From the Guidelines
Cholelithiasis and cholecystitis are distinct but related gallbladder conditions, with cholelithiasis referring to the presence of gallstones and cholecystitis referring to inflammation of the gallbladder, often caused by gallstones blocking the cystic duct. The main difference between the two conditions is that cholelithiasis can exist without symptoms, while cholecystitis typically presents with severe right upper quadrant pain, fever, nausea, vomiting, and tenderness.
Key Differences
- Cholelithiasis is the condition of having gallstones, which are hardened deposits of digestive fluid that can form when bile contains too much cholesterol, bilirubin, or not enough bile salts 1.
- Cholecystitis is active inflammation of the gallbladder, which represents a more serious clinical situation requiring prompt medical attention 2.
Treatment Approaches
- Asymptomatic cholelithiasis may require no treatment, while symptomatic cases might need elective cholecystectomy (gallbladder removal) 3.
- Acute cholecystitis requires more urgent intervention, including antibiotics, pain management, and often emergency cholecystectomy 4.
Recent Guidelines
- The 2020 World Society of Emergency Surgery guidelines recommend laparoscopic cholecystectomy as the preferred treatment for acute calculus cholecystitis, with open cholecystectomy as an alternative 2.
- The 2017 WSES guidelines for the management of intra-abdominal infections recommend early laparoscopic cholecystectomy for acute cholecystitis, with delayed cholecystectomy as an option for patients who are not fit for immediate surgery 4.
From the Research
Definition and Symptoms
- Cholelithiasis refers to a condition in which hardened deposits, known as gallstones, exist within the gallbladder 5.
- Cholecystitis is the inflammation of the gallbladder, which can be acute or chronic, and is often associated with gallstones 6, 7.
- Symptoms of cholecystitis include right upper quadrant pain, fever, and leukocytosis, while cholelithiasis may be asymptomatic or cause symptoms when the bile duct is blocked 5, 7.
Causes and Complications
- Cholelithiasis can lead to complications such as choledocholithiasis, where gallstones are present in the common bile duct, and cholangitis, an infection of the common bile duct 5, 7.
- Cholecystitis can also lead to serious complications, including gangrenous cholecystitis and gallstone pancreatitis 8, 7.
- The presence of gallstones in the gallbladder or common bile duct can increase the risk of developing cholecystitis or other complications 6, 9.
Treatment and Management
- Treatment options for cholelithiasis include surgery, laparoscopy, endoscopy, and percutaneous techniques, which can be used alone or in combination 5.
- Management of cholecystitis typically involves supportive care, antibiotics, and cholecystectomy, with the goal of reducing morbidity and mortality 8, 7.
- Antibiotic use in patients undergoing cholecystectomy for gallbladder disease is recommended in certain cases, such as acute cholecystitis, but not in low-risk patients undergoing elective laparoscopic cholecystectomy 8.