Cholecystitis means inflammation of the gallbladder. It is a common disease encountered by internal physicians and surgeons.
In the majority of cases, the inflammation is related to presence of gallstones. The wall of the gallbladder may be irritated by the stones and in addition, the stones can block the bile outflow from the gallbladder making an ideal situation for local bacterial infection. Less frequently, there are reported cases of cholecystitis non-related to gallstones, which occurs in severely ill patients where it accompanies weakened immune system and mucosal barrier. This type of cholecystitis has a significantly worse prognosis due to the poor general condition of the patient.
We distinguish two main forms of the disease – acute cholecystitis (sudden onset) and chronic (long-lasting).
The condition appears relatively suddenly. The affected person suffers from acute abdominal pain, which is located in the right upper quadrant of the abdomen. Sometimes, the pain may irradiate to the back between the shoulder blades. The pain is followed with high fever and chills. When the condition is related to disorder of bile outflow, the jaundice may appear. Other symptoms such as loss of appetite and vomiting are almost always present as well.
In this case, the wall of the gallbladder is chronically inflamed and it thickens. The disease manifests more subtly including the loss of appetite and intermittent abdominal pain. Chronic cholecystitis may be accompanied with recurring episodes of acute inflammation.
Note: Chronic cholecystitis may be in some people associated with calcium deposition in the gallbladder's wall and the subsequent formation of the so-called porcelain gallbladder.
The abdominal pain present in the right upper quadrant should be followed by careful physical examination of the abdomen any then by the abdominal ultrasound. The ultrasound may show the inflamed wall of the gallbladder and presence of gallstones. Skilled ulrasonographist is even sometimes able to differentiate acute cholecystitis from chronic. Blood tests usually confirm inflammatory changes such as elevation of CRP and the number of white blood cells. Liver tests may be secondary elevated as well.
There are two main ways of approach – conservative (non-surgical) and surgical. The conservative approach is applied more frequently in subacute inflammation. It includes bed rest, strict diet, adequate hydration, painkillers and antibiotics. In case that the inflammation is combined with bile duct obstruction by a gallstone, ERCP is usually performed to remove the obstruction.
The other solution is surgical removal of the gallbladder, which is preferred either in the first 48 hours of symptoms, or weeks after cessation of acute inflammation. Another situation when the surgical intervention is undoubtedly indicated is uncontrollable deterioration of the patient’s condition unresponsive to conservative treatment with the risk of peritonitis and sepsis.