Cholecystitis (Gallbladder Inflammation): Symptoms, Causes, Treatment & Prevention

 

Gallbladder swelling and irritation, often known as inflammation of the gallbladder (cholecystitis) (ko-luh-sis-TIE-tis). The gallbladder is a little, pear-shaped organ located beneath the liver on the right side of the abdomen. Food-digesting fluid is stored in the gallbladder. Bile is the term for this liquid. Bile is released into the small intestine by the gallbladder.

Cholecystitis is typically caused by gallstones that obstruct the tube that exits the gallbladder. Bile accumulates as a result, which may lead to inflammation. Bile duct abnormalities, tumors, severe illnesses, and certain infections are additional causes of cholecystitis.

Gallbladder rupture is one of the major consequences of untreated cholecystitis. These have the potential to be fatal. Surgery to remove the gallbladder is a common treatment for cholecystitis.

What is Cholecystitis?

The term "cholecystitis" (pronounced "KO-leh-sis-TY-tiss") refers to inflammation of the gallbladder, a little, pear-shaped organ lives that under the liver that stores the bile produced by the liver. After eating, your gallbladder helps break down fats by sending bile to your small intestine. Bile ducts are microscopic pipelines that it uses to send and receive bile. Inflammation, pain, and swelling within your gallbladder might be caused by an infection or obstruction in the gallbladder or the bile ducts that connect to it.






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What types of cholecystitis are there?

Inflammation of the gallbladder can be:

• Acute (abrupt and urgent)

• Chronic (long-lasting and slow)

• Calculous (associated with gallstones)

• Acalculous (unrelated to gallstones)

A gallbladder that is inflamed may react slowly to a chronic issue or quickly to an urgent one. This is how acute and chronic cholecystitis differ from one another.

Both acute and chronic cholecystitis are typically caused by gallstones. Thus, the majority of instances are "calculous." "Acalculous" is a term used by medical professionals to differentiate cholecystitis unrelated to gallstones.

Symptoms:

Cholecystitis symptoms can include:

• Severe discomfort in the center or upper right abdomen

• Pain that radiates to the back or right shoulder

• Sensitivity when touching the abdomen

• Nausea

• Fever

Causes:

Gallbladder inflammation is known as cholecystitis. Inflammation of the gallbladder may result from:

• Gallstones. Gallstones, which are hard bile particles that can form in the gallbladder, are most frequently the cause of cholecystitis. The tube that transports bile out of the gallbladder can get clogged by gallstones. The cystic duct is the name of the tube. The gallbladder becomes swollen and irritated when there is bile buildup there.

• Tumor. Bile may not be able to exit the gallbladder normally due to a tumor. Bile accumulation brought on by this can result in cholecystitis.

• Obstruction of the bile duct. Cholecystitis can result from the bile duct being blocked by stones, thickened bile, and microscopic particles known as sludge. Blockage may also result from bile duct kinking or scarring.

• Infection. Gallbladder edema and irritation can be brought on by AIDS and other viral diseases.

• Serious illness. A very serious illness can reduce blood flow to the gallbladder and damage blood vessels. Cholecystitis may result from this.

What are the cholecystitis risk factors?

Gallstones increase your risk of developing cholecystitis. Gallstones are more likely to occur if you:

• Are women

• Are pregnant

• Possess obesity

• Have diabetes

• Possess high cholesterol levels

• Have quickly lost weight

• Are over forty years old

Complications:

Cholecystitis complications include:

• Damage to your pancreas, liver, or bile ducts (pancreatitis).

• Reduced nutrition absorption and digestion in the small intestine.

• Gallbladder fibrosis (scarring) and decreased function as a result of persistent inflammation.

• Swelling that results in gangrenous cholecystitis and necrosis, or tissue death.

• A gallbladder perforation, or tear, can result in peritonitis, an infection of the abdominal cavity.

• Peritonitis that causes an abscess or bloodstream infection (septicemia).

• Gallbladder infection. Bile may become infected if it builds up in the gallbladder.

• Gallbladder tissue death. If cholecystitis is left untreated, gallbladder tissue may die. This is termed gangrene. This most common problem typically affects older persons, those who delay to obtaining treatment, and those with diabetes. Gangrene can lead to a tear in the gallbladder. Or it may cause the gallbladder to explode.

• Torn gallbladder. A tear, called a perforation, in the gallbladder may develop from gallbladder enlargement or infection or the death of gallbladder tissue.

How is the diagnosis of cholecystitis made?

A medical professional will begin by asking about your symptoms. They may ask you to inhale deeply while they gently press on your upper right belly if they suspect cholecystitis. This is a hallmark symptom of cholecystitis (Murphy's sign) if it hurts. In order to find further clues, they will perform follow-up testing, such as blood tests and imaging of your gallbladder and bile ducts.

The following tests could be used to detect cholecystitis:

• CBC stands for complete blood count

•  Liver function test

• Ultrasound of the abdomen

• Ultrasound endoscopy

• Computed tomography (CT) scan

• Hepatobiliary iminodiacetic acid scan, or HIDA scan

Treatment

Will cholecystitis go away?

Treatment is necessary for every cause of cholecystitis. Your symptoms might go away if a gallstone that is obstructing your bile duct or gallbladder comes loose on its own. However, the suffering and risk are too high to wait for this to occur. It's unlikely that your problems would end if it did. Another gallstone or the same gallstone may become stuck once more.

How is cholecystitis treated?

In the hospital, cholecystitis is treated right away. Supportive care is the first step in treatment and includes:

• Intravenous (IV) fluids while your digestive system is at rest.

• IV antibiotics for infection prevention or treatment.

• The majority of patients require IV pain medication.

• Surgery to remove your gallbladder is the only effective treatment for cholecystitis. Gallstones are among the most common causes of cholecystitis that start in the gallbladder. In rare instances, surgery may not be required if the cause of your cholecystitis is something that can be treated on its own, such as an infection unrelated to gallstones. Other health conditions may also need you delay or avoid surgery.

If you are delaying or avoiding surgery, you may have:

Your gallbladder's fluid drains to relieve pressure. Through a small abdominal incision, a medical professional may insert a drainage tube into your gallbladder. Alternatively, they may use an endoscopic ultrasonography to insert a drainage tube from your gallbladder into your digestive system. Your mouth is used to reach your organs during this nonsurgical operation.
Gallstone removal using endoscopy. Another nonsurgical method for visualizing your biliary system is endoscopic retrograde cholangiopancreatography (ERCP), which combines an upper endoscopy with X-ray technology. Gallstones stuck in your bile ducts can be removed by an endoscopist using tiny instruments that are passed through the endoscope. Your initial symptoms may be relieved by doing this.

Surgery

Both acute and chronic cholecystitis are bound to recur even if your current episode is over—the gallstone that was lodged is no longer stuck, or the symptoms that led you to the hospital have subsided. Once gallstones have caused acute cholecystitis, they are likely to do so again. Chronic cholecystitis can result from recurrent episodes of acute cholecystitis, and both conditions can cause cumulative damage.

Healthcare professionals advise gallbladder removal surgery (cholecystectomy) to avoid the consequences of recurrent episodes of gallbladder inflammation. There are few side effects from this routine, simple surgery. The majority of patients can undergo minimally invasive laparoscopic surgery. Only a few tiny incisions are necessary for a laparoscopic cholecystectomy. Open surgery may be necessary in more complex cases.

What are the side effects of cholecystitis surgery?

Your gallbladder is not necessary for the proper operation of your digestive and biliary systems. The primary function of your gallbladder is to store the bile produced by your liver. Your bile ducts are redirected to send bile straight from your liver to your small intestine after a surgeon removes your gallbladder. It will take many weeks to several months for your body to adjust to this shift. During this period, you may experience transient symptoms such as:

• Slower bile flow, which can cause your biliary system to feel painful or under pressure.

• Some people have diarrhea because they have difficulty digesting fats.

Prevention

By preventing gallstones, you can lower your risk of cholecystitis:

• Reduce your weight gradually. Gallstones may become more likely if you lose weight quickly.

• Maintain a healthy weight. Gallstones are more common in those who are overweight. Reduce calories and increase physical exercise to get a healthy weight. Maintain a healthy weight by eating well and exercising.

• Select a nutritious diet. Consuming foods that are poor in fiber and heavy in fat may increase the risk of gallstones. Eat a lot of fruits, veggies, and whole grains to reduce your risk.

What is the seriousness of cholecystitis?

Bile flow obstruction is typically the cause of acute cholecystitis. More than just your gallbladder may be impacted by this. Inflammation and even infection can result from a blockage in your biliary system, which is the network of organs that exchange bile through your bile ducts. You may become ill if backed-up bile overflows into your bloodstream. Additionally, your digestive system won't get the necessary bile.

Organ swelling and severe inflammation can result in tissue death (gangrene), which can split or tear the organ (gangrenous cholecystitis). Even though chronic cholecystitis is typically less severe, persistent inflammation can still cause serious damage. Scar tissue may form inside your gallbladder, impairing its ability to contract. Your bile flow may potentially slow as a result of this.

References

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• Ferri FF. Cholecystitis. In: Ferri's Clinical Advisor 2025. Elsevier; 2025. https://www.clinicalkey.com. Accessed July 3, 2024.

• Jones MW, Gnanapandithan K, Panneerselvam D, et al. Chronic Cholecystitis (https://www.ncbi.nlm.nih.gov/books/NBK470236/). 2022 Oct 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Accessed 9/21/2024.

• Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones/all-content. Accessed July 3, 2024.

• Hudson JL, et al. Endoscopic approaches to cholecystitis. American Journal of Gastroenterology. 2023; doi:10.14309/ajg.0000000000002351.

• Merck Manual Consumer Version. Cholecystitis (https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/gallbladder-and-bile-duct-disorders/cholecystitis). Accessed 9/21/2023.

• Vollmer CM, et al. Treatment of acute calculous cholecystitis. https://www.uptodate.com/contents/search. Accessed July 3. 2024.

• Afdhal NH. Acalculous cholecystitis: Clinical manifestations, diagnosis, and management. https://www.uptodate.com/contents/search. Accessed July 3. 2024.

• Merck Manual Professional Version. Chronic Cholecystitis (https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/gallbladder-and-bile-duct-disorders/chronic-cholecystitis?query=Cholecystitis). Accessed 9/21/2023.

• National Organization for Rare Disorders (U.S.). Acute Cholecystitis (https://rarediseases.org/rare-diseases/cholecystitis/). Accessed 9/21/2023.