Cholecystitis

Cholecystitis (Gallbladder Infection)

Cholecystitis, or gallbladder infection, occurs when the gallbladder becomes inflamed and irritated, often leading to intense pain and fever. This develops when bile becomes trapped in the gallbladder, often due to gallstones blocking the opening. In severe cases, the gallbladder can rupture and cause widespread infection, or lose its function altogether.

What Are the Different Types of Cholecystitis?

Cholecystitis can be broadly categorised into two types:

• Acute Cholecystitis

  - Sudden gallbladder inflammation with intense and steady pain in the upper abdomen. In some cases, acute cholecystitis may occur without gallstones, known as acalculous cholecystitis.

• Chronic Cholecystitis

  - Repeated episodes of acute cholecystitis, causing the gallbladder walls to thicken and shrink. Over time, the gallbladder loses its ability to store, concentrate, and secrete bile.

What Are the Symptoms of Cholecystitis?

The most common symptom of cholecystitis is severe pain in the middle or upper right section of the abdomen that can last several hours. This pain may also radiate to the right shoulder blade or the middle back.

Other signs and symptoms of cholecystitis to watch out for include:

• Nausea and vomiting
• Fever and chills
• Abdominal bloating
• Jaundice (Yellowing of the skin and eyes)
• Dark urine or pale stools

What Causes Cholecystitis?

The most common cause of cholecystitis is gallstones – hardened bile deposits that can block the gallbladder’s opening. Cholecystitis may also be caused by:

• Biliary Sludge - A mixture of bile components that can accumulate in the gallbladder opening.
• Tumours - Cancerous growths in the pancreas or liver can prevent bile from draining out of the gallbladder.
• Infection - Certain infections from untreated gallstones or other underlying conditions can cause an abscess or scarring at the gallbladder opening.
• Ischemia - Reduced blood flow to the gallbladder due to damaged blood vessels from a critical illness or physical trauma may lead to cholecystitis.

What Are the Risk Factors for Cholecystitis?

Several factors can increase an individual's risk of developing cholecystitis, including:

• Age - Individuals over the age of 40 are more susceptible to developing cholecystitis.
• Gender - Women are more likely to develop cholecystitis than men, primarily due to hormonal factors such as oestrogen.
• Pregnancy - Pregnant women are more prone to cholecystitis, particularly during the third trimester, due to hormonal changes and decreased gallbladder motility.
• Certain Medications - Oestrogen replacement drugs or birth control pills may increase the risk of gallstone formation and cholecystitis.
• Obesity - Individuals who are overweight or obese are at a higher risk of having cholecystitis because of increased cholesterol levels and bile secretion.
• Rapid Weight Loss - Sudden, significant weight loss may affect gallbladder function, including bile production and flow, and result in cholecystitis.
• Underlying Health Conditions - Cholecystitis may occur in patients with preexisting conditions such as diabetes, liver cirrhosis, Crohn's disease, and hyperlipidaemia.

How Is Cholecystitis Diagnosed?

For a detailed cholecystitis diagnosis, the doctor will ask about the patient’s medical history and symptoms. The next step is a physical examination, where the doctor palpates the upper right abdomen to check if the patient suddenly stops breathing when pressure is applied.

If cholecystitis is suspected, several diagnostic tests and procedures may be ordered to confirm the presence of stones or signs of inflammation in the gallbladder and the bile ducts. These include:

• Blood Test - This test can reveal signs of an infected or damaged gallbladder, such as elevated white blood cell count, C-reactive protein (CRP), bilirubin, and liver enzymes.
• Ultrasound - An ultrasound assesses the gallbladder’s size and wall thickness, the presence of deformities or stones, and the condition of the bile ducts.
• CT or MRI Scan - These tests provide detailed images of the biliary system. They are usually performed for further evaluation, especially for complex or abnormal cases.
• Endoscopic Retrograde Cholangiopancreatography (ERCP) - An endoscope is inserted through the throat and a dye is injected to visualise the biliary system and detect blockages on X-rays.
• Gallbladder Radionuclide Scan - During the procedure, a safe radioactive dye is injected and travels into the bile ducts to identify any blockages, like gallstones.

What Are the Treatment Options for Cholecystitis?

Treatment for cholecystitis typically requires a hospital stay to control inflammation in the gallbladder. Depending on the severity and stage of the disease, cholecystitis can be treated with:

• Medications - For mild cases, doctors often prescribe non-surgical treatments, such as intravenous (IV) fluids to prevent dehydration, antibiotics to manage infections, and pain relievers to ease discomfort until the inflammation in the gallbladder subsides.
• Surgery - Since cholecystitis may recur, doctors recommend that patients have their gallbladder surgically removed.
  • Laparoscopic Cholecystectomy - A surgeon makes small incisions in the patient’s abdomen and inserts a laparoscope and specialised tools to remove the gallbladder.
  • Open Cholecystectomy - A surgeon makes a single, long incision in the abdomen to extract the gallbladder; this may be necessary for severe cholecystitis or if previous surgeries have had complications.

When surgery is not viable, doctors may opt for alternative procedures to alleviate fluid buildup in the gallbladder, including:

• Percutaneous Cholecystostomy - A doctor installs a small drainage tube through the skin on the abdomen or passes a scope through the mouth to drain bile and alleviate gallbladder inflammation.
• Endoscopic Retrograde Cholangiopancreatography (ERCP) - A doctor uses an endoscope and X-rays to identify gallstones, which can then be removed using small surgical tools.

What Can Happen to Cholecystitis if Left Untreated?

Without timely treatment of cholecystitis, severe complications may develop, including:

• Emphysematous Cholecystitis - A rare but life-threatening variant of acute cholecystitis, caused by gas-forming organisms.
• Cholestasis - An accumulation of bile in the liver and bloodstream, causing jaundice and other complications.
• Burst Gallbladder - A rupture or perforation of the gallbladder that can lead to an infection in the abdominal cavity (peritonitis).
• Gallbladder Distention - A stretched and swollen gallbladder that causes intensifying pain and increases the risk of rupture.
• Pancreatitis - An inflammation of the pancreas that can lead to severe pain and digestive problems.
• Gangrenous Cholecystitis - Increased pressure caused by inflammation can obstruct blood flow to the gallbladder, leading to tissue death.
• Gallbladder Cancer - A rare complication for patients with recurrent gallbladder inflammation.

Meet Our Cholecystitis Specialist

Dr Wong Jen San

Consultant Hepatobiliary & Pancreatic SurgeonMBChB (UK), MMed (S’pore), Msc (S’pore), FRCS (Edin), FAMS

Dr Wong Jen San specialises in the diagnosis and treatment of cholecystitis and other gallbladder conditions, particularly through minimally invasive laparoscopic surgery. He received his medical degree from the University of Leicester and obtained fellowships at renowned medical institutions in the United Kingdom and Japan. Through his years of expertise, he has developed the skills to manage various cases, from mild gallstones to complex gallbladder inflammation.