Cholecystitis: Types, Causes, and Risk Factors

• Cholecystitis is inflammation of the gallbladder.

Types of Cholecystitis

• Acute cholecystitis is a sudden inflammation of the gallbladder, often caused by gallstones blocking the cystic duct.
• Chronic cholecystitis is long-term inflammation of the gallbladder, often resulting from repeated acute attacks or chronic irritation by gallstones.
• Acalculous cholecystitis is gallbladder inflammation without gallstones, typically occurring in critically ill patients.

Causes

• Gallstones (cholelithiasis) are the most common cause, leading to obstruction of the cystic duct.
• Bacterial infection can sometimes cause cholecystitis, but it is less common than gallstones.
• Tumors can obstruct bile flow and lead to gallbladder inflammation.
• Reduced blood flow to the gallbladder may cause acalculous cholecystitis, particularly in critically ill patients.

Risk Factors

• Female gender is a risk factor due to hormonal influences on cholesterol levels.
• Age increases the risk of gallstone formation.
• Obesity is associated with higher cholesterol levels in bile.
• Rapid weight loss can increase the risk of gallstones.
• Family history of gallstones increases the likelihood.
• Certain ethnicities, such as Native Americans, have a higher prevalence of gallstones.
• Diabetes mellitus increases the risk of gallbladder disease.
• Cholesterol-lowering medications can sometimes increase the amount of cholesterol in bile.
• Pregnancy can increase the risk due to hormonal changes.

Symptoms

• Severe, steady pain in the upper right abdomen is a common symptom.
• Pain that radiates to the right shoulder or back may occur.
• Tenderness over the abdomen, especially upon palpation, is typical.
• Nausea and vomiting often accompany the pain.
• Fever may indicate infection.
• Jaundice, or yellowing of the skin and eyes, can occur if the bile duct is blocked.

Diagnosis

• Physical examination involves assessing abdominal tenderness and guarding.
• Blood tests look for elevated white blood cell count, bilirubin, and liver enzymes.
• Ultrasound is commonly used to visualize gallstones and gallbladder inflammation.
• CT scan can provide detailed images of the gallbladder and surrounding structures.
• HIDA scan (hepatobiliary iminodiacetic acid scan) assesses gallbladder function and obstruction.
• Magnetic resonance cholangiopancreatography (MRCP) provides detailed images of the biliary system.

Complications

• Gallbladder rupture can lead to peritonitis, a life-threatening infection of the abdominal cavity.
• Gallbladder gangrene is tissue death due to lack of blood supply and infection.
• Empyema, or pus accumulation in the gallbladder, can occur.
• Cholangitis, an infection of the bile ducts, may develop.
• Pancreatitis can result from gallstone migration into the common bile duct.
• Chronic cholecystitis can cause a chronically inflamed, fibrotic gallbladder.
• Porcelain gallbladder is calcification of the gallbladder wall, which increases the risk of gallbladder cancer.
• Sepsis is a life-threatening complication from severe infection.

Treatment

• Hospitalization is often necessary for acute cholecystitis.
• Pain management includes analgesics to relieve discomfort.
• Intravenous fluids are administered to maintain hydration.
• Antibiotics are used to treat infection.
• Cholecystectomy, or gallbladder removal surgery, is the definitive treatment.
• Laparoscopic cholecystectomy is a minimally invasive surgical approach.
• Open cholecystectomy is performed when laparoscopic surgery is not feasible.
• Percutaneous cholecystostomy involves placing a drainage tube into the gallbladder to relieve pressure and infection in patients unfit for surgery.
• Ursodiol, a medication that dissolves gallstones, may be used in select cases with small cholesterol stones, but it is not effective for acute cholecystitis.

Prevention

• Maintaining a healthy weight reduces the risk of gallstones.
• Eating a balanced diet with plenty of fiber can help prevent gallstone formation.
• Avoiding rapid weight loss can lower the risk of gallstones.
• Regular exercise promotes healthy gallbladder function.

Acalculous Cholecystitis

• Often seen in seriously ill, hospitalized patients.
• Associated with prolonged fasting or total parenteral nutrition (TPN).
• Can be caused by gallbladder stasis, ischemia, or infection.
• Diagnosis may be difficult due to the absence of gallstones.
• Treatment includes antibiotics, percutaneous cholecystostomy, or cholecystectomy.

Chronic Cholecystitis

• Results from repeated episodes of acute cholecystitis or chronic irritation.
• Leads to thickening and scarring of the gallbladder wall.
• Symptoms may be vague or similar to acute cholecystitis but milder.
• Can lead to porcelain gallbladder, a risk factor for gallbladder cancer.
• Treatment typically involves cholecystectomy.

Gallbladder Cancer Risk

• Chronic inflammation increases the risk of gallbladder cancer.
• Porcelain gallbladder is associated with an elevated risk of malignancy.
• Gallstones are present in a high percentage of patients with gallbladder cancer.
• Early detection and treatment are critical for improving outcomes.