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Cholecystitis

Cholecystitis

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Definition

The gallbladder is located under the liver and near the stomach. Gallstones form when cholesterol or bile stored in the gallbladder hardens into pieces of stone-like material. Gallstones are made of cholesterol salts or bilirubin salts. Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or almost any combination.

Gallstones
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Causes

Gallstones are caused when bile or cholesterol crystalizes into gallstones.

Gallstones can form under the following conditions:

  • Too much cholesterol in the bile
  • Too much bilirubin in the bile
  • Not enough bile salts
  • When the gallbladder does not empty completely or often enough due to blockage or poor contraction

Risk Factors

People who are older than 60 are at increased risk for gallstones. Women between 20-60 years old and those with high estrogen levels are also at increased risk. People of Native American, Mexican American, and Northern European descent are also at increased risk.

Other factors that may increase your risk of gallstones include:

  • Problems that affect the gallbladder such as:
    • Inflammation of the lining of the gallbladder
    • Poor gallbladder function
    • Diseases of the gallbladder and ducts
    • Previous gallstones
  • Dietary factors such as a:
    • Obesity
    • Rapid weight loss and fasting
    • High fat diet
  • Certain conditions such as diabetes or Crohn’s disease
  • Blockage in the biliary tract
  • History of intestinal problems
  • Blood diseases that increase breakdown of hemoglobin and therefore bile production, including sickle cell anemia
  • Gastric bypass surgery
  • Liver disease, such as cirrhosis
  • Metabolic syndrome
  • Lack of physical activity
  • Heredity

Certain medications can increase your risk of gallstones, including:

  • Thiazide diuretics
  • Cholesterol-lowering drugs—fibrates
  • Ceftriaxone
  • Octreotide
  • Somastatin

Symptoms

Many people have gallstones without symptoms, called silent gallstones. In some cases, these are treated.

Gallstones may cause pain in the upper abdomen. This is sometimes called an attack because it begins suddenly, often after a fatty meal. The pain is severe and may last for 30 minutes or several hours.

Other symptoms include:

  • Intermittent pain on the right, below the rib cage; the pain may spread
  • Bloating, nausea, and vomiting
  • Belching, gas, and indigestion

If you have the following symptoms, see your doctor right away:

  • Abdominal pain
  • Sweating
  • Chills
  • Low-grade fever
  • Yellowish color of the skin or whites of the eyes
  • Clay-colored stools

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids may be tested. This can be done with blood tests.

Images may be taken of your bodily structures. This can be done with:

  • Abdominal ultrasound
  • Magnetic resonance cholangiopancreatography (MRCP)
  • Hepatobiliary scintigraphy (HIDA) scan
  • Abdominal CT scan
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Cholecystogram

Treatment

Talk to your doctor about the best treatment plan for you.

Options include:

Prevention

To reduce your chance of getting gallstones:

  • Maintain a healthy weight.
  • Avoid rapid weight loss diets.
  • Exercise regularly.
  • Eat a diet low in saturated fat.
  • Eat plenty of fruits, vegetables, and whole grain foods.
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