Cholecystitis (from Greek "cholecyst" meaning "gallblader", and "itis" meaning "inflammation" is inflammation of the gallbladder.

Patient information

What is cholecystitis? The word seems so complex
"Cholecyst" is another word for gallbladder. And anything "-itis" is inflammation. So cholecystitis is inflammation of the gallbladder.

What's the gallbladder? Does it hold pee?
No, that's the bladder . But it does hold something. Bile ! So you can remember this because of the presence of the word " cyst", as in a bag holding the bile.

• Beginning w/ Sx of biliary colic, w/ RUQ abdominal pain, but these Sx become more severe and constant
• Systemic Sx (Nausea/vomiting, Fever) (75%)
• Abdominal pain
• R shoulder pain
• Gallbladder is almost always tender to palpation
• Size of gallbladder can be felt from outside the body (38%)
• Murphy's sign, which is pain w/ deep inspiration causing termination of breath when pressing on the RUQ of the abdomen
• Jaundice may occur, but is usually mild. If severe, can suggest another cause, e.g. choledocholithiasis
• Vague Sx, especially in Pt's w/ diabetes, chronic disease, or immunocompromised, that may not include fever or localized tenderness

Patient information

What should I expect if I have cholecystitis ?
Inflammation as always is going to be painful. But whereabouts - where is the gallbladder located? It's just below the liver, and the liver is found on the right hand side of your chest. Your tummy is just below your chest, so it's going to be at the upper right hand side of your tummy. Infective causes also wreak havoc throughout the body, so you might also have nausea, vomiting, and fever.

• Cholecystitis occurs mostly due to blockage of the cystic duct with gallstones
• This blockage causes a buildup of bile in the gallbladder, and increased pressure within the gallbladder → RUQ abdominal pain
• Concentrated bile, pressure, and sometimes secondary infection by intestinal microorganisms (predominantly E coli, Klebsiella, Enterobactera and Bacteroides) irritates and damages the gallbladder wall, causing inflammation/swelling of the gallbladder
• Inflammation/swelling of the gallbladder can reduce normal blood flow to areas of the gallbladder, causing cell death due to ischemia, and necrosis due to hypoxia

Patient information

Why exactly does the bile holder become inflammed? Does an evil bug attack it or something?
Sort of Because bile usually moves through the gallbladder, infective processes are usually not going to happen, much like how algae is not going to accumulate in a running river. So there's usually a blockage with something. The most common thing is a stone, what we call a "gallstone". So if there's a block, just like a rock in a river, the river isn't really going to flow. When that happens, we get accumulation of algae - or in this case, accumulation of things that can cause infection, usually bacteria. It's usually the cystic duct that gets blocked.

What's the cystic duct?
The duct that appears immediately after the gallbladder is the "cystic duct". The cystic duct and hepatic duct join together to form the "common bile duct". The common bile duct joints with the pancreatic duct to form the "ampulla of Vater", which empties out into the small intestine (specifically, the 2nd part of the duodenum).

Is there ALWAYS an infection...?
Nup ! Think about that rock blocking off a river. The thing is that the river continues to flow regardless of that rock. If it continues to flow, the river is going to overflow. But that's because a river HAS somewhere ot overflow... into land ! Remember we mentioned the "cystic duct" is immediately after the gallbladder. So if THAT becomes blocked... the gallbladder itself is going to swell up, and become inflammed !!!

How about if it's NOT the cystic duck that is where the stone is?
Duck ?? All of the "ducts" that we mentioned are known as the "biliary tree". Why? Because it's one of the "branches" (see what I did there !) where bile flows. And you're correct, stones can migrate and lodge itself in other locations. If it lodges itself in the "biliary tree" (other than at the cystic duct), it can cause "acute ascending cholangitis", which is an infection of the bile ducts. If it lodges itself in the "ampulla of Vater", it can obstruct the exocrine system of the pancreas, and cause "pancreatitis".

• Female gender
• Increasing age
• Pregnancy
• Oral contraceptives
• Obesity
• Diabetes mellitus
• Ethnicity (Native North American)
• Rapid weight loss

• Sx
• Increased WBC
• Abdominal U/S

• Uncomplicated cholecystitis has excellent prognosis
• >25% of Pt's require surgery or develop complications
• Delayed Dx of acute cholecystitis increases morbidity/mortality
• Can present as a single episode, but may recur on multiple occassions

• Most Pt's with gallstones will not go on to develop cholecystitis

• Ascending cholangitis (inflammation of the biliary tree, cf gallbladder)
• Pancreatitis (caused by blockage of the ampulla of Vater, cf the cystic duct)