Chronic Cholecystitis

What Is Chronic Cholecystitis?

Cholecystitis (ko-luh-sis-TIE-tis) or acute cholecystitis is the inflammation of your gallbladder. If this condition persists for a prolonged period of time or if you have repeated attacks, it is called chronic cholecystitis.

The gallbladder is a small, pear-shaped organ located under your liver. It stores bile made by the liver and sends it to the small intestine via the common bile duct (CBD) to aid in the digestion of fats. The CBD connects the liver, the gallbladder, and the pancreas to the small intestine. Gallstones blocking the CBD are the leading cause of cholecystitis. This blockage means that bile builds up in the gallbladder, and that buildup causes the gallbladder to become inflamed.

This is a serious condition. If not treated properly, the gallbladder could rupture. Treatment usually involves antibiotics, pain medications, or removal of the gallbladder.

What Causes Chronic Cholecystitis?

This condition usually begins with the formation of gallstones in the gallbladder. According to the Cleveland Clinic, whether you have gallstones may depend on several factors, including inherited body chemistry, weight, gallbladder activity, and diet (Cleveland).

Gallstones form when substances in the bile form crystal-like particles. They can range from the size of a grain of sand to the size of a golf ball. The presence of gallstones causes pressure, irritation, and may cause infection. In time, the walls of the gallbladder begin to thicken. Eventually, the gallbladder starts to shrink. These changes make it harder for the gallbladder to function properly.

In addition to gallstones, cholecystitis can be caused by:

  • infection in the CBD drainage system
  • CBD blockage
  • excess cholesterol in the gallbladder (can happen during pregnancy or after rapid weight loss)
  • decreased blood supply to the gallbladder because of diabetes
  • tumors in the liver or pancreas
  • tumor in the gallbladder—this is rare

When you experience repeated or prolonged attacks of cholecystitis, it becomes a chronic condition.

Who Gets Cholecystitis?

Gallstones are more common in women than in men. Because of this, women are more likely to develop cholecystitis. The risk of developing this condition increases after age 40. Also, Hispanics and Native Americans have a higher risk of developing gallstones than other people.

Signs and Symptoms of Cholecystitis

Symptoms of cholecystitis can appear suddenly or develop slowly over a period of years. Signs and symptoms include:

  • severe abdominal pains that may feel sharp or dull
  • abdominal cramping and bloating
  • pain that spreads to your back or below your right shoulder blade
  • fever and chills
  • nausea and vomiting
  • loose, light-colored stools
  • jaundice (when the skin and whites of your eyes turn yellow)
  • itching

A typical attack can last two or three days, but symptoms vary widely from person to person.

Complications can include:

  • pancreatitis (inflammation of the pancreas)
  • cancer of the gallbladder (rare)
  • gangrene
  • perforation of the gallbladder
  • enlarged gallbladder due to inflammation
  • infection
  • death of gallbladder tissue

How Cholecystitis Is Diagnosed

Your doctor will take your medical history and conduct a physical examination. The symptoms of cholecystitis are similar to those of other conditions, so he or she must rule out those conditions.

Some tests that can help diagnose cholecystitis are:

  • abdominal CT scan: Using X-rays, the CT scan produces very detailed pictures of your abdomen.
  • abdominal ultrasound: The ultrasound helps your doctor view all the internal organs in your abdomen and see how blood flows through your vessels.
  • blood tests: Blood tests can identify infections.
  • cholescintigraphy/HIDA scan: An injection of a small amount of radioactive material is used to identify abnormal contractions or obstructions of your gallbladder and bile ducts.
  • endoscopic retrograde cholangiopancreatography (ERCP):Using an endoscope (a long, flexible tube inserted down the throat), dye, and an X-ray, the doctor can thoroughly examine your organs and find defects or problems.
  • percutaneous transhepatic cholangiography (PTC): Contrast dye is inserted into the liver with a needle, which allows the bile ducts to be seen on X-ray.

Treatment Options for Cholecystitis

Treatment will be determined by the cause of your attack. Your doctor will also consider your overall health when choosing your treatment. Options include:

  • antibiotics for fighting infection
  • oral dissolution therapy using medications to help dissolve gallstones
  • pain relievers for controlling pain during treatment

If you have a ruptured gallbladder, surgical removal of your gallbladder will be required. Surgery is often used in cases of chronic cholecystitis. Today, gallbladder surgery is generally done laparoscopically. Your surgeon will make small incisions in your abdomen and insert small surgical tools to perform the surgery. In most cases, the surgery can be performed as an outpatient procedure, which means a shorter recovery time.

Your healthcare team will advise you about lifestyle and dietary guidelines that can also improve your condition.

Long-Term Outlook for Chronic Cholecystitis

When treated properly, the long-term outlook is quite good. You do not need a gallbladder to live or to digest food. If your gallbladder is removed, bile will flow directly from your liver into your small intestine.

Can Chronic Cholecystitis Be Prevented?

If you have had one or more bouts of cholecystitis, speak to your doctor to learn what changes you can make to avoid chronic cholecystitis. Ask about dietary guidelines that may include lowering your intake of fat. Regular exercise is often helpful.

Gallstones are the main cause of cholecystitis. If this is what caused your attack, you can lower your risk of developing more gallstones by maintaining a healthy weight. If you need to lose weight, take care to do it slowly because rapid weight loss can increase your risk of developing gallstones.