What is chronic cholecystitis?
Cholecystitis is the sudden inflammation of your
gallbladder. If this condition persists over time, such as for months, with repeated attacks, or if there are recurrent problems with gallbladder function, it’s known as chronic
The gallbladder is a small, pear-shaped organ
located on the underside of 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 causes bile to build up in the
gallbladder, and that buildup causes the gallbladder to become inflamed.
If this happens acutely in the face of chronic
inflammation, it is a serious condition. The gallbladder could rupture if it’s
not treated properly, and this is considered a medical emergency. Treatment
usually involves antibiotics, pain medications, and 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:
- dietary habits
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. The walls of the
gallbladder begin to thicken over time. Eventually, the gallbladder starts to
shrink. These changes make it harder for the gallbladder to function properly.
In addition to gallstones,
cholecystitis can be due to:
- infection of
the CBD drainage system
- a CBD blockage
- excess cholesterol in the gallbladder, which can
happen during pregnancy or after rapid weight loss
- decreased blood
supply to the gallbladder because of diabetes
- tumors in the
liver or pancreas
- tumors in the
gallbladder, which is rare
When you experience repeated
or prolonged attacks of cholecystitis, it becomes a chronic condition.
Who gets cholecystitis?
A number of factors increase
your chances of getting cholecystitis:
- Gallstones are
more common in women than in men. This makes women more likely than men to develop cholecystitis.
- The changing of
hormones can often cause it. Pregnant women or people on hormone therapy are at
- The Cleveland Clinic states that
the risk of developing this condition increases after age 40.
- Hispanics and
Native Americans have a higher risk of developing gallstones than other people.
- People who are
obese are also more likely to get this condition.
- Rapid weight
loss or weight gain can bring upon the disorder.
- If you have
diabetes, you are at risk of getting cholecystitis.
Symptoms of cholecystitis
Symptoms of cholecystitis can
appear suddenly or develop slowly over a period of years. Most of the time
these symptoms appear after a meal that is high in fat.
- severe abdominal pains that may feel sharp or dull
- abdominal cramping and bloating
- pain that spreads to your back or below your right
- loose, light-colored stools
- jaundice, which is when your skin and the whites
of your eyes turn yellow
A typical attack can last two
or three days, but symptoms of cholecystitis vary widely from person
to person. The symptoms appear on the right or middle upper part of
your stomach. The pain will usually last for 30 minutes.
Complications can include:
- pancreatitis, an inflammation
of the pancreas
- perforation of
the gallbladder as a result of infection
gallbladder due to inflammation
- infection may
cause the bile to build up
- cancer of the
gallbladder (this is a rare, long-term complication)
- death of
gallbladder tissue (this can lead to a tear and ultimately a burst of the organ)
The symptoms of cholecystitis
can be treated at home with pain medication and rest, if you have
been properly diagnosed. It’s important that you talk to your doctor first
before making the decision to treat at home. You may also take antibiotics
and avoid fatty foods.
You should always seek medical
attention if you are getting severe pains in your abdomen or if your fever does
How cholecystitis is diagnosed
Your doctor will take your
medical history and conduct a physical exam. The symptoms of cholecystitis are
similar to those of other conditions, so they must rule out those conditions.
There are tests that can help
- The CT scan
uses X-rays to produce very detailed pictures of your abdomen. This is the most
sensitive test, and is likely the best bet in locating the problem.
- Your doctor
may use an abdominal ultrasound to view your gallbladder and liver. This will
help them visualize stones and duct obstructions.
- Blood tests can
identify infections in the bloodstream.
cholescintigraphy, or a HIDA scan, an injection of a small amount of
radioactive material can help identify abnormal contractions or obstructions of
your gallbladder and bile ducts. This is also an accurate method of locating
the problem. It can take anywhere from an hour to four hours to get your
retrograde cholangiopancreatography involves using an endoscope (a long,
flexible tube inserted down your throat), dye, and an X-ray to thoroughly
examine your organs and find defects or problems.
- In a
percutaneous transhepatic cholangiography, your doctor will insert contrast dye
into your liver with a needle. This allows your doctor to see your bile ducts
Treatment options for cholecystitis
The specific cause of your
attack will determine the course of treatment. Your doctor will also consider
your overall health when choosing your treatment. The options include:
- broad-spectrum antibiotics for fighting
- oral dissolution therapy using
medications to help dissolve gallstones (this is typically a last
resort, reserved for individuals who cannot undergo surgery)
- pain relievers for controlling
pain during treatment
Surgery is often the course
of action 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 is 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
Lifestyle and diet changes
Having cholecystitis means
you should make important changes to your diet. Upon recovery, eating five to six
smaller meals a day is recommended. This allows the bile in your digestive
tract to normalize. One big meal can throw off the system and produce a spasm
in the gallbladder and bile ducts.
Stick to a low-fat diet
with lean proteins, such as poultry or fish. Avoid fatty meats, fried food, and
any high-fat foods, including whole milk products.
Long-term outlook for chronic cholecystitis
When treated properly, the
long-term outlook is quite good. You don’t need a gallbladder to live or to
digest food. Without your gallbladder, bile will flow directly from your liver
into your small intestine.
Can chronic cholecystitis be prevented?
If you’ve had one or more bouts
of cholecystitis, speak to your doctor to learn about changes you can make to
avoid chronic cholecystitis. Ask about dietary guidelines that may include
reducing how much fat you eat. Regular exercise is often helpful.
Gallstones are the main cause
of cholecystitis. You can lower your risk of developing more gallstones by
maintaining a healthy weight. If you need to lose weight, try to do it slowly
because rapid weight loss can increase your risk of developing gallstones.