Acute and chronic cholecystitis: what they are, symptoms and treatment

Cholecystitis is inflammation of the gallbladder, a small pouch that is in contact with the liver, and that stores bile, a very important fluid for the digestion of fats. This inflammation can be acute, being called acute cholecystitis, with intense and rapidly worsening symptoms, or chronic, with milder symptoms that last for weeks to months.

A cholecystitis causes signs and symptoms such as colic abdominal pain, nausea, vomiting, fever and tenderness on the abdomen. Pain for more than 6 hours helps to differentiate between acute cholecystitis and chronic cholelithiasis pain.

Acute gallbladder inflammation can happen through 2 mechanisms:

  • Lithiasic or calculous cholecystitis : is the main cause of cholecystitis and is more frequent in middle-aged women. It happens when a stone, also called a stone, causes obstruction of the duct that empties the bile. Thus, bile accumulates in the gallbladder and makes it distended and inflamed. Understand what causes the gallbladder stone ;
  • Alitiásic cholecystitis : it is more rare and causes inflammation of the gallbladder without the presence of stones. The symptoms are similar to those of lithiasic cholecystitis, but the treatment is more difficult and with a worse chance of cure, as it usually happens in seriously ill people.

In any case, cholecystitis should be treated as soon as possible, and one should not wait much longer than 6 hours after the onset of symptoms, to avoid more serious complications such as rupture of the gallbladder or generalized infection.

Main symptoms

The most characteristic symptom of cholecystitis is abdominal pain, however, other symptoms may vary if it is an acute or chronic illness.

1. Acute cholecystitis

In most cases, the signs and symptoms of cholecystitis include:

  • Cramping pain in the upper right part of the abdomen, lasting more than 6 hours. This pain can also start above the navel and then move to the upper right;
  • Abdominal pain radiating to the right shoulder or back;
  • Sensitivity in the abdomen during palpation on medical examination;
  • Nausea and vomiting, with loss of appetite;
  • Fever, below 39ºC;
  • Appearance of general malaise;
  • Fast heart rate;
  • Yellow skin and eyes in some cases.

In addition to these signs, the doctor also looks for Murphy’s sign, which is very common in cholecystitis and which consists of asking the person to inhale deeply, while pressing the abdomen on the upper right. The signal is considered positive and, therefore, indicative of cholecystitis, when the person holds their breath, failing to continue to inhale.

The symptoms indicated usually appear about 1 hour or a little more after eating fatty foods, as bile is used by the body to help digest fats and absorb nutrients.

However, in patients over the age of 60 or more debilitated, the symptoms may be different. In such cases, it is important to be aware of other signs such as mental confusion, fever and a colder, bluer skin. In these cases, you should go to the hospital quickly.

2. Chronic cholecystitis

Chronic cholecystitis is a long-lasting, drawn-out inflammation. It is caused by a process similar to that of acute cholecystitis, and may or may not be associated with the presence of stone. 

Symptoms usually appear after eating high-fat foods and at the end of the day, similar to those of acute cholecystitis, but milder:

  • Pain in the upper right part of the abdomen, radiating to the right shoulder or back;
  • More severe pain crises, which improve after a few hours, biliary colic;
  • Sensitivity in the abdomen during palpation on medical examination;
  • Nausea, vomiting, loss of appetite, bloated feeling and increased gas;
  • Feeling of discomfort;
  • Yellow skin and eyes in some cases.

Chronic cholecystitis appears to be caused by small episodes of inflammation of the gallbladder, which happen several times, over time. As a consequence of these repeated crises, the gallbladder may undergo changes, becoming smaller and with thicker walls. It can also end up developing complications, such as calcification of its walls, called the porcelain vesicle, the formation of fistulas, pancreatitis or even the development of cancer.

How to confirm the diagnosis

When symptoms suggestive of cholecystitis appear, it is recommended to consult a general practitioner or gastroenterologist to analyze the case and perform diagnostic tests, such as blood tests, ultrasound or cholecintilography.

Cholecintilography is generally used when the ultrasound result is not clear enough to assess whether the gallbladder is thickened or inflamed, or if it has problems filling it.

What are the causes

In most cases, cholecystitis is caused by gallstones, which cause the flow of bile to be obstructed in a channel called the cystic duct, which allows bile to escape from the gallbladder. Most cases also occur associated with a gallstone condition, which may or may not have symptoms, with about ¼ of people with stones developing acute cholecystitis at some point.

In some cases, the obstruction is not due to a stone, but to a lump, a tumor, the presence of parasites or even after surgery on the bile ducts. 

In the cases of alitiásic cholecystitis, inflammation in the gallbladder occurs due to causes that are still not well understood, but the elderly people, who are critically ill, who have undergone complicated surgery or diabetics, for example, are at risk.

How the treatment is done

Treatment for cholecystitis is usually started with admission to the hospital to help control inflammation and relieve pain, and then gall bladder removal surgery is performed. It is generally recommended that the gallbladder be operated on within the first 3 days of the onset of acute inflammation.

Thus, treatment may include:

  • Fasting : as the gallbladder is used for digestion, the doctor may recommend stopping the intake of food and water for some time to relieve pressure on the gallbladder and improve symptoms;
  • Fluids directly in the vein : due to the restriction to eat or drink, it is necessary to maintain the hydration of the organism with saline directly in the vein;
  • Antibiotics : in more than half of the cases, the vesicle becomes infected within 48 hours after the onset of cholecystitis, as its distension facilitates the proliferation of bacteria inside;
  • Analgesics : can be used until the pain is relieved and the inflammation of the gall bladder is reduced;
  • Surgery to remove the gallbladder : laparoscopic cholecystectomy is the main form of surgery to treat cholecystitis. This method allows for faster recovery as it is less aggressive to the body. Understand how gall bladder surgery is performed and recovery .

In cases where cholecystitis is very severe and the patient is unable to undergo surgery immediately, a gallbladder drain is performed, which helps to remove pus from the gallbladder and decrease inflammation, thus opening the canal. obstructed. At the same time, antibiotics are administered to prevent the gallbladder from becoming infected. After the condition is more stable, surgery to remove the gallbladder can be done. 

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