cholecystitis

Cholecystitis is a medical condition marked by inflammation of the gallbladder, a small organ located beneath the liver that stores bile. Bile is essential for the digestion of fats. This inflammation is most often caused by gallstones that block the bile ducts, although infections and other conditions can also contribute. Cholecystitis can be acute, presenting suddenly and severely, or chronic, recurring over time.

If left untreated, cholecystitis can lead to severe complications such as gallbladder rupture, infection, or tissue death. Therefore, early diagnosis and timely medical intervention are crucial. With lifestyle changes, medication, and in some cases surgery, most individuals recover fully.

Cholecystitis refers to the inflammation of the gallbladder, typically caused by an obstruction of the cystic duct due to gallstones. The obstruction leads to the accumulation of bile, which in turn irritates the gallbladder walls, causing inflammation and infection.

There are two primary forms:

• Acute Cholecystitis: Sudden onset of inflammation, usually due to gallstones.
• Chronic Cholecystitis: Repeated episodes of inflammation which can lead to a shrunken, poorly functioning gallbladder.

The condition affects both men and women but is more common in females, especially those over the age of 40.

Global Prevalence

Cholecystitis is a common health issue worldwide, particularly in Western countries where high-fat diets contribute to gallstone formation. According to research:

• Gallstone disease affects 10–15% of the adult population in developed countries.
• Of those with gallstones, about 1–3% develop acute cholecystitis each year.

Prevalence in India

India sees a growing number of cholecystitis cases due to changing dietary habits and increasing obesity rates.

• Gallstone disease prevalence in India ranges from 4–10%, more common in the northern states.
• Women in North India, especially above 40 years, show higher rates of gallbladder-related diseases.
   

Cholecystitis is classified into several types depending on its cause and course:

• Calculous Cholecystitis: Most common type, caused by gallstones obstructing the bile ducts.
• Acalculous Cholecystitis: Occurs without gallstones, often in critically ill patients.
• Acute Cholecystitis: Sudden inflammation, typically painful and requiring immediate treatment.
• Chronic Cholecystitis: Repeated inflammation leading to gallbladder damage.

The primary cause is gallstones, but other factors can lead to inflammation of the gallbladder:

• Gallstones (Cholelithiasis): Block the cystic duct, preventing bile outflow.
• Bile Sludge: Thickened bile can obstruct the ducts.
• Infections: Viral or bacterial infections, especially in immunocompromised individuals.
• Tumours: Can block bile drainage and lead to inflammation.
• Trauma or Surgery: Especially abdominal surgeries can trigger inflammation.
• Fasting or Rapid Weight Loss: Can lead to bile stasis and gallstone formation.

Symptoms often come on suddenly and include:

• Sharp pain in the upper right or centre of the abdomen
• Pain that radiates to the right shoulder or back
• Fever and chills
• Nausea and vomiting
• Tenderness over the abdomen
• Bloating and indigestion
• Jaundice (in severe or chronic cases)

Diagnosis involves a combination of clinical evaluation, imaging, and laboratory tests:

• Physical Examination: Detects tenderness in the right upper quadrant.
• Blood Tests:
  
  • Elevated white blood cell count (WBC)
  • Liver function tests (LFTs)
  • C-reactive protein (CRP)
• Imaging Tests:
  
  • Ultrasound: First-line test to detect gallstones and gallbladder wall thickening.
  • CT Scan: Provides detailed images, especially for complications.
  • HIDA Scan: Assesses gallbladder function and bile flow.
• MRI/MRCP: Useful for visualising bile ducts and detecting obstructions.

Treatment depends on severity and type. Options include:

• Hospitalisation: For acute cases, immediate hospital care is required.
• Medications:
  
  • Antibiotics to treat or prevent infection. (Brand: Cefix 400mg Tablet)
  • Pain relievers and anti-inflammatory drugs (Brand: Voveran SR)
  • Antiemetics for nausea
• Fasting and IV Fluids: Allows the gallbladder to rest.
• Surgery:
  
  • Cholecystectomy: Surgical removal of the gallbladder, often laparoscopic.
• Urgent surgery may be needed for complications like perforation or gangrene.

While not a replacement for medical treatment, the following may support recovery:

• Dietary Adjustments: Low-fat, high-fibre diets reduce gallstone formation.
• Herbal Remedies: Milk thistle and turmeric are said to support liver and gallbladder health.
• Acupuncture: May help relieve pain and improve digestion.
• Yoga and Exercise: Improve overall digestive health and reduce obesity risk.

• Female gender, especially over 40
• Obesity and sedentary lifestyle
• Pregnancy or hormone replacement therapy
• Rapid weight loss
• Diabetes
• Family history of gallstones
• High-fat, low-fibre diet
   

Untreated cholecystitis can lead to serious health issues:

• Gallbladder Gangrene: Tissue death from prolonged inflammation
• Gallbladder Perforation: Can lead to peritonitis, a life-threatening condition
• Empyema: Pus accumulation in the gallbladder
• Cholangitis: Bile duct infection
• Sepsis: Systemic infection
• Pancreatitis: Inflammation of the pancreas if stones block pancreatic ducts

• Follow a gallbladder-friendly diet
• Avoid fried, spicy, and processed foods
• Eat small, frequent meals
• Stay hydrated
• Take medications as prescribed
• Attend regular medical follow-ups
• Incorporate mild physical activity daily

• Myth: Only obese people get cholecystitis
   Fact: Even thin individuals can develop gallstones or bile sludge.
• Myth: Surgery is always required
   Fact: Mild cases may resolve with antibiotics and supportive care.
• Myth: You can’t live without a gallbladder
   Fact: Many people live normal lives post-cholecystectomy.
• Myth: It’s caused by stress alone
   Fact: Stress can aggravate symptoms but isn't a primary cause.
   

Seek medical help immediately if you experience:

• Persistent abdominal pain lasting more than 5 hours
• Fever with chills
• Yellowing of eyes or skin (jaundice)
• Severe nausea and vomiting
• Pain after eating fatty foods

• What type of cholecystitis do I have?
• What are my treatment options?
• Will I need surgery?
• What are the risks of not treating it?
• What dietary changes should I make?
• Can I prevent future episodes?
• How long is the recovery period?

• Be Informed: Understand the disease to offer meaningful support
• Assist with Appointments: Help manage their medical schedule
• Prepare Appropriate Meals: Cook low-fat, gallbladder-friendly foods
• Provide Emotional Support: Listen and reassure them
• Encourage Lifestyle Changes: Promote healthy eating and exercise

Cholecystitis is a common yet serious condition affecting the gallbladder. With early diagnosis and appropriate treatment, it is highly manageable. Surgery is curative in most cases, and adopting a healthier lifestyle can help prevent recurrence. Being aware of symptoms, seeking timely medical care, and supporting affected individuals can make a significant difference in managing the disease.