Cholecystitis is inflammation of the gallbladder. Most cases are caused by gallstones. If you have cholecystitis you will normally be admitted to hospital for treatment with painkillers, fluids, (and sometimes antibiotics) directly into a vein. The inflammation may settle down with treatment. However, removal of the gallbladder is usually advised to prevent further bouts of cholecystitis.
Bile is a fluid made in the liver. Bile contains various substances, including bile pigments, bile salts, cholesterol and lecithin. Bile is passed into tiny tubes called bile ducts. The bile ducts join together (like the branches of a tree) to form the main bile duct. Bile constantly drips down the bile ducts, into the main bile duct, and then into the gut.
The gallbladder lies under the liver on the right side of the upper abdomen. It is like a pouch which comes off the main bile duct and fills with bile. It is a 'reservoir' which stores bile. The gallbladder contracts (squeezes) when we eat. This empties the stored bile back into the main bile duct. The bile passes along the remainder of the bile duct into the duodenum (the first part of the gut after the stomach).
Bile helps to digest food, particularly fatty foods.
Cholecystitis means inflammation of the gallbladder. The exact number of cases in the UK is not known. However, it is not an uncommon condition, and it is quite a common cause for hospital admission. Women are affected more often than men.
Symptoms tend to develop quite quickly, over a few hours or so. They include:
Gallstones occur when bile, which is normally fluid, forms stones. Gallstones commonly contain lumps of cholesterol-like (fatty) material that has solidified and hardened. Sometimes bile pigments or calcium deposits form gallstones. Sometimes just a few small stones are formed; sometimes a great many. Occasionally, just one large stone is formed. About 1 in 3 women, and 1 in 6 men, form gallstones at some stage in their life. They become more common with increasing age.
Most people with gallstones do not have any symptoms or problems, and do not know they have them. Commonly, the stones simply stay in the gallbladder and cause no harm. However, in some people, gallstones can cause problems. (See separate leaflet called 'Gallstones' which briefly lists the various problems that gallstones can cause.)
Cholecystitis is one problem that can occur with gallstones. About 19 in 20 cases of cholecystitis are thought to be caused by gallstones. What seems to happen is that a gallstone becomes stuck in the cystic duct (this is the tube that drains bile out from the gallbladder into the bile duct). Bile then builds up in the gallbladder, which becomes stretched (distended). Because of this, the walls of the gallbladder become inflamed. In some cases the inflamed gallbladder becomes infected. An infected gallbladder is more prone to lead to complications (see below).
No gallstones are found in about 1 in 20 cases of cholecystitis. In many of these cases it is unclear as to why the gallbladder became inflamed and/or infected.
An ultrasound scan is commonly done to clarify the diagnosis. This is a painless test which uses sound waves to scan the abdomen. An ultrasound scan can usually detect gallstones, and also if the wall of the gallbladder is thickened (as occurs with cholecystitis). If the diagnosis is in doubt then other more detailed scans may be done.
You will normally be admitted to hospital. Usually, you will not be allowed to eat or drink (to rest the gallbladder), and you will be given fluids and painkillers directly into a vein through a 'drip'. With this initial treatment the gallstone that caused the blockage often falls back into the gallbladder, and the inflammation and symptoms often settle down. If the doctor suspects that the gallbladder has become infected, you will also be given antibiotics directly into a vein through the 'drip'.
The gallbladder will usually be removed by an operation. The operation is often done within a few days of being admitted to hospital. Sometimes the operation is delayed for several weeks until the inflammation has settled. Different techniques to remove the gallbladder may be used depending on various factors.
If you do not have your gallbladder removed, there is a reasonable chance that you will have no further problems if the inflammation settles down. However, there is also a good chance that you would have further bouts of cholecystitis in the future. This is why the usual treatment is to remove the gallbladder.
If treatment is delayed or not available, in some cases the gallbladder becomes severely infected and even gangrenous. This can lead to blood poisoning (septicaemia), which is very serious and can be life-threatening. Other possible complications include: the gallbladder may perforate (burst), or a fistula (channel) may form between the gallbladder and gut as a result of continued inflammation.
You do not need a gallbladder to digest food. Bile still flows from the liver to the gut once the gallbladder is removed. However, there is no longer any storage area for bile between meals. The flow of bile is therefore constant, without the surges of bile that occur from a gallbladder when you eat a meal.
You can usually eat a normal diet without any problems after your gallbladder is removed. However, up to half of people who have had their gallbladder removed have some mild abdominal pain or bloating from time to time. This may be more noticeable after eating a fatty meal. Some people notice an increase in the frequency of passing stools (motions or faeces) after their gallbladder is removed. This is like mild diarrhoea. It can be treated by antidiarrhoeal medication if it becomes troublesome.