Cholecystitis: Difference between revisions
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{{Infobox medical condition | |||
| name = Cholecystitis | |||
| image = [[File:AcuteCholMark.png|250px]] | |||
| caption = Ultrasound image showing acute cholecystitis | |||
| field = [[Gastroenterology]] | |||
| symptoms = [[Right upper quadrant pain]], [[fever]], [[nausea]], [[vomiting]] | |||
| complications = [[Gangrene]], [[perforation]], [[peritonitis]], [[sepsis]] | |||
| onset = Sudden | |||
| duration = Hours to days | |||
| causes = [[Gallstones]], [[bile duct obstruction]] | |||
| risks = [[Obesity]], [[pregnancy]], [[rapid weight loss]], [[diabetes]] | |||
| diagnosis = [[Ultrasound]], [[CT scan]], [[HIDA scan]] | |||
| differential = [[Peptic ulcer disease]], [[pancreatitis]], [[hepatitis]] | |||
| treatment = [[Cholecystectomy]], [[antibiotics]], [[pain management]] | |||
| medication = [[Analgesics]], [[antibiotics]] | |||
| prognosis = Generally good with treatment | |||
| frequency = Common | |||
| deaths = Rare with treatment | |||
}} | |||
==Cholecystitis== | ==Cholecystitis== | ||
[[File:Histopathology of eosinophilic cholecystitis.jpg|alt=Histopathology of eosinophilic cholecystitis|thumb|Histopathology of eosinophilic cholecystitis]] | [[File:Histopathology of eosinophilic cholecystitis.jpg|alt=Histopathology of eosinophilic cholecystitis|left|thumb|Histopathology of eosinophilic cholecystitis]] | ||
Inflammation of the gallbladder, typically causing fever, nausea, and often severe abdominal pain. Depending on the presentation, it can be considered acute or chronic cholecystitis. | Inflammation of the gallbladder, typically causing fever, nausea, and often severe abdominal pain. Depending on the presentation, it can be considered acute or chronic cholecystitis. | ||
[[File:Cholecystitis CMUJ.jpg|alt=Cholecystitis |thumb|Cholecystitis ]] | [[File:Cholecystitis CMUJ.jpg|alt=Cholecystitis |left|thumb|Cholecystitis ]] | ||
==Causes== | ==Causes== | ||
'''Acute cholecystitis''' occurs when bile becomes trapped in the gallbladder due to a blockage in the bile ducts. Some of the causes for this include gallstone which can get dislodged from the [[gallbladder]] and block the cystic duct leading to backup of the bile. When a stone blocks this duct, bile builds up, causing irritation and pressure in the gallbladder which in turn can lead to swelling and infection. | '''Acute cholecystitis''' occurs when bile becomes trapped in the gallbladder due to a blockage in the bile ducts. Some of the causes for this include gallstone which can get dislodged from the [[gallbladder]] and block the cystic duct leading to backup of the bile. When a stone blocks this duct, bile builds up, causing irritation and pressure in the gallbladder which in turn can lead to swelling and infection. | ||
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* Gallstones | * Gallstones | ||
* Serious illnesses, such as HIV or diabetes | * Serious illnesses, such as HIV or diabetes | ||
* Tumors of the gallbladder which are generally considered rare. | * Tumors of the gallbladder which are generally considered rare. | ||
Some people are more at risk for gallstones as noted below. | Some people are more at risk for gallstones as noted below. | ||
'''Chronic cholecystitis''' | '''Chronic cholecystitis''' | ||
[[File:Chronic calculous cholecystitis.jpg|alt=Chronic calculous cholecystitis|thumb|Chronic calculous cholecystitis]] | [[File:Chronic calculous cholecystitis.jpg|alt=Chronic calculous cholecystitis|left|thumb|Chronic calculous cholecystitis]] | ||
* Most of the time, chronic cholecystitis is caused by repeated attacks of acute (sudden) cholecystitis. | * Most of the time, chronic cholecystitis is caused by repeated attacks of acute (sudden) cholecystitis. | ||
* Most of these attacks are caused by gallstones in the gallbladder. | * Most of these attacks are caused by gallstones in the gallbladder. | ||
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* The disease occurs more often in women than in men. | * The disease occurs more often in women than in men. | ||
* It is more common after age 40. Birth control pills and pregnancy are factors that increase the risk for gallstones. | * It is more common after age 40. Birth control pills and pregnancy are factors that increase the risk for gallstones. | ||
==Risk factors== | ==Risk factors== | ||
Risk factors include: | Risk factors include: | ||
| Line 41: | Line 56: | ||
* Losing or gaining weight rapidly | * Losing or gaining weight rapidly | ||
* [[Diabetes]] | * [[Diabetes]] | ||
[[File:Enlarged gallbladder with gallstone and cholecystitis.jpg|alt=Enlarged gallbladder with gallstone and cholecystitis|thumb|Enlarged gallbladder with gallstone and cholecystitis]] | [[File:Enlarged gallbladder with gallstone and cholecystitis.jpg|alt=Enlarged gallbladder with gallstone and cholecystitis|left|thumb|Enlarged gallbladder with gallstone and cholecystitis]] | ||
* Sometimes, the bile duct becomes blocked temporarily when it is called acute cholecystitis. | * Sometimes, the bile duct becomes blocked temporarily when it is called acute cholecystitis. | ||
* When this occurs repeatedly, it can lead to long-term or chronic cholecystitis. | * When this occurs repeatedly, it can lead to long-term or chronic cholecystitis. | ||
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* Eventually, the gallbladder becomes thick and hard. | * Eventually, the gallbladder becomes thick and hard. | ||
It does not store and release bile as well as it did. | It does not store and release bile as well as it did. | ||
==Management== | ==Management== | ||
A thorough history and physical examination should be obtained including prior history of similar episodes, food intake, especially recent intake of fatty foods. Enquire about the nature of the pain, severity, and any radiation to the right shoulder which can happen with cholecystitis. During the physical examination, palpate the abdomen for tenderness, rigidity, rebound tenderness, and also elicit [[Murphy's sign]]. | A thorough history and physical examination should be obtained including prior history of similar episodes, food intake, especially recent intake of fatty foods. Enquire about the nature of the pain, severity, and any radiation to the right shoulder which can happen with cholecystitis. During the physical examination, palpate the abdomen for tenderness, rigidity, rebound tenderness, and also elicit [[Murphy's sign]]. | ||
[[File:Severe acute ulcerated and hemorrhagic cholecystitis, HE 3.JPG|alt=Severe acute ulcerated and hemorrhagic cholecystitis|thumb|'''Severe acute ulcerated and hemorrhagic cholecystitis''']] | [[File:Severe acute ulcerated and hemorrhagic cholecystitis, HE 3.JPG|alt=Severe acute ulcerated and hemorrhagic cholecystitis|left|thumb|'''Severe acute ulcerated and hemorrhagic cholecystitis''']] | ||
Blood tests include: | Blood tests include: | ||
* [[Amylase]] and [[lipase]] | * [[Amylase]] and [[lipase]] | ||
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* [[Complete blood count]] (CBC) | * [[Complete blood count]] (CBC) | ||
* Liver function tests | * Liver function tests | ||
Imaging studies | Imaging studies | ||
* Abdominal [[ultrasound]] | * Abdominal [[ultrasound]] | ||
* Abdominal [[CT scan]] or MRI scan | * Abdominal [[CT scan]] or MRI scan | ||
| Line 64: | Line 76: | ||
* Oral [[cholecystogram]] | * Oral [[cholecystogram]] | ||
* Gallbladder radionuclide scan | * Gallbladder radionuclide scan | ||
==Treatment== | ==Treatment== | ||
* If you have severe belly pain, seek medical attention right away. | * If you have severe belly pain, seek medical attention right away. | ||
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* You also may be given antibiotics to fight infection. | * You also may be given antibiotics to fight infection. | ||
* Cholecystitis may clear up on its own. | * Cholecystitis may clear up on its own. | ||
[[File:Ultrasonography of cholecystitis.jpg|alt=Ultrasonography of cholecystitis|thumb|Ultrasonography of cholecystitis]] | [[File:Ultrasonography of cholecystitis.jpg|alt=Ultrasonography of cholecystitis|left|thumb|Ultrasonography of cholecystitis]] | ||
==Surgery== | ==Surgery== | ||
If you have gallstones leading cholecystitis, especially of it happens repeatedly, you will probably need surgery to remove your gallbladder. | If you have gallstones leading cholecystitis, especially of it happens repeatedly, you will probably need surgery to remove your gallbladder. | ||
Nonsurgical treatment includes: | Nonsurgical treatment includes: | ||
* [[Antibiotics]] you take at home to fight infection | * [[Antibiotics]] you take at home to fight infection | ||
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* Persistent bile duct blockage | * Persistent bile duct blockage | ||
* Inflammation of the common bile duct | * Inflammation of the common bile duct | ||
[[File:Xanthogranulomatous cholecystitis -- low mag.jpg|alt=Xanthogranulomatous cholecystitis|thumb|Xanthogranulomatous cholecystitis]] | [[File:Xanthogranulomatous cholecystitis -- low mag.jpg|alt=Xanthogranulomatous cholecystitis|left|thumb|Xanthogranulomatous cholecystitis]] | ||
If you are very ill, a tube may be placed through your belly into your gallbladder to drain it. Once you feel better, your provider may recommend that you have surgery. | If you are very ill, a tube may be placed through your belly into your gallbladder to drain it. Once you feel better, your provider may recommend that you have surgery. | ||
==Prognosis== | ==Prognosis== | ||
Most people who have surgery to remove their gallbladder recover completely. | Most people who have surgery to remove their gallbladder recover completely. | ||
==Possible Complications== | ==Possible Complications== | ||
* Untreated, cholecystitis may lead to any of the following health problems: | * Untreated, cholecystitis may lead to any of the following health problems: | ||
| Line 98: | Line 106: | ||
* [[Perforation]] | * [[Perforation]] | ||
* [[Peritonitis]] (inflammation of the lining of the abdomen) | * [[Peritonitis]] (inflammation of the lining of the abdomen) | ||
==Prevention== | ==Prevention== | ||
Reducing fatty food intake and removal of gallbladder can prevent further attacks | Reducing fatty food intake and removal of gallbladder can prevent further attacks | ||
Latest revision as of 02:21, 5 April 2025
Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD's medical weight loss NYC, sleep center NYC
Philadelphia medical weight loss and Philadelphia sleep clinics
| Cholecystitis | |
|---|---|
| File:AcuteCholMark.png | |
| Synonyms | N/A |
| Pronounce | N/A |
| Specialty | N/A |
| Symptoms | Right upper quadrant pain, fever, nausea, vomiting |
| Complications | Gangrene, perforation, peritonitis, sepsis |
| Onset | Sudden |
| Duration | Hours to days |
| Types | N/A |
| Causes | Gallstones, bile duct obstruction |
| Risks | Obesity, pregnancy, rapid weight loss, diabetes |
| Diagnosis | Ultrasound, CT scan, HIDA scan |
| Differential diagnosis | Peptic ulcer disease, pancreatitis, hepatitis |
| Prevention | N/A |
| Treatment | Cholecystectomy, antibiotics, pain management |
| Medication | Analgesics, antibiotics |
| Prognosis | Generally good with treatment |
| Frequency | Common |
| Deaths | Rare with treatment |
Cholecystitis[edit]
Inflammation of the gallbladder, typically causing fever, nausea, and often severe abdominal pain. Depending on the presentation, it can be considered acute or chronic cholecystitis.
Causes[edit]
Acute cholecystitis occurs when bile becomes trapped in the gallbladder due to a blockage in the bile ducts. Some of the causes for this include gallstone which can get dislodged from the gallbladder and block the cystic duct leading to backup of the bile. When a stone blocks this duct, bile builds up, causing irritation and pressure in the gallbladder which in turn can lead to swelling and infection.
- Gallstones
- Serious illnesses, such as HIV or diabetes
- Tumors of the gallbladder which are generally considered rare.
Some people are more at risk for gallstones as noted below. Chronic cholecystitis
- Most of the time, chronic cholecystitis is caused by repeated attacks of acute (sudden) cholecystitis.
- Most of these attacks are caused by gallstones in the gallbladder.
- These attacks cause the walls of the gallbladder to thicken.
- The gallbladder begins to shrink. Over time, the gallbladder is less able to concentrate, store, and release bile.
- The disease occurs more often in women than in men.
- It is more common after age 40. Birth control pills and pregnancy are factors that increase the risk for gallstones.
Risk factors[edit]
Risk factors include:
- Being female
- Pregnancy
- Hormone therapy
- Older age
- Being Native American or Hispanic
- Obesity
- Losing or gaining weight rapidly
- Diabetes
- Sometimes, the bile duct becomes blocked temporarily when it is called acute cholecystitis.
- When this occurs repeatedly, it can lead to long-term or chronic cholecystitis.
- This is swelling and irritation that continues over time.
- Eventually, the gallbladder becomes thick and hard.
It does not store and release bile as well as it did.
Management[edit]
A thorough history and physical examination should be obtained including prior history of similar episodes, food intake, especially recent intake of fatty foods. Enquire about the nature of the pain, severity, and any radiation to the right shoulder which can happen with cholecystitis. During the physical examination, palpate the abdomen for tenderness, rigidity, rebound tenderness, and also elicit Murphy's sign.
Blood tests include:
- Amylase and lipase
- Bilirubin
- Complete blood count (CBC)
- Liver function tests
Imaging studies
- Abdominal ultrasound
- Abdominal CT scan or MRI scan
- Abdominal x-ray
- Oral cholecystogram
- Gallbladder radionuclide scan
Treatment[edit]
- If you have severe belly pain, seek medical attention right away.
- In the emergency room, you may be given fluids through a vein.
- You also may be given antibiotics to fight infection.
- Cholecystitis may clear up on its own.
Surgery[edit]
If you have gallstones leading cholecystitis, especially of it happens repeatedly, you will probably need surgery to remove your gallbladder. Nonsurgical treatment includes:
- Antibiotics you take at home to fight infection
- Low-fat diet (if you are able to eat)
- Pain medicines
- You may need emergency surgery if you have complications such as:
- Gangrene (tissue death) of the gallbladder
- Perforation (a hole that forms in the wall of the gallbladder)
- Pancreatitis (inflamed pancreas)
- Persistent bile duct blockage
- Inflammation of the common bile duct
If you are very ill, a tube may be placed through your belly into your gallbladder to drain it. Once you feel better, your provider may recommend that you have surgery.
Prognosis[edit]
Most people who have surgery to remove their gallbladder recover completely.
Possible Complications[edit]
- Untreated, cholecystitis may lead to any of the following health problems:
- Empyema (pus in the gallbladder)
- Gangrene
- Injury to the bile ducts draining the liver (may occur after gallbladder surgery)
- Pancreatitis
- Perforation
- Peritonitis (inflammation of the lining of the abdomen)
Prevention[edit]
Reducing fatty food intake and removal of gallbladder can prevent further attacks
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