Chronic Cholecystitis: Causes, Symptoms & Diagnosis

Chronic Cholecystitis

What is chronic cholecystitis?


  1. Chronic cholecystitis is a serious condition that is considered a medical emergency.
  2. Surgery is often the course of action.
  3. A typical bout can last two or three days. Symptoms vary from person to person.

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 cholecystitis.

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:

  • genetic predisposition
  • weight
  • gallbladder activity
  • 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?

Risk Factors

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 greater risk.
  • 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.

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. 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
  • enlarged 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 not break.

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 diagnose cholecystitis:

  • 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.
  • 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. This is also an accurate method of locating the problem. It can take anywhere from an hour to four hours to get your results back.
  • Endoscopic 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 on X-ray.

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 infection
  • 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 condition.

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.

Recovery time

You Asked, We Answered

  • How long does it usually take for a full recovery from chronic cholecystitis surgery and what are some things a person should keep in mind during the recovery period?
  • Recovery from gallbladder surgery depends upon the type of surgery you have. Individuals who undergo the laparoscopic procedure will recover faster than those who have traditional surgery, where an abdominal incision is made. Regardless of the type of surgery you have, recovery guidelines can be similar, and expect at least six weeks for full healing. Always follow your surgeon’s specific recommendations. Common care instructions include:

    • avoid lifting greater than 10 pounds
    • eat a low-fat diet with small frequent meals
    • expect fatigue, so get plenty of rest
    • stay hydrated
    • monitor all surgical wounds for redness, drainage, or increased pain

    - Judith Marcin, MD

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