Chronic cholecystitis
Cholecystitis - chronic
Chronic cholecystitis is swelling and irritation of the gallbladder that continues over time.
The gallbladder is a sac located under the liver. It stores bile that is made in the liver.
Bile helps with the digestion of fats in the small intestine.
This is a CT scan of the upper abdomen showing cholecystitis (gall stones).
Cholelithiasis can be seen on a cholangiogram. Radio-opaque dye is used to enhance the x-ray. Multiple stones are present in the gallbladder (PTCA).
Cholecystolithiasis. CT scan of the upper abdomen showing multiple gallstones.
A cholecystogram in a patient with gallstones.
Causes
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.
Stones are great for tossing into a stream or using to line your flowerbeds. But they're not so great when they're trapped inside your gallbladder. If you've got pain in the upper part of your belly, a fever, or yellow skin, they could be signs that you've got gallstones. The stones that form in your gallbladder aren't made of rock. Usually, they're made of cholesterol, a type of fat in your blood. Or, they could be made from a substance called bilirubin, which is processed in your liver. Gallstones can be as small as a grain of sand, or as big as a golf ball. You're more likely to get gallstones if you're over age 40, or if you have a chronic condition like diabetes, anemia, or cirrhosis of the liver. People who've had weight-loss surgery, or who went on a crash diet and lost weight very quickly can also develop gallstones. Gallstones are more common in women than in men, and they may run in families. So, how do you know if you have gallstones? Well, you might not realize it, because often gallstones don't cause any pain. They're often found accidentally during an x-ray or surgery to treat another condition. If the gallstone is very large, though, it may get stuck in one of the tubes, called ducts, which connect to the gallbladder. Then you'll probably feel a sharp or cramping pain in the upper right or middle part of your abdomen. You may also have a fever and feel sick to your stomach. Your doctor can do an ultrasound, or other scan of the gallbladder area to find out if gallstones are causing your pain. You may also have blood tests to check your liver function and to see if your bilirubin levels are too high. You may not need to treat gallstones, unless they're causing symptoms. If that's the case, your doctor will recommend treatment which is usually surgery to remove them. Often, this is done with a laparoscopic procedure that removes the gallstone through very small cuts or incisions. Normally, you can go home the same day as your surgery, or the next day. Most people don't need to have their whole gallbladder removed, unless they have complications, like a blocked duct. There is also medicine that can dissolve cholesterol gallstones, but it isn't that effective because it can take two years or more to work, and often the stones form again after you're done taking it. You can't really prevent gallstones, except by avoiding rapid weight loss or health conditions that can cause gallstones such as obesity, diabetes, or cirrhosis. But if you do get them, gallstones are pretty easy to treat. Most people don't have any symptoms or complications from them, and those who do have symptoms usually recover completely and don't get gallstones again after their surgery. It's important that you call your doctor if you are having abdominal pain, yellow skin or eyes, so you can find out for sure whether you have gallstones, and get them treated.
Symptoms
Acute cholecystitis is a painful condition that leads to chronic cholecystitis. It is not clear whether chronic cholecystitis causes any symptoms.
Symptoms of acute cholecystitis can include:
- Sharp, cramping, or dull pain in upper right or upper middle of your belly
- Steady pain lasting about 30 minutes
- Pain that spreads to your back or below your right shoulder blade
- Clay-colored stools
- Fever
- Nausea and vomiting
- Yellowing of skin and whites of the eyes (jaundice)
Exams and Tests
Your health care provider may order the following blood tests:
- Amylase and lipase in order to diagnose diseases of the pancreas
- Complete blood count (CBC)
- Liver function tests in order to evaluate how well the liver is working
Tests that reveal gallstones or inflammation in the gallbladder include:
- Abdominal ultrasound
- Abdominal CT scan
- Gallbladder scan (HIDA scan)
- Oral cholecystogram (rarely done)
Treatment
Surgery is the most common treatment. Surgery to remove the gallbladder is called cholecystectomy.
- Laparoscopic cholecystectomy is most often done. This surgery uses smaller surgical cuts, which result in a faster recovery. Many people are able to go home from the hospital on the same day as surgery, or the next morning.
- Open cholecystectomy requires a larger cut in the upper-right part of the abdomen.
If you are too ill to have surgery because of other diseases or conditions, the gallstones may be dissolved with medicine you take by mouth. However, this may take 2 years or longer to work. The stones may return after treatment.
Outlook (Prognosis)
Cholecystectomy is a common procedure with a low risk.
Possible Complications
Complications may include:
- Cancer of the gallbladder (rarely)
- Jaundice
- Pancreatitis
- Worsening of the condition
When to Contact a Medical Professional
Contact your provider if you develop symptoms of cholecystitis.
Prevention
The condition is not always preventable. Eating less fatty foods may relieve symptoms in people. However, the benefit of a low-fat diet has not been proven.
References
Gill RM, Kakar S. Liver and gallbladder. In: Kumar V, Abbas AK, Aster JC, eds. Robbins and Cotran Pathologic Basis of Disease. 10th ed. Philadelphia, PA: Elsevier; 2021:chap 18.
Quigley BC, Adsay NV. Diseases of the gallbladder. In: Burt AD, Ferrell LD, Hubscher SG, eds. MacSween's Pathology of the Liver. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 10.
Wang DQH, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 65.
Version Info
Last reviewed on: 10/25/2021
Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
