Cholecystitis

Signs and Symptoms of Cholecystitis

In the right upper quadrant of the abdominal cavity, the liver produces bile, which is a liquid that digests fats like oils, greasy foods, butter and other products. The main bile duct, or tube, runs from the liver to the small intestine; it sends a constant flow of bile into the digestive system when we eat. If you eat a lot of fats in one meal, like a greasy burger and fries, the body signals the gallbladder—which sits against and just below the liver and is a storage bag for bile off of the main duct—to release extra bile into the system, and it squeezes out more to digest the extra fat.

In some people, the bile solution is not in balance, and stones can form in the gallbladder from cholesterol or other substances. When the gallbladder tries to squeeze out bile, if a stone blocks the exit to the cystic (gallbladder) duct, it can cause pain and blockage of the bile system. Sometimes, this blockage is temporary, and the pain gets better within hours. This may be referred to as biliary colic, or a gallbladder attack.

Other times, the blockage and pain persist, and the gallbladder wall becomes inflamed and swollen. This is known as cholecystitis. Bacterial overgrowth can result, and can lead to infection of not just the gallbladder, but the main bile duct as well, or cholangitis. For most patients, the pain is felt in the upper right abdomen and sometimes in the middle upper abdomen as well. Fever is possible, and if there is blockage in the main bile duct by a stone, the bile can back up in the liver, causing leakage of pigments into the blood and a yellow color to the skin, called jaundice.

Many patients with pain or inflammation of the gallbladder feel like throwing up, whether they do or not. Other possible symptoms are diarrhea, which could reflect poor digestion of fats, or lighter stool color, if bile isn’t reaching the intestines normally.

Diagnosis of Cholecystitis

The doctor will take a careful history, asking about when and how your symptoms started, like pain or vomiting, and whether there have been changes since they started. A physical examination enables your doctor to evaluate for presence and degree of tenderness, and blood is drawn to check labs related to infection, liver function, and other possible causes of your symptoms. Imaging may be performed, most commonly an ultrasound, which can show the presence of stones in the gallbladder, whether its wall is inflamed, and if blockage of the main duct is suspected. On CT scan, the doctor may also be able to see stones, dilated or swollen ducts or fluid around the gallbladder, but ultrasound is a more reliable way to see gallstones. A HIDA scan is an imaging study which involves following intravenously injected radiotracer from the liver into the biliary system, including the gallbladder, and then into the intestine. If the gallbladder cannot be seen on this test, the cystic duct is blocked, either by stone or swelling, and it is diagnostic of acute cholecystitis.

Treatment of Cholecystitis

Most often, acute cholecystitis is treated with IV antibiotics, IV fluids and bowel rest. Surgery to remove the gallbladder is generally recommended during the same hospital admission. And In most cases, the gallbladder can be removed laparoscopically, with a few small incisions, through which a special camera and instruments are used to perform the operation. Carbon dioxide is introduced into the abdominal cavity, which expands, allowing the surgeon to see the gallbladder and liver clearly. An anesthesiologist puts the patient to sleep for the operation, and wakes them up afterward. Pain from the incisions is managed with oral medication, and you should be able to eat again soon after surgery. Recovery time is usually shorter than with a longer incision directly over the gallbladder (“open” cholecystectomy), although one may still be necessary in some cases.

Without a gallbladder, bile still flows from the liver to the intestine, and fats still get digested. But a meal which is very high in fat may overwhelm the system, since there is no longer a storage reservoir to provide extra bile. Early after gallbladder surgery, if a patient does eat too much fat in one meal, they may experience bloating, gas, cramps and diarrhea, as the undigested fat moves through the intestines. Most patients’ bodies slowly adjust to the absence of the gallbladder, and they are eventually able to eat much as they did before their surgery. But if they do overdo it with a fatty meal, it is easy to recognize and correct by moderating the fat content the next time.