What is cholecystitis?

Cholecystitis is an inflammation of the gallbladder. Your gallbladder is a small pear-shaped organ tucked away under your liver in the upper right section of your abdomen. The gallbladder’s job is to store bile – a fat-digesting fluid made by the liver – and to release it after you eat a meal. Cholecystitis usually develops when the bile gets trapped in your gallbladder, and becomes infected with bacteria. Bile gets trapped when gallstones block the flow of bile out of your gallbladder.

What are gallstones and how do they block the flow of bile?

Gallstones are hardened deposits of the digestive fluids that form in your gallbladder, and can range in size from a tiny grain of sand (called sludge) to a golf ball. They are made up of either cholesterol or pigment stones. Gallstones made of cholesterol are yellow-greenish in color, and are more common. Pigment stones are mostly made of bilirubin, a substance that is created when the liver breaks down red blood cells.

Gallstones themselves are not necessarily a problem. It’s possible to have gallstones sitting in your gallbladder, never bothering you and, in that case, they don’t need to be treated. However, gallstones that leave the gallbladder can get stuck in your ducts (tubes). They block the flow of bile out of your gallbladder, which causes a buildup of bile. These events cause the walls of your gallbladder to become inflamed and swell, and that can lead to bacterial infection of the bile. Your life can even be in danger unless you seek prompt medical and surgical help.

How does the gallbladder work?

The gallbladder connects to your liver by a duct system (tubes) that look like a tree trunk with branches. There are many ducts, or “branches” inside your liver. These tree branches connect to two main tree limbs in your liver, called the right and left hepatic ducts. These two ducts merge (like the trunk of a tree) to form your common hepatic duct. One main “tree limb” coming off the common hepatic duct is called the cystic duct. It connects directly into your gallbladder. The common hepatic duct, the “tree trunk,” continues but its name changes to the common bile duct. Your common bile duct empties into the duodenum section of the small intestine.

Bile, a fat-dissolving liquid substance that is made continuously by your liver, travels through the duct system and enters your digestive system at the duodenum. When you are not eating, a valve structure at the common bile duct and duodenum connection, called the major duodenal papilla, is usually closed. This allows the bile to reflux back through the cystic duct into your gallbladder to be stored. During mealtime, your gallbladder contracts, and the valve opens, pushing the stored bile out of your gallbladder, through the cystic duct and down the common bile duct into your intestine. Bile mixes with the partially digested food, further helping the breakdown of the fat in your diet.

Gallstones, or even sludge, in the gallbladder can obstruct this normal flow of bile, leading to cholecystitis.

How common is cholecystitis?

Approximately 120,000 Americans are treated for acute cholecystitis every year. Women make up 60% of this number.

Who is at risk to get cholecystitis?

You are at greater risk of developing cholecystitis if you:

  • Have a family history of gallstones.
  • Are a woman age 50 or older.
  • Are a man or woman age 60 or older.
  • Eat a diet high in fat and cholesterol.
  • Are overweight or obese.
  • Have diabetes.
  • Are of Native American, Scandinavian or Hispanic descent.
  • Are currently pregnant or have had several pregnancies.
  • Are a woman who takes estrogen replacement therapy or birth control pills.
  • Have lost weight rapidly.

What causes cholecystitis?

Cholecystitis is commonly caused by gallstones that have blocked your cystic duct, which prevents bile from exiting your gallbladder. Your gallbladder becomes swollen and may become infected with bacteria. Less common causes include blocked bile ducts due to scarring, reduced blood flow to your gallbladder, tumors that block the flow of bile from your gallbladder, or viral infections that inflame your gallbladder.

Cholecystitis is caused by gallstones getting stuck in the cystic duct.

Structure of the digestive anatomy showcasing the liver, stomach, pancreas and gallbladder.

What are the symptoms of cholecystitis?

Symptoms can be acute or chronic.

Acute cholecystitis comes on suddenly and causes severe, ongoing pain. More than 95% of people with acute cholecystitis have gallstones. Pain begins in your mid to upper right abdomen and may spread to your right shoulder blade or back. Pain is strongest 15 to 20 minutes after eating and it continues. Pain that remains severe is considered a medical emergency.

Chronic cholecystitis means you’ve had repeated attacks of inflammation and pain. Pain tends to be less severe and doesn’t last as long as acute cholecystitis. The repeated attacks are usually caused by gallstones blocking the cystic duct intermittently.

Other signs and symptoms of cholecystitis may include:

  • Tenderness in your abdomen when it's touched.
  • Nausea and bloating.
  • Vomiting.
  • Fever above 100.4 F (38 C). Fever may not be present in older adults and usually doesn’t occur in people with chronic cholecystitis.
  • Chills.
  • Abdominal pain that gets worse when taking a deep breath.
  • Abdominal pain and cramping after eating – especially fatty foods.
  • Jaundice (a yellowing of skin and eyes).

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