Cholecystitis is an inflammatory disease of the gallbladder, a small organ located under the liver that stores and concentrates bile produced by the liver. Bile plays a key role in digestion by helping to break down fats in the small intestine. When bile flow is obstructed or an infection develops, the gallbladder can become inflamed, leading to cholecystitis.

This condition can be acute, developing suddenly and causing severe pain, or chronic, characterized by recurrent episodes of inflammation and less pronounced symptoms. In most cases, cholecystitis is associated with the presence of gallstones that block the bile ducts.

Causes and Risk Factors for Cholecystitis

The primary cause of cholecystitis is bile duct obstruction, most often caused by gallstones (cholelithiasis). These stones are formed from cholesterol or bilirubin and can block the cystic duct leading from the gallbladder or the common bile duct. The blockage leads to bile stasis, increased pressure within the gallbladder, distension, and subsequent inflammation.

In addition to gallstones, there are other factors that contribute to the development of cholecystitis:

Acalculous cholecystitis: A rare form that occurs without the presence of stones. It is often associated with severe illnesses such as trauma, burns, sepsis, prolonged fasting or intravenous nutrition, as well as certain infections.
Infections: Bacterial infections can develop in stagnant bile, exacerbating inflammation.
Tumors: Neoplasms blocking the bile ducts can also cause cholecystitis.
Bile duct strictures: Scarring or other abnormalities can impede normal bile flow.
Blood supply disorders: In rare cases, ischemia of the gallbladder can lead to its inflammation.

Risk factors for gallstone formation, and consequently for cholecystitis, include:

Female gender (especially after multiple pregnancies).
Age over 40.
Obesity.
Rapid weight loss.
Pregnancy.
Use of certain hormonal medications (e.g., estrogens).
Diabetes mellitus.
Hereditary predisposition.

Symptoms: How to Recognize Cholecystitis?

The symptoms of cholecystitis depend on its form — acute or chronic.

Acute Cholecystitis

Acute cholecystitis develops suddenly and requires immediate medical attention. Characteristic symptoms include:

Severe pain in the right upper quadrant of the abdomen: The pain often radiates to the right shoulder or back. It may worsen after eating fatty foods.
Nausea and vomiting: Often accompany the pain syndrome.
Fever and chills: Signs of an inflammatory process and possible infection.
Jaundice: Yellowing of the skin and sclera may indicate obstruction of the common bile duct.
Positive Murphy's sign: Increased pain upon palpation of the right hypochondrium during inhalation.

Without timely treatment, acute cholecystitis can lead to serious complications such as gallbladder perforation, peritonitis, or abscess formation.

Chronic Cholecystitis

Chronic cholecystitis is characterized by less pronounced but recurrent symptoms that can last for months or years. It is often the result of repeated episodes of acute inflammation or constant irritation of the gallbladder by stones. Symptoms may include:

Dull, aching pain or discomfort in the right hypochondrium, especially after meals.
A feeling of heaviness or bloating in the abdomen.
Dyspepsia: Belching, heartburn, abdominal bloating, intolerance to fatty foods.
Periodic nausea.

Diagnostics of Cholecystitis

The diagnosis of cholecystitis is based on medical history, physical examination, and instrumental studies.

Abdominal Ultrasound: This is the primary diagnostic method. It allows for the detection of gallstones, thickening of the gallbladder walls, the presence of fluid around it, and dilation of the bile ducts.
Computed Tomography (CT) or Magnetic Resonance Imaging (MRI): May be ordered for a more detailed assessment of the gallbladder and surrounding tissues, especially if complications or acalculous cholecystitis are suspected.
Cholescintigraphy (HIDA scan): Used to assess gallbladder function and bile duct patency. A radioactive tracer is injected intravenously and its path is tracked through the liver, bile ducts, and gallbladder.
Complete Blood Count and Biochemistry: Shows signs of inflammation (elevated white blood cell count) and may reveal liver function abnormalities (elevated bilirubin, ALT, AST, alkaline phosphatase).
Endoscopic Retrograde Cholangiopancreatography (ERCP): Used not only for diagnosis but also for removing stones from the common bile duct if they are detected.

Modern Treatment Methods for Cholecystitis

Treatment for cholecystitis depends on its form, the severity of symptoms, and the presence of complications. In most cases of acute cholecystitis, hospitalization is required.

Conservative Treatment

Conservative therapy is aimed at reducing inflammation, pain, and preventing complications. It includes:

Painkillers: To manage the pain syndrome.
Antibiotics: Prescribed if a bacterial infection is suspected or for its prevention.
Intravenous fluids: To maintain hydration and electrolyte balance.
Diet: Fasting is recommended during the acute period, followed by the gradual introduction of light, low-fat foods.
Antispasmodics: To relax the smooth muscles of the bile ducts.

In chronic cholecystitis, especially if it is not associated with stones or symptoms are mild, a diet, medications to improve bile flow (choleretics, cholekinetics), and regular monitoring may be recommended.

Surgical Treatment (Cholecystectomy)

Removal of the gallbladder (cholecystectomy) is the primary and most effective treatment for calculous cholecystitis (with stones) and is often used for acute cholecystitis.

Laparoscopic cholecystectomy: This is a minimally invasive surgery in which the gallbladder is removed through several small incisions in the abdomen using a laparoscope. It is the "gold standard" and the preferred method due to less trauma, faster recovery, and fewer postoperative complications.
Open cholecystectomy: Performed through one large incision in the abdomen. This method is used in cases where laparoscopic surgery is impossible or contraindicated (e.g., in cases of severe inflammation, adhesions, previous abdominal surgeries, or complications).

After gallbladder removal, most people lead a normal life. Bile will flow directly from the liver into the small intestine. Some patients may experience temporary changes in digestion, such as diarrhea, but these symptoms usually resolve.

Prevention and Prognosis

Prevention of cholecystitis mainly comes down to preventing the formation of gallstones. This includes:

Healthy eating: A balanced diet low in saturated fats and cholesterol, rich in fiber (fruits, vegetables, whole grains).
Maintaining a healthy weight: Avoiding obesity and rapid weight fluctuations.
Regular physical activity.
Adequate water intake.

The prognosis for timely diagnosis and adequate treatment of cholecystitis, especially after cholecystectomy, is generally favorable. Most patients recover completely and return to a full life. However, without treatment, acute cholecystitis can lead to serious, life-threatening complications.

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Disclaimer: The information provided in this article is for reference purposes only and should not be used for self-diagnosis or self-treatment. Always consult a qualified medical professional for diagnosis and the selection of an optimal treatment plan.

Cholecystitis and Gallstones: Causes, Symptoms, and Treatment