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 and fluids (and sometimes antibiotic medicines) 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.
Understanding the gallbladder and bile
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 tummy (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 squeezes (contracts) 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 first part of the gut known as the duodenum.
Bile helps to digest food, particularly fatty foods.
What is cholecystitis and how common is it?
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.
What are the symptoms of cholecystitis?
Symptoms tend to develop quite quickly, over a few hours or so. They include:
- Pain in the upper tummy (abdomen) - the main symptom. It is usually worse on the right side under the ribs. The pain may radiate (travel) to the back or to the right shoulder. The pain tends to be worse if you breathe in deeply.
- You may also develop a feeling of sickness (nausea); you may be sick (vomit) and you may have a high temperature (fever).
What causes cholecystitis?
Most cases of cholecystitis are caused by gallstones
Gallstones occur when bile, which is normally fluid, forms stones. Gallstones commonly contain lumps of fatty (cholesterol-like) 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 lives. 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 for more details.
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).
Other causes of cholecystitis are uncommon
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.
How is cholecystitis diagnosed?
An ultrasound scan is commonly done to clarify the diagnosis. This is a painless test which uses sound waves to scan the tummy (abdomen). An ultrasound scan can usually detect gallstones and also whether 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.
What is the treatment for cholecystitis?
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.
- Keyhole surgery is now the most common way to remove a gallbladder. The medical term for this operation is laparoscopic cholecystectomy. It is called keyhole surgery as only small cuts are needed in the tummy (abdomen) with small scars remaining afterwards. The operation is done with the aid of a special telescope that is pushed into the abdomen through one small cut. This allows the surgeon to see the gallbladder. Instruments pushed through another small cut are used to cut out and remove the gallbladder. Keyhole surgery is not suitable for all people.
- Some people need a traditional operation to remove the gallbladder. This is called cholecystectomy. In this operation a larger cut is needed to get at the gallbladder.
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.
What are the possible complications of cholecystitis?
If treatment is delayed or not available, in some cases the gallbladder becomes severely infected. Some of the gallbladder tissue may even die and decay (become gangrenous). This can lead to blood poisoning (septicaemia), which is very serious and can be life-threatening. Other possible complications include the gallbladder bursting (perforating), or a channel (fistula) forming between the gallbladder and gut as a result of continued inflammation.
After a gallbladder is removed
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, although some patients are advised to eat a low-fat diet. Up to half of people who have had their gallbladder removed have some mild tummy (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 (faeces) after their gallbladder is removed. This is like mild diarrhoea. It can be treated by antidiarrhoeal medication if it becomes troublesome.
Whilst it is unusual to have problems following gallbladder removal, some patients develop problems including tummy (abdominal) pain, yellowing of the skin or the whites of the eyes (jaundice) or indigestion symptoms.
Dr Tim Kenny
Dr Nick Imm
Dr Adrian Bonsall