Cholecystitis (Gallbladder Inflammation)

Overview

Cholecystitis is the inflammation of the gallbladder, a small, pear‑shaped organ located beneath the liver that stores bile. The most common form is acute cholecystitis, which typically develops suddenly when a gallstone blocks the cystic duct, leading to bile buildup, irritation, and infection. Chronic cholecystitis results from repeated episodes of inflammation and can cause thickening of the gallbladder wall and scarring.

Key points:

• Often linked to gallstones (≈90% of cases).
• Can be complicated by infection, perforation, or gangrene of the gallbladder.
• More prevalent in adults aged 40–70, but can occur at any age.

[1] Mayo Clinic, “Cholecystitis”

Symptoms Checklist

• ☐ Sudden, severe pain in the upper right abdomen (often radiating to the right shoulder or back)
• ☐ Pain that worsens after eating a fatty meal
• ☐ Fever (usually >38°C / 100.4°F)
• ☐ Nausea and/or vomiting
• ☐ Tenderness over the right upper quadrant (RUQ) of the abdomen
• ☐ Jaundice (yellowing of skin/eyes) – may indicate a bile duct obstruction
• ☐ Loss of appetite

[2] Cleveland Clinic, “Acute Cholecystitis”

Risk Factors

• Gallstones (the single biggest risk factor)
• Female gender – estrogen increases cholesterol saturation in bile
• Age >40 years
• Obesity or rapid weight loss (e.g., after bariatric surgery)
• Diabetes mellitus
• Family history of gallstones
• Certain ethnicities (e.g., Native American, Hispanic)
• Use of hormone replacement therapy or oral contraceptives

[3] NIH National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), “Gallstones”

Diagnosis

Diagnosis combines a clinical assessment with imaging and laboratory tests:

1. Physical examination – RUQ tenderness, Murphy’s sign (pain on deep inspiration while the examiner palpates the RUQ).
2. Blood tests – Elevated white blood cell count, liver enzymes (ALT, AST), bilirubin, and C‑reactive protein.
3. Ultrasound – First‑line imaging; shows gallstones, gallbladder wall thickening (>3 mm), pericholecystic fluid, and a sonographic Murphy’s sign.
4. HIDA scan (hepatic iminodiacetic acid scan) – Assesses gallbladder ejection; non‑filling suggests obstruction.
5. CT scan or MRI – Used when complications (e.g., perforation, abscess) are suspected.

[4] Johns Hopkins Medicine, “Acute Cholecystitis”

Treatment Options

Medical Management

• Hospital admission for observation, IV fluids, and pain control (e.g., opioids or NSAIDs).
• Antibiotics – Broad‑spectrum coverage (e.g., ceftriaxone + metronidazole) if infection is suspected.
• Fasting (NPO) – Allows the gallbladder to rest before surgery.

Surgical Options

• Laparoscopic cholecystectomy – Preferred treatment; removes the gallbladder minimally invasively and is usually performed within 24–72 hours of diagnosis.
• Open cholecystectomy – Reserved for complicated cases (e.g., severe inflammation, perforation).
• Percutaneous cholecystostomy – Image‑guided drainage of the gallbladder for patients who are too ill for immediate surgery.

Home / Supportive Care (post‑operative or mild cases)

• Gradual return to a low‑fat diet for 2–4 weeks.
• Hydration and small, frequent meals.
• Over‑the‑counter pain relievers (acetaminophen) as directed.
• Follow‑up appointments to monitor wound healing and liver function.

[5] Mayo Clinic, “Cholecystectomy”

Prevention

• Maintain a healthy weight – Aim for a BMI < 25; rapid weight loss can increase gallstone risk, so lose weight gradually (1–2 lb/week).
• Eat a balanced diet – High‑fiber, low‑refined‑carbohydrate, and moderate‑fat meals reduce cholesterol saturation in bile.
• Stay physically active – Regular aerobic exercise (150 min/week) improves gallbladder motility.
• Limit intake of sugary drinks and high‑cholesterol foods.
• If you have diabetes, keep blood glucose under control.
• Discuss hormone therapy risks with your physician; consider the lowest effective dose.

[6] CDC, “Gallbladder Disease Prevention”

Living With Cholecystitis (Gallbladder Inflammation)

After treatment—especially after gallbladder removal—most people live normal, healthy lives. Here are practical tips:

• Dietary adjustments – Initially stick to bland, low‑fat foods (broth, boiled vegetables, lean proteins). Gradually re‑introduce healthy fats (olive oil, avocado) as tolerated.
• Meal timing – Eat smaller portions 4–5 times daily to avoid overloading the digestive system.
• Hydration – Aim for ≥8 glasses of water per day; adequate fluid helps bile flow.
• Weight management – Maintain a stable weight; avoid crash diets.
• Regular follow‑up – Annual physicals and liver function tests if you have underlying liver disease.
• Know your triggers – Keep a food diary to identify any foods that cause discomfort.
• Physical activity – Light walking after meals can aid digestion.

[7] Johns Hopkins Medicine, “Life After Gallbladder Removal”

When to Seek Emergency Care

Acute cholecystitis can progress rapidly to life‑threatening complications. Go to the emergency department or call 911 if you experience any of the following:

• Severe, worsening abdominal pain that does not improve with rest or medication.
• Fever ≥38.5 °C (101.3 °F) with chills.
• Persistent vomiting or inability to keep fluids down.
• Yellowing of the skin or eyes (jaundice).
• Rapid heart rate (tachycardia) or low blood pressure (hypotension).
• Confusion, dizziness, or fainting.
• Signs of a ruptured gallbladder (sudden sharp pain, abdominal distension, severe sepsis).

[8] Cleveland Clinic, “When to Call the Doctor for Gallbladder Problems”