Cholecystitis: Causes

Cholecystitis – is an inflammatory disease of the gallbladder. This condition usually develops gradually and is not always noticeable to the patient. Cholecystitis most commonly affects women, primarily those who are middle-aged (over 40–50 years old), although it also occurs in other patient groups.

The main causes of cholecystitis include:

• Metabolic disorders
• Increased intra-abdominal pressure (pregnancy, exercise, constipation)
• Biliary dyskinesia
• Chronic infections
• Low physical activity
• Unhealthy diet

Cholecystitis may develop as a result of gallstone disease, when stones damage the gallbladder wall, causing inflammation and obstructing the normal flow of bile. In some cases, inflammation develops after trauma to the gallbladder area.

Depending on the course of the disease, cholecystitis is classified as acute or chronic.
Main symptoms of acute cholecystitis:

• Intermittent pain in the right upper abdomen that may radiate to the right shoulder or
  shoulder blade
• Nausea and vomiting
• Chills and elevated body temperature
• Possible jaundice and itching of the skin

Main symptoms of chronic cholecystitis

• Aching pain in the right side of the abdomen
• A feeling of heaviness or discomfort after eating, especially after fatty or spicy foods or
  carbonated drinks
• Nausea
• Flatulence (bloating)

Acute cholecystitis

Acute cholecystitis is characterized by a rapid onset and more pronounced symptoms than the chronic form. Patients report severe pain in the right upper abdomen, pain radiating to the right shoulder or shoulder blade, fever, chills, nausea, or vomiting. Complicated forms may cause jaundice of the skin and mucous membranes, as well as itching.

Acute cholecystitis often requires hospitalization and the immediate initiation of treatment. In some cases, surgery may be necessary.

Depending on whether calculi (gallstones) are present, acute cholecystitis is classified as:

• calculous (with gallstones);
• acalculous.

According to the type and severity of pathological changes, the following forms are distinguished:

• catarrhal cholecystitis – swelling of the gallbladder mucosa
• phlegmonous cholecystitis – development of a purulent process
• gangrenous cholecystitis – development of tissue necrosis
• destructive cholecystitis – perforation of the gallbladder wall

This classification is important when selecting the optimal treatment for each form of the disease. The catarrhal form can be treated with medication. The other forms require hospitalization and surgery.

Chronic cholecystitis

Chronic cholecystitis may be asymptomatic or present with intermittent aching pain in the right upper abdomen, usually occurring 1-2 hours after eating and possibly radiating to the right shoulder, shoulder blade, or neck.
Like acute cholecystitis, chronic cholecystitis may be calculous or acalculous, with or without impaired gallbladder motility, among other forms.

Without adequate treatment, the following complications of cholecystitis may develop:

• gallbladder hydrops
• gallbladder empyema
• gallbladder gangrene
• perforation of the gallbladder wall and peritonitis
• cholangitis (inflammation of the bile ducts)
• jaundice
• abdominal adhesions
• liver abscesses
• a fistula between the gallbladder and the intestine

In most cases, complications can be life-threatening and require urgent surgical treatment.

Diagnosis

Acute cholecystitis begins with moderate to severe abdominal pain. During the consultation, the doctor will therefore ask the patient about their symptoms, perform a general examination, and
palpate the abdomen. Based on these findings, the doctor can determine which condition may be affecting the patient. An abdominal ultrasound is performed to confirm the diagnosis.

If necessary, other diagnostic procedures may also be performed:

• computed tomography
• endoscopic examination (gastroduodenoscopy) of the esophagus, stomach, and duodenum
• cholangiography (contrast-enhanced X-ray imaging of the bile ducts)
• blood and urine tests

The doctor determines which examinations are necessary for each patient after reviewing their symptoms and medical history and performing a clinical examination.

Treatment

Cholecystitis can be treated with medication or surgery. In most cases, the patient must be admitted to hospital for medical treatment and strict adherence to a prescribed diet. Surgery is performed for complicated forms of the condition, when a purulent infection develops, or when gallstones are present in the gallbladder.
The doctor determines the optimal treatment approach after all necessary tests and diagnostic procedures have been completed.