What are the causes, risk factors, preventive measures, signs and symptoms, and treatment options for Cholecystitis (inflammation of the gallbladder)?

From the Guidelines

Cholecystitis is inflammation of the gallbladder, typically caused by gallstones blocking the cystic duct.

Cause and Risk Factors:

Cholecystitis is usually caused by gallstones, but can also be caused by bile duct problems, tumors, or certain infections 1. Risk factors include a history of gallstones, obesity, female gender, age over 40, family history of gallstones, and certain medical conditions such as diabetes.

Preventive Measures:

Maintaining a healthy weight, eating a balanced diet, and avoiding fatty foods may help prevent gallstones 1. Regular exercise and a healthy lifestyle can also reduce the risk of developing gallstones.

Signs and Symptoms:

Symptoms of cholecystitis include severe abdominal pain, especially in the upper right quadrant, nausea and vomiting, fever, and tenderness in the abdomen 1. Other symptoms may include jaundice, dark urine, and pale stools.

Treatment:

Treatment for cholecystitis usually involves hospitalization and may include:

• Early laparoscopic cholecystectomy, which should be performed as soon as possible, but can be performed up to 10 days of onset of symptoms 1
• Antibiotics such as ceftriaxone or ciprofloxacin to treat infection
• Pain management with medications such as morphine or acetaminophen
• Fluid replacement and bowel rest
• Surgical removal of the gallbladder (cholecystectomy) may be necessary in severe cases or if complications develop
• ERCP (endoscopic retrograde cholangiopancreatography) may be performed to remove gallstones from the bile ducts
• In severe cases, treatment may involve more intensive interventions, such as percutaneous cholecystostomy, where a tube is inserted through the skin to drain the gallbladder 1
• Endoscopic ultrasound–guided gallbladder drainage (EUS-GBD) is also an option for high-risk surgical patients, with high rates of technical and clinical success and low rates of adverse events 1

It is essential to seek medical attention immediately if symptoms of cholecystitis occur, as delayed treatment can lead to serious complications. In elderly patients, laparoscopic approach should always be attempted at first, except in case of absolute anesthetic contraindications and septic shock 1.

From the Research

Causes and Risk Factors

• Acute cholecystitis is usually caused by gallstones obstructing the cystic duct 2, 3, 4
• Approximately 5% to 10% of patients with acute cholecystitis have acalculous cholecystitis, defined as acute inflammation of the gallbladder without gallstones, typically in the setting of severe critical illness 2
• Other contributing factors may be involved in the pathogenesis of acute cholecystitis, in addition to obstruction of the cystic duct 5

Preventive Measures

• No specific preventive measures are mentioned in the provided studies, but early treatment of gallstone disease may help prevent acute cholecystitis 2, 6

Signs and Symptoms

• Typical presentation of acute cholecystitis consists of acute right upper quadrant pain, fever, and nausea that may be associated with eating 2
• Physical examination findings of right upper quadrant tenderness 2
• Atypical presentations may occur, with negative Murphy's sign, no fever, and normal or mildly elevated laboratory results 5

Diagnostic Tests

• Ultrasonography of the right upper quadrant has a sensitivity of approximately 81% and a specificity of approximately 83% for the diagnosis of acute cholecystitis 2
• Hepatobiliary scintigraphy (a nuclear medicine study that includes the intravenous injection of a radiotracer excreted in the bile) is the gold standard diagnostic test when an ultrasound result does not provide a definitive diagnosis 2
• Abdominal computerized tomography (CT) scan and right upper quadrant (RUQ) abdominal ultrasound may also be used to diagnose acute cholecystitis 5
• Hepatobiliary iminodiacetic acid (HIDA) scan may be used to confirm the diagnosis of acute cholecystitis 5

Treatment Options

• Early laparoscopic cholecystectomy (performed within 1-3 days of diagnosis) is associated with improved patient outcomes, including fewer composite postoperative complications, a shorter length of hospital stay, and lower hospital costs 2, 6
• Percutaneous cholecystostomy tube placement is an effective therapy for patients with an exceptionally high perioperative risk, but is associated with higher rates of postprocedural complications compared with laparoscopic cholecystectomy 2
• Open cholecystectomy may be considered as an alternative to laparoscopic cholecystectomy, but the choice of approach depends on various factors such as patient history and surgeon preference 4
• Medical management, including fasting, intravenous fluid infusion, antimicrobial therapy, and possible administration of analgesics, may be used to stabilize the patient before surgery 6