Chronic Cholecystitis

What Is Chronic Cholecystitis?

Cholecystitis or acute cholecystitis is the sudden inflammation of your gallbladder. If this condition persists for a prolonged period of time, such as months, or if you have repeated attacks, it’s known as chronic cholecystitis.

The gallbladder is a small, pear-shaped organ located on the underside 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.

This 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?

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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 genetic predisposition, weight, gallbladder activity, and 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
  • tumor in the gallbladder, which is rare

When you experience repeated or prolonged attacks of cholecystitis, it becomes a chronic condition.

Who Gets Cholecystitis?

Risk Factors

A number of factors increase your chances of getting cholecystitis:

  • Gallstones are more common in women than in men. Because of this, women are more likely than men to develop cholecystitis.
  • 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.
  • Obese individuals are also more likely to get this condition.

Signs and Symptoms of Cholecystitis

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Symptoms of cholecystitis can appear suddenly or develop slowly over a period of years. Signs and symptoms include:

  • severe abdominal pains that may feel sharp or dull
  • abdominal cramping and bloating
  • pain that spreads to your back or below your right shoulder blade
  • fever
  • chills
  • nausea
  • vomiting
  • loose, light-colored stools
  • jaundice, which is when your skin and the whites of your eyes turn yellow
  • itching

A typical attack can last two or three days, but symptoms of cholecystitis vary widely from person-to-person.

Complications can include:

  • pancreatitis, which is an inflammation of the pancreas
  • cancer of the gallbladder, which is rare
  • gangrene
  • perforation of the gallbladder
  • enlarged gallbladder due to inflammation
  • infection
  • death of gallbladder tissue

How Cholecystitis Is Diagnosed

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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 diagnose cholecystitis:

  • The CT scan uses X-rays to produce very detailed pictures of your abdomen.
  • The abdominal ultrasound helps your doctor view all the internal organs in your abdomen and see how blood flows through your vessels.
  • Blood tests can identify infections.
  • In 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.
  • Endoscopic retrograde cholangiopancreatography (ERCP) 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 (PTC), your doctor will insert contrast dye into your liver with a needle. This allows your doctor to see your bile ducts on X-ray.

Treatment Options for Cholecystitis

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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 infection
  • oral dissolution therapy using medications to help dissolve gallstones
  • pain relievers for controlling pain during treatment

If you have a ruptured gallbladder, surgical removal of your gallbladder will be necessary. 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 condition.

Long-Term Outlook for Chronic Cholecystitis

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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?

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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.

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