Cholecystitis is the medical term for an inflamed gallbladder. A typical symptom is a sharp pain that spreads upward from the right side of your belly.
The most common cause of cholecystitis is the presence of gallstones that block the bile ducts. But infection of the gallbladder can occur in the presence or absence of gallstones.
At UPMC, we see many cases of acute cholecystitis every year. In most cases, we suggest surgery to remove the gallbladder when it's inflamed or infected.
On this page:
What Is Cholecystitis?
Cholecystitis is infection or inflammation of the gallbladder.
The gallbladder is a small, pear-shaped organ below your liver. It stores bile, a fluid your body uses to digest fat. After you eat, the gallbladder releases bile through the common bile duct and into your small intestine.
Cholecystitis starts when gallstones block the bile from flowing through the bile ducts to the small intestine. When this blockage happens, your gallbladder may not work well, or it may stop working altogether. That can cause digestive problems, such as pain and vomiting.
Without treatment, cholecystitis can lead to serious problems like pancreatitis or jaundice. If your gallbladder bursts, it’s a medical emergency. A ruptured gallbladder can lead to a life-threatening infection of the abdomen called peritonitis.
Other names for cholecystitis are gallbladder disease or an inflamed gallbladder. Cholecystitis can be acute (occurs quickly) or chronic (occurs slowly over years).
What are the types of cholecystitis?
Cholecystitis can be acute or chronic.
Acute cholecystitis
Acute gallbladder disease comes on suddenly. It can cause severe pain on the right side of the belly. The pain often spreads upward into the shoulder blades.
If you have symptoms of acute cholecystitis, you should seek medical attention. If the gallbladder bursts, it can be life-threatening.
Chronic cholecystitis
People sometimes have milder forms of gallbladder disease, with recurring episodes of inflammation. These bouts can eventually damage the wall of the gallbladder. Sometimes doctors treat chronic cases with medicine and/or dietary changes.
How common is cholecystitis?
Gallstone disease is very common. About 14 million women and six million men in the U.S. between the ages of 20 and 74 have gallstones. Surgeons perform about 500,000 cholecystectomies (gall bladder removals) every year in this country.
What causes cholecystitis?
In most cases, gallstones in the bile cause cholecystitis.
Gallstones are hardened deposits of bile. They can contain cholesterol, bilirubin, calcium salts, and waste from the liver. Gallstones can block the gallbladder's opening and cause bile to build up, leading to swelling and infection.
Your bile ducts can also become blocked by a substance called gallbladder sludge. This thick material is a mix of bile and crystals that builds up in your gallbladder. It’s more common in pregnant women and people who’ve lost weight very quickly.
More rarely, gallbladder disease happens for other reasons, such as:
- Autoimmune diseases, in which the immune system attacks healthy cells in the gallbladder and creates scar tissue.
- An infection that causes an abscess or scarring at the gallbladder's opening.
- Tumors or cancer in the gallbladder.
Cholecystitis risk factors
Some people are more prone to getting gallbladder disease.
Risk factors include:
- Age — Cholecystic disease is more likely to occur in people ages 40 and up.
- Diabetes — People with type 2 diabetes are at higher risk for gallbladder disease.
- Fasting or using IV feeding tubes — Both factors can increase your cholesterol levels, which can lead to gallstone formation.
- Genetics — People with Native American or Hispanic backgrounds are at higher risk for gallbladder problems.
- Pregnancy — Pregnant women have a higher risk of getting the disease than non-pregnant women. Women taking hormone therapy are also at higher risk.
- Obesity — Being obese or eating a diet high in saturated fats raises your risk of gallbladder problems.
- Sex — About 60% of people with acute gallbladder disease are women.
Complications of cholecystitis
In some cases, mild symptoms of gallbladder disease will go away on their own after two or three days, but often return.
But an untreated inflamed gallbladder can also lead to:
- Pancreatitis
- Infection/Sepsis
- Infection of the bile ducts
- Scarring and strictures in the liver
What Are the Signs and Symptoms of Cholecystitis?
Symptoms of gallbladder problems often start after a meal. You may notice discomfort after eating greasy or spicy foods.
Cholecystitis symptoms include:
- Bloating and gas.
- Fever.
- Indigestion or heartburn.
- Loose bowel movements.
- Loss of appetite.
- Nausea and vomiting.
- Pain in the upper right part of your belly.
When should I see a doctor about my cholecystitis symptoms?
If you have any of the symptoms above on a recurring basis, you should make an appointment with your primary care doctor (PCP). They may refer you to a general surgeon.
Red flags that you should seek urgent care include:
- Dark urine or light-colored, loose stools.
- Fever of more than 101° F with abdominal pain.
- Persistent vomiting.
- Sharp, severe pain in the upper right or upper middle of your belly. It may spread upward to the shoulder blades. This pain may last 30 minutes to several hours.
- Yellowed skin and whites of the eye (jaundice).
How Do You Diagnose Cholecystitis?
To diagnose gallbladder disease, your doctor will start by asking about your symptoms. Then they’ll do a physical exam, gently pressing on your belly to find out where the pain is.
Tests to diagnose cholecystitis
Your doctor may order the following tests to confirm a diagnosis of gallbladder disease:
- Abdominal ultrasound — Uses sound waves to make pictures of the gallbladder and bile ducts. Ultrasound can show gallstones and signs of inflammation.
- Blood tests — Can reveal signs of an inflamed, infected, or diseased gallbladder. For instance, gallbladder disease can cause elevated liver enzyme levels in the blood.
- CT scan — Uses x-rays to show detailed pictures of the abdominal organs. It can help identify blocked bile ducts and gallstones.
- Hepatobiliary nuclear imaging — Injects a small amount of a radioactive chemical into the body. A scan shows how the chemical flows through the liver and gallbladder before the body expels it.
- Magnetic resonance cholangiopancreatography (MRCP) — A type of MRI that makes detailed images of the liver, gallbladder, bile ducts, pancreas, and pancreatic ducts. It can show gallstones, blocked bile ducts, and inflammation.
How Do You Treat Cholecystitis?
The goal of gallbladder treatment is to eliminate painful symptoms of the disease and prevent life-threatening infections.
In most cases, doctors suggest surgery to remove the gallbladder. The risk of problems from gallbladder disease is higher than the risk of surgery.
While the gallbladder helps with digestion, you can live without it.
Dietary changes
Your doctor may suggest dietary changes for people with mild signs of cholecystitis. Eating fewer fatty, greasy, or spicy foods may help improve your symptoms.
However, even if you make changes to your diet, you may still need surgery later.
Medicine to treat cholecystitis
Before recommending surgery, your doctor may suggest treating cholecystitis with:
- Antibiotics for infections.
- Fasting to rest the gallbladder.
- Pain medication.
Surgery for cholecystitis
Usually, the best way to treat gallbladder disease is surgery to remove the gallbladder (cholecystectomy).
Cholecystectomy is one of the most common surgical procedures today. Doctors perform more than 1.2 million cholecystectomies in the U.S. every year.
At UPMC, we perform gallbladder surgery using several different procedures.
Laparoscopic gallbladder removal
The most common method of cholecystectomy is with laparoscopic surgery. Using this minimally invasive method, doctors make several small incisions (cuts) in the belly instead of one large one.
They insert a flexible tube with a tiny camera to see images on a monitor. Special surgical tools are used to take out the gallbladder and close the openings in the liver and small intestine.
Your surgeon may need to switch to open gallbladder removal during the operation. Sometimes there are issues during laparoscopic surgery that make it unsafe to continue that way.
Open gallbladder removal
Some people need open surgery with larger incisions to remove their gallbladder.
Imaging tests may reveal that the surgeon will have trouble getting to the gallbladder using the minimally invasive technique.
Doctors may also suggest open surgery if they need to clean the abdomen to prevent infection.
Draining the gallbladder
If you are too ill for gallbladder surgery, your doctor may recommend draining bile from the gallbladder. Imaging techniques allow the doctor to guide the tube into place.
How effective is treatment?
Most people do very well after having their gallbladder removed. You can live without your gallbladder. If your gallbladder gets removed, bile can flow directly from the liver into your small intestine.
How long does it take to recover after surgery for cholecystitis?
After laparoscopic surgery, most people are able to go home the same day. After open gallbladder surgery, you may need to stay in the hospital for a few days.
Your recovery time will depend on the type of surgery you had and any issues during surgery.
In most cases, laparoscopic gallbladder removal takes a week to 10 days to heal. Open gallbladder removal takes four to six weeks to recover.
You'll need to follow up with your surgeon in two to three weeks. Your doctor can see how you’re healing.
What Are the Risks and Complications of Cholecystectomy?
Cholecystectomy is one of the safest and most common surgeries performed in the U.S. Complications from gallbladder surgery are rare.
But every surgery has some risks, which include:
- Bleeding or bruising at the incision site.
- Blood clots.
- Infection.
- Reaction to the anesthesia.
Specific risks and complications of gallbladder surgery include:
- Bile leaking into your abdomen.
- Damage to blood vessels that go to your liver.
- Injury to your common bile duct, small intestine, or colon.
- Swelling of your pancreas (pancreatitis).
