Cholecystitis Be Treated?

Treating cholecystitis primarily depends on its severity and whether it is acute or chronic. In most cases of acute cholecystitis, hospitalisation is required for close observation and treatment.

• Initial management: Acute cholecystitis treatment begins with hospitalisation and an initial regime of fasting, intravenous (IV) fluids, pain management, and antibiotics. This conservative treatment aims to allow the gallbladder to rest, prevent dehydration, manage pain, and control infection or inflammation.
• Surgical treatment: The surgical removal of the gallbladder (cholecystectomy) is the definitive treatment for both acute and chronic cholecystitis. It’s usually done through a minimally invasive laparoscopic procedure, but in complex cases, an open cholecystectomy might be necessary.
• Non-surgical options: In certain cases where surgery isn’t feasible due to patient condition or other factors, non-surgical options like Endoscopic Retrograde Cholangiopancreatography (ERCP) or Percutaneous Drainage can be utilised.

With appropriate treatment and early diagnosis, patients with cholecystitis generally have a good prognosis. It’s crucial to seek medical attention promptly if you suspect cholecystitis based on symptoms like severe abdominal pain.

When Is Cholecystitis Considered Serious?

Cholecystitis can result in major complications if left untreated. It is considered serious under these conditions:

• Gangrenous cholecystitis: This happens when the blood supply to the gallbladder gets cut off, leading to tissue death.
• Perforated gallbladder: Rupture of the inflamed gallbladder could result in bile leakage into the abdomen, causing peritonitis and serious infection.
• Sepsis: An infection spreading from cholecystitis into your bloodstream can cause sepsis, a life-threatening condition.
• Abscess formation: Abscess around the gallbladder may require further medical intervention and drainage.
• Acalculous cholecystitis: This type occurs without gallstones and can be associated with severe illness or trauma and has a higher mortality rate.
• Delayed treatment: Late diagnosis or treatment of cholecystitis significantly increases the risk of complications.

Prevention Of Cholecystitis

Although preventing cholecystitis might not be entirely possible, one can take steps to reduce their risks. Maintaining a healthy weight and avoiding rapid weight loss can help, as obesity and sudden weight loss could increase your risk of gallstones—a primary cause of cholecystitis. 

Regular exercise and a balanced diet low in fats and high in fibre can also help maintain good gallbladder health. It is always recommended to visit your family doctor if you have persistent abdominal pain.

When To Consult A Doctor For Cholecystitis?

If you’re experiencing persistent or severe abdominal pain, high fever, or yellowing of the skin and eyes (jaundice), it’s time to consult a doctor. A gastroenterologist specialising in digestive system disorders may be the most appropriate person to consult. Timely diagnosis and treatment of cholecystitis are crucial to prevent serious complications.