What is Cholecystitis (Gallbladder Inflammation)?

Cholecystitis is the inflammation of the gallbladder, a small, pear-shaped digestive organ located in the upper right abdomen near the liver. Normally, bile aids in the digestion of food, particularly fats, and flows from the gallbladder to the small intestine. If the bile flow is blocked, it causes the gallbladder to swell, become inflamed, and result in pain. Bile duct obstruction is often caused bygallstones blocking the cystic duct, as well as by bile duct problems or tumors.

Cholecystitis is considered a serious health problem. Most patients with this condition require immediate treatment, as gallbladder inflammation can become a chronic condition if left untreated or if inflammation recurs. Furthermore, patients who do not receive complete treatment risk serious complications, such as a ruptured gallbladder, which can be life-threatening.

Symptoms of Cholecystitis

Cholecystitis is often caused by gallstones blocking the cystic duct, preventing bile from flowing into the small intestine. When too much bile is trapped inside the gallbladder, it increases pressure, leading to swelling and inflammation. Patients with cholecystitis typically exhibit the following symptoms:

• Pain in the upper right or central abdomen that often lasts for at least 30 minutes. Patients may experience sharp, cramping, or throbbing pain in this area.
• Abdominal pain that radiates to the back or under the right shoulder blade.
• Pain worsens when taking deep breaths.
• Abdominal pain occurs after eating, especially after consuming large quantities of food or meals high in fat.
• Tenderness in the right abdomen. Pressing on the area causes severe pain, and stool may be light-colored or "clay-colored."
• Bloating.
• High fever.
• Nausea and vomiting.
• Sweating.
• Loss of appetite.
• Yellowing of the skin and whites of the eyes (jaundice).

Patients experiencing severe acute abdominal pain lasting several hours, or accompanied by other symptoms such as jaundice or fever, should seek medical attention immediately, as cholecystitis requires urgent diagnosis and treatment to prevent further complications.

Causes of Cholecystitis

Cholecystitis is a health problem resulting from the inflammation of the gallbladder. The causes of this inflammation can be divided into gallstone-related cholecystitis and cholecystitis from other causes:

• Calculous Cholecystitis (Gallstone-Related)

  Gallstones are the most common cause, accounting for about 95% of cases. Gallstones form from the accumulation of cholesterol and salts in bile. The gallstone obstructs the cystic duct, preventing bile flow and causing it to accumulate inside the gallbladder, resulting in swelling and inflammation. Approximately 1 in 5 patients also have an associated bacterial infection.

• Acalculous Cholecystitis (Non-Gallstone Related)

  Other causes of gallbladder inflammation are less common but are often more severe than gallstone-related cholecystitis and result in more complications. These other causes include:

  • Complications from other health issues, such as diabetes or HIV infection, which can cause the gallbladder to swell.
  • Tumors in the liver or pancreas that obstruct the outflow of bile from the gallbladder, causing bile to stagnate and leading to inflammation.
  • Bloodstream infection (Sepsis).
  • Reduced blood flow to the gallbladder, often a complication of major surgery.
  • Injury sustained from an accident.

Diagnosis of Cholecystitis

To diagnose cholecystitis, patients will undergo tests. The doctor will inquire about symptoms, medical history, and perform a physical examination, checking the upper right abdomen for swelling or tenderness upon palpation. Additionally, the doctor may order other tests, including:

• Blood Tests The doctor will draw blood to check for pancreatic function, such as Amylase and Lipase enzymes,Complete Blood Count (CBC), and liver function. These tests also look for infection or signs of gallbladder-related health issues.
• Imaging Scans Imaging tests for the gallbladder include several types:
  • Ultrasound The doctor will perform an abdominal ultrasound to check for gallstones, thickening of the gallbladder wall, excessive bile volume, or other signs of cholecystitis. Abdominal ultrasound helps the doctor assess the size and shape of the patient's gallbladder and is a commonly used method for diagnosis.
  • Hepatobiliary Iminodiacetic Acid Scan (HIDA Scan) The doctor will examine the upper small intestine, gallbladder, and bile ducts. This scan helps visualize the production and flow of bile from the liver to the small intestine, including any blockage issues. The patient will be injected with a radioactive tracer, which mixes with bile-producing cells, allowing visualization of bile flow in the ducts.
  • Other Tests The doctor may also order other tests, such as X-ray, Computerized Tomography Scan (CT scan), or Magnetic Resonance Imaging (MRI). These examinations help the doctor further diagnose gallbladder problems.

Treatment of Cholecystitis

Patients diagnosed with cholecystitis require immediate treatment. The patient must be hospitalized, where the doctor will monitor the gallbladder inflammation and other symptoms. Treatment for cholecystitis involves initial management and surgery, as follows:

• Initial Management

  The doctor will instruct the patient to refrain from eating or drinking (Nil Per Os or NPO) to reduce the contraction of the gallbladder sphincter, reduce the release of substances, and help the gallbladder rest. However, the doctor will provide intravenous (IV) fluids to prevent dehydration and administer IV pain medication to relieve pain from the inflammation. Patients with a gallbladder infection will also receive antibiotics. Patients typically require initial treatment for several weeks, which may involve staying in the hospital or continuing recovery at home once the condition improves. This initial treatment may occasionally allow the obstructing gallstone to pass and prevents the inflammation from worsening.

• Surgery

  Patients with cholecystitis need immediate surgery if the inflammation recurs or if they experience other complications, including tissue death (Gangrene), gallbladder perforation, pancreatitis, bile duct obstruction, or cholangitis. In severe cases, a tube may be inserted through the abdomen into the gallbladder to drain the obstructed bile. The timing of gallbladder surgery varies based on the severity of the illness and the risk profile during and after the operation. Low-risk patients may undergo surgery within 48 hours while hospitalized, or after waiting for the inflammation to subside, which takes about 2–3 weeks. Surgical techniques for cholecystitis include laparoscopic surgery and open abdominal surgery:

  • Laparoscopic Surgery (Keyhole Surgery)

    This technique is the most commonly used for cholecystitis. The doctor makes several small incisions in the patient's abdomen. A small camera (laparoscope) is inserted through one incision to visualize the gallbladder and guide the surgery, and surgical instruments are inserted through the other incisions to remove the gallbladder.

  • Open Abdominal Surgery

    The doctor makes a large incision in the patient's abdomen to remove the gallbladder. However, this technique is not frequently used for routine cholecystectomy.

  Patients who have their gallbladder removed can generally lead normal daily lives without long-term effects from the surgery. However, patients may experience temporary side effects during the recovery period. Common side effects from gallbladder surgery include:

  • Swelling, bruising, and wound pain lasting about 2–3 days. Patients will receive pain medication to help alleviate symptoms.
  • Discomfort resulting from anesthesia or pain medication.
  • Abdominal and shoulder pain due to trapped gas in the abdomen. Patients should take pain medication to relieve abdominal discomfort.
  • Bloating, diarrhea, and gas, which may occur for about 2–3 weeks. Patients should consume high-fiber foods and take prescribed medication to reduce loose stools.

  Additionally, patients should have their sutures removed no later than 7–10 days after surgery if the doctor used non-dissolvable sutures. During the recovery period, patients can care for themselves as follows:

  • Eat normally, choosing nutritious and complete meals.
  • Engage in appropriate light exercise, such as walking. Avoid overexertion, and consult a doctor before returning to strenuous physical activity.
  • You should wait about 1 week before driving. Test whether you can fasten your seatbelt and drive safely without anxiety before attempting to drive in traffic.

Complications of Cholecystitis

Patients who receive delayed or no treatment for cholecystitis may experience several complications, which can be life-threatening:

• Gallbladder Infection

  Bile obstruction within the gallbladder leads to inflammation, which can cause the gallbladder to become infected, forming pus (Abscess), and potentially leading to Peritonitis(inflammation of the abdominal lining).

• Gallbladder Tissue Death (Gangrene)

  Patients who do not receive treatment may develop gangrene of the gallbladder tissue. This condition can lead to gallbladder perforation or rupture. Tissue death in the gallbladder causes a severe infection that can spread throughout the body.

• Gallbladder Perforation (Rupture)

  Patients with a gallbladder infection or severe enlargement are at risk of gallbladder perforation. A ruptured gallbladder can cause an internal abdominal infection or peritonitis, and lead to the formation of pus and abscesses.

• Pancreatitis

  Patients who do not receive treatment for cholecystitis may developpancreatitis as a complication.

• Gallbladder Cancer

  This complication is rare, occurring in about 1 in 10,000 people. Patients with a history of gallstones have a higher risk of developing gallbladder cancer. Symptoms may mimic other gallbladder problems, including abdominal pain, high fever (around 38°C or more), and jaundice. Patients with gallbladder cancer are typically treated with chemotherapy and radiation therapy.

Prevention of Cholecystitis

While cholecystitis cannot be fully prevented, preventing gallstones—the primary cause of the disease—can reduce the risk of developing cholecystitis. Risk reduction methods include:

• Lose Weight

  Overweight individuals have a higher risk of developing gallstones due to increased cholesterol levels in the bile, which leads to stone formation. Weight loss should be gradual, aiming for 0.5–1 kilogram per week. Avoid crash dieting (rapid weight loss), as this can affect body chemistry and also stimulate the formation of gallstones.

• Maintain a Healthy Weight

  Maintain a weight within the standard range (neither obese nor overly thin) by choosing a balanced diet and exercising appropriately. Reduce caloric intake to a suitable amount and engage in regular physical activity.

• Eat a Healthy Diet

  Choose foods high in fiber, such as vegetables, fruits, and various whole grains, as diets rich in fat and low in fiber increase the risk of gallstones.

• Avoid Alcohol

  Drinking less alcohol may help reduce the risk of gallstone formation.

Cholecystitis: What to Avoid Eating?

Foods that should be avoided by individuals with cholecystitis:

1. High-Fat Foods

   • Fat is a key trigger that forces the gallbladder to work harder, such as fatty meats, fried foods, processed meats (sausages, bacon), and oily snacks.
   • High fat intake can cause the gallbladder to contract more vigorously and result in abdominal pain.

2. Fried and Oily Foods

   • Foods fried in large amounts of oil, such as French fries, fried chicken, and various fried snacks, can exacerbate cholecystitis.
   • Choose cooking methods like baking, steaming, or boiling instead of frying to reduce fat content.

3. High-Fat Dairy Products

   • High-fat milk, butter, cheese, cream, and yogurt should be avoided, as these foods contain saturated fat that is difficult to digest, making the gallbladder work harder.
   • If necessary, choose low-fat or fat-free dairy alternatives.

4. Very Sweet Foods

   • Sweets, sugar, ice cream, cakes, and sugary drinks should be avoided, as sugar can stimulate fat production and increase the risk of gallstones.

5. Red Meat and Processed Meats

   • Beef, pork, and processed meat products are high in saturated fat and can place a heavier burden on the digestive system, potentially triggering cholecystitis or abdominal pain easily.

6. High-Sodium Foods

   • Processed foods with high salt content, such as canned goods, instant noodles, and salted snacks, not only increase blood pressure but also strain the digestive system and can exacerbate cholecystitis.

7. Alcoholic Beverages

   • Alcohol negatively affects the digestive system and can worsen gallbladder function, particularly in patients with existing liver problems. Alcohol consumption may worsen cholecystitis symptoms.

8. Caffeinated Beverages

   • Coffee, tea, or energy drinks containing caffeine may stimulate gallbladder contraction and increase abdominal pain. These drinks should be limited or avoided.

Additional Recommendations:

Patients should eat easily digestible foods such as vegetables, fresh fruits, whole grains, and lean protein from fish and chicken, prepared by baking or boiling to maintain gallbladder health. Meals should be divided into small, frequent portions throughout the day instead of large meals to prevent the gallbladder from being overworked in digesting fat.