Cholecystitis is a painful condition caused by an inflamed gallbladder. The most common cause is gallstones.
What is cholecystitis?
Cholecystitis means inflammation of the gallbladder. Most cases are caused by gallstones. Women are affected more often than men. If you have acute cholecystitis you will normally be admitted to hospital for treatment with painkillers and fluids (and sometimes antibiotic medicines) passed directly into a vein.
The inflammation may settle down with treatment. However, surgical removal of the gallbladder is usually advised to prevent further bouts of cholecystitis.
Where is the gallbladder and what is bile?
The gallbladder is in the tummy (abdomen) and sits on the right-hand side, under the liver. Bile is a fluid which is made in the liver and then stored in the gallbladder. It helps our bodies digest food - especially fatty foods.
Read more about the gallbladder and bile.
In the diagram you can see how the gallbladder lies under the liver on the right side of the upper tummy (abdomen). You can see how close the liver and gallbladder are to the stomach and duodenum.
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 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.
How do gallstones cause cholecystitis?
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.
The symptoms of acute cholecystitis tend to be quite characteristic. They usually come on rather quickly and you can feel very unwell.
- Pain in the upper tummy (abdomen) - the main symptom. It is usually worse on the right side, under the ribs. The pain may travel (radiate) to the back or to the right shoulder and tends to last several hours. 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).
- You may have a high temperature (fever).
If you are examined by a healthcare professional, they may find you have a positive 'Murphy's sign', meaning that you notice an increase in pain when the doctor places their hand under your ribs on the right hand side, and then asks you to take a deep breath.
What does an ultrasound scan do?
An ultrasound scan is a generally painless test which uses sound waves to scan the tummy (abdomen). It takes around 30 minutes to complete the scan. 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.
Are there any other tests I might need?
In hospital you may also have the following tests:
- Monitoring of your temperature, pulse and blood pressure.
- Assessment of your urine output.
- Blood tests.
- A computerised tomography (CT) scan of the tummy (abdomen).
What else could cause these symptoms?
The symptoms of cholecystitis are quite characteristic but other conditions can sometimes appear similar. These include appendicitis, a stomach ulcer, pancreatitis and pneumonia. All of these can make you seriously unwell so it's important to get the diagnosis right. The tests performed in hospital will help to check the diagnosis.
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.
Do I have to have surgery?
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. This is why the usual treatment is to remove the gallbladder.
What happens after the gallbladder is removed?
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.
What is post-cholecystectomy syndrome?
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.
Further reading and references
; Gallstones. BMJ. 2007 Aug 11335(7614):295-9.
; NICE CKS, January 2017 (UK access only)
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