Gallbladder Inflammation (Cholecystitis)

What is cholecystitis?
Cholecystitis occurs when the gallbladder wall and nearby abdominal lining becomes inflamed. In 90% of cases, cholecystitis is caused by a gallstone in the cystic duct, the duct that connects the gallbladder to the hepatic duct. Gallstones are frequently the cause of inflammation.

What are the causes and risk factors for cholecystitis?

• Female Gender — Women are more likely to develop gallstones than men.
• Being 40 uears of age or older The risk of gallstones is known to increase with age. The condition is extremely rare in childhood and becomes progressively more frequent over time, with age 40 representing a possible cut-off between relatively low and high rates. Gallstones are present in about 10 percent of men and 20 percent of women by the age of 60.
• Native American, Hispanic, and Caucasian — Gallstones appear to occur more frequently in Native American, Hispanic, and western Caucasian individuals. In contrast, there appear to be lower rates of chole-lithiasis in African American, natives of South Africa, and Japanese populations.
• Family history of cholecystitis— Studies of family histories indicate that cholelithiasis or gallstones, runs in certain families, suggesting that genetics has a role in gallstone development.

Other factors — An increased risk of cholelithiasis, or gallstones, may also be nassociated with a number other factors including:

• Obesity
• Frequent fasting
• Rapid weight loss
• Lack of physical activity
• Diabetes mellitus
• Sickle cell disease (and other conditions associated with rapid destruction of red blood cells such as in patients with mechanical heart valves)
• Cirrhosis, or severe scarring, of the liver
• Certain medications (e.g., octreotide, clofibrate)
• Alcohol abuse
• Pregnancy
• Use of estrogen preparations (such as birth control pills)

Cholecystitis can occur suddenly or gradually over many years.

Key Points:

1. Cholecystitis occurs when the gallbladder becomes inflamed, usually due to gallstones
2. The most common risk factors include a high fat diet, obesity, being female and over 40, alcohol abuse, and certain medications
3. Risk is higher in Native Americans, Whites, and Hispanics

What are the symptoms of cholecystitis (or gallbladder infammation)?
Severe and sudden pain in the upper right part of the abdomen is the most common symptom, and frequently can last two to three days. However, each individual may experience symptoms quite differently. The following are the additional symptoms of gallstones:

• recurrent painful attacks for several hours after meals
• pain (often worse with deep breaths and extends to lower part of right shoulder blade)
• nausea
• vomiting
• rigid abdominal muscles on right side
• slight fever
• chills
• itching (rare)
• loose, light-colored bowel movements
• abdominal bloating
• jaundice - yellowing of the skin and eyes.

The symptoms of cholecystitis may resemble other medical conditions or problems.
Always consult your physician for a diagnosis.

Key Points:

1. The most common symptom: Abdominal pain in the upper right part of the abdomen, especially after eating. Pain may be sudden and severe
2. Nausea, vomiting, bloating, light colored diarrhea, and jaundice may also occur

How is cholecystitis diagnosed?
In addition to a complete medical history and examination, diagnostic procedures for cholecystitis may include the following:

• Ultrasound (Also called sonography.) - a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen such as the liver spleen, and kidneys and to assess blood flow through various vessels. This is the best way to visualize gallstones.
• If an obstruction of a bile duct, which may be caused by a stone, structure, or tumor, is detected, the following tests may be conducted:
• Hepatobiliary scintigraphy - an imaging technique of the liver, bile ducts, gallbladder, and upper part of the small intestine.
• Cholangiography - x-ray examination of the bile ducts using an intravenous (IV) dye (contrast).
• Per-cu-taneous trans-hepatic cholan-giography (PTCA) - a needle is introduced through the skin and into the liver where the dye (contrast) is deposited and the bile duct structures can be viewed by x-ray.
• Endoscopic retrograde cholangio-pancreatography (ERCP) - a procedure that allows the physician to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. The procedure combines x-ray and the use of an endoscope - a long, flexible, lighted tube. The scope is guided through the patient's mouth and throat, then through the esophagus, stomach, and duodenum. This test is done when the structure of the bile ducts or pancreatic ducts are in question.

Can gallstones be prevented?
GALLSTONE PREVENTION —The following advice cam help prevent the development of gallstones:

• EAT A HIGH FIBER LOW FAT DIET A diet that is high in fiber and calcium and low in saturated fats.
• Consumption of three well balanced meals daily, with each meal containing some fat to ensure good gallbladder contraction. Be careful, however, of ingesting saturated fats that can lead to other medical problems. The ingestion pf fat can prevent stagnation in the gallbladder, which is one of the factors of gallstone formation in susceptible individuals.
• MAINTAIN A HEALTHY WEIGHT Maintenance of a normal standard body weight through regular, appropriate exercise and proper calorie restriction. Obese people (with and without known gallstones) who are undergoing a rapid weight-loss program should be supervised by their physician and may require specific treatment with oral bile acids to prevent the development of gallstones during weight loss.
• A medicine known as Actigall (ursodiol) can also be used to prevent the formation of gallstones in obese patients who are dieting and losing weight rapidly.

Key Points:

1. Diagnosis includes a medical examination and history, and certain tests
2. The most common tests are ultrasound and a test called cholangiography; both can help the doctor identify gallbladder inflammation and gallstones

What are the treatments? Specific treatment for cholecystitis will be determined by your physician based on your:

• age, overall health, and medical history
• extent of the disease
• tolerance of specific medicines, procedures, or therapies
• expectations for the course of the disease
• opinion or preference

Treatment for acute cholecystitis usually involves a hospital stay, to reduce stimulation to the gallbladder. Antibiotics from the cephalosporin family and others such as ampicillin, flagyl, or cipro may be administered to reduce the inflammation and/or fight the infection. Sometimes, the gallbladder is surgically removed.
– Hospitalization
– Antibiotics
– Surgical removal of the gall bladder
– Medications to dissolve gall stones
– Medications to prevent formation of gallstones
Your doctor will determine the best treatment for you.


Other treatment options may include:

• Low-fat diet
• Oral dissolution therapy - drugs made from bile acid are used to dissolve the stones such as Actigall(or ursodiol), which can slowly dissolve gallstones that are made predominantly of cholesterol.
• Actigall can also be used to prevent the formation of cholesterol gallstones in obese patients who are losing weight rapidly, and to treat a certain type of liver disease (called primary biliary cirrhosis). pain management with analgesics, non-steroidal anti-inflammatory medication, opiates if needed

What are the possible complications?

• There are usually no complications
• Complications may occur if other organs are involved
• Gallstones can sometimes return

The overall prognosis for cholecystitis is favorable, since it is considered to be a benign disease. In some individuals, complications may arise if other organs are involved. Gallstones can return in the bile duct system after surgical removal of the gallbladder.

Key Points:

1. Treatment depends on severity of disease and how well a person may tolerate certain procedures or medications
2. Treatment may include hospitalization, antibiotics, medications to dissolve gallstones, or surgical removal of the gallbladder

References:
1. National Institutes of Health www.nih.gov
2. Center for Disease Control www.cdc.gov
3. Barie, PS, Acute acalculous cholecystitis. J Am Coll Surg 1995; 180:232.
4. Ziessman, HA. Cholecystokinin cholescintigraphy: Clinical indications and proper methodology. Radiol Clin North Am 2001; 39:997.
5. Kalloo, AN, Kantsevoy, SV. Gallstones and biliary disease. Prim Care 2001; 28:591.
6. Ahmed, A, Cheung, RC, Keeffe, EB. Management of gallstones and their complications. Am Fam Physician 2000; 61:1673.
7. The American College of Gastroenterology (ACG) www.acg.gi.org

Copyright 2007, MD Kiosk