Cholecystitis: causes, symptoms & treatment

Cholecystitis

We talk about cholecystitis when there is inflammation of the gallbladder due to the presence of stones. The gallbladder is the organ below the liver. It is a small “bag,” which stores the bile produced by the liver. The latter promotes good digestion, especially in case of a heavy meal. This is because bile is primarily used to digest fats and alcohol.

The presence of gallstones is far from rare: it is estimated that around 10% of the population has gallstones in the gallbladder. However, these stones do not necessarily cause significant discomfort or pain. Only 1% of the population needs to be operated on for cholecystitis.

How are the stones formed?

When the wall of the gallbladder is damaged, the bile stagnates, concentrates and eventually forms crystals. As they aggregate with each other, they then form “liver stones” (gallstones), which can measure up to 7 or 8 cm.

These stones are made up, in varying proportions from person to person, of cholesterol, limescale and bile salts. They can cause blockage in the cystic duct, through which bile passes normally.

The gallbladder will then swell, become inflamed and cause severe pain: this is called acute cholecystitis. The gallbladder can also become the site of infection: indeed, when lithiasis form, the bacteria present in the bile stagnate and proliferate.

Risk factors

Cholecystitis can affect anyone. However, several factors can favor the occurrence of gallstones:

  • Gender

Women are more likely to develop cholecystitis. During pregnancy, the bile contains more cholesterol, promoting the development of stones. This is even more true in women who experience significant weight loss after pregnancy.

  • Age

Over the years, the rhythm of the gallbladder tends to slow down, and it loses its motor skills, favoring the crystallization of the bile. Thus, more than 60% of people over the age of 80 are affected by gallstones.

  • Weight

People who are overweight, have significant changes in weight, or follow a high calorie diet are at greater risk of developing acute cholecystitis.

  • Medication

Treatments for hypertriglyceridemia or estrogen-based treatments can affect the functioning of the gallbladder.

  • Chronic illness

Certain intestinal diseases (Crohn’s disease), as well as diabetes and cystic fibrosis can promote stone formation.

Symptoms of cholecystitis

Although cholecystitis is very well managed today, it can be very painful. Among the symptoms that should alert you:

  • Hepatic colic: This is a sudden, severe pain in the pit of the stomach or under the sides. Doctors talk about a sensation of “stabbing” in the stomach, which radiates to the back;
  • A state of fatigue and restlessness;
  • Nausea;
  • A fever over 38.5;
  • Digestive discomfort: a feeling of weight on the stomach after meals

In the presence of these symptoms, urgent medical consultation is necessary.

Diagnosis

When symptoms of cholecystitis appear, the first examination is a palpation of the abdomen. If the area is painful on palpation, and the latter causes difficulty in breathing, then additional examinations will be necessary.

The diagnosis of cholecystitis is usually made by an ultrasound, which can confirm the presence of stones, thickening of the walls of the gallbladder, or the presence of fluid around it. A blood test can be done as a supplement, to show biological signs of inflammation and/or infection.

In cases of acute cholecystitis, an MRI or endoscopy may be done, to clarify the diagnosis and find the best treatment.

Treatments

Once the diagnosis is confirmed, a first drug treatment can be offered to the patient in order to limit the pain. While medication can ease symptoms, full recovery requires surgery.

Indeed, surgery is the standard treatment for acute cholecystitis. It involves removing the gallbladder, which is not a vital organ. When cholecystitis is older than three days, treatment with an antibiotic will first be given to neutralize the infection. The surgery will be performed a couple months later. If the cholecystitis is less than three days old, the surgery can be done immediately.

Today, the operation is done in the vast majority of cases by laparoscopy. It avoids opening the abdominal wall: only a small incision is made to insert a mini-camera and very fine surgical instruments. This common procedure gives very good results, prevents recurrence, and limits the duration of hospitalization and convalescence.

If gallbladder removal is necessary, rest assured: it has a secondary role in the digestion process. The removal of the gallbladder therefore has few consequences in daily life. Compared to the inconvenience associated with stones, your digestive comfort will even generally be improved!

Complications

When cholecystitis is managed quickly, recovery is possible after two weeks. However, if the diagnosis and management are late, complications can occur.

The main complications of cholecystitis are the migration of stones into the bile duct, the channel between the gallbladder and the duodenum. They then lead to an infection of the canal called cholangitis. The bile duct is also in contact with the main duct of the pancreas, if the duct is infected, the infection can go up to the pancreas: this is called pancreatitis. Since cases of cholecystitis are detected early and well managed, this type of complication is increasingly rare.

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