Cholecystitis – Diagnosis and Treatment
Diagnosis
Detecting cholecystitis or acute cholecystitis usually starts with a physical exam. Key symptoms may include right upper abdominal pain, fever, nausea, vomiting, and tenderness.
The healthcare provider often checks for Murphy’s sign, where pain worsens when pressing on the upper right abdomen during a deep breath.
Diagnostic Steps:
| Test | Main Purpose |
|---|---|
| Blood tests | Check for infection/inflammation |
| Ultrasound | Show gallbladder/duct issues |
| HIDA scan | Track bile movement/blockages |
| Liver tests | Check liver and bile health |
- Blood Tests: These look for signs like raised white blood cells, which may signal infection (leukocytosis) or inflammation.
- Imaging: Clinicians commonly use abdominal ultrasonography to view the gallbladder for inflammation, gallstones, or cystic duct blockage. Ultrasound can also help find chronic cholecystitis, acalculous cholecystitis, and biliary colic.
- HIDA Scan: This test uses a small amount of radioactive dye to track how bile moves from the liver through the bile ducts. It can show if bile flow is blocked.
- Other Tests: Clinicians may use CT scans, endoscopic ultrasound, liver function tests, or cholescintigraphy to rule out other problems like jaundice or bacterial infections.
Treatment
Surgical Removal of the Gallbladder
Surgeons often remove the gallbladder for many people with cholecystitis. This surgical procedure is called cholecystectomy. Surgeons usually perform this using a minimally invasive approach called laparoscopic cholecystectomy.
In this method, the surgeon makes several small cuts in the abdomen and uses special instruments to remove the gallbladder. This approach usually leads to less pain and a quicker recovery compared to open surgery.
Surgeons sometimes perform open cholecystectomy if laparoscopic surgery is not possible. In this case, they make a larger cut in the stomach area to reach and remove the gallbladder.
The choice between laparoscopic and open surgery depends on your condition and health risks. Most surgeries for gallbladder problems occur during a hospital stay if the patient is stable and can tolerate surgery.
Removing the gallbladder does not stop a person from digesting food. Instead of storing bile in the gallbladder, the body lets bile flow straight from the liver into the small intestine.
This change usually does not cause major problems with digestion, but some people may notice mild changes in their digestive habits.
Other surgical or nonsurgical treatments include:
| Treatment Type | Purpose |
|---|---|
| Intravenous fluids | Prevent dehydration |
| Antibiotics | Treat or prevent infection |
| Pain medications | Manage pain and discomfort |
| ERCP (endoscopic retrograde cholangiopancreatography) | Remove bile duct stones |
| Cholecystostomy (gallbladder drainage) | Relieve infection when surgery is too risky |
If a person cannot have surgery right away, doctors may drain the gallbladder with a tube called a cholecystostomy. This can lower infection and inflammation until the person is healthy enough for surgery.
Doctors may also prescribe medications to dissolve certain types of gallstones, such as ursodeoxycholic acid. However, this is less common and often takes a long time to work.
Most people with cholecystitis will eventually need surgery to stop the condition from coming back.
Getting Ready for Your Visit
Steps You Can Take Before Your Visit
Preparation can help improve the visit and make sure all key concerns are discussed. Here are steps to take:
- Ask About Appointment Rules: Some visits need special steps, such as not eating or avoiding certain foods. Patients should confirm if they need to be fasting or follow any other instructions.
- Write Down All Symptoms: List every problem. This includes pain in the upper right belly, nausea, yellow skin, or changes in stool—these could point toward issues with the gallbladder, bile, or gallstones.
- Note Important Health Facts: Include any history of gallstones, diabetes, obesity, or a diet high in fat and cholesterol. Mention recent stress or major life changes too, since these can affect digestion.
- List All Medications and Supplements: People should write down everything they are taking, including prescription drugs, over-the-counter medications, vitamins, and herbal supplements, along with dosages.
- Bring Support: Having a friend or family member can help remember details and ask questions you may not think of.
- Prepare Your Questions: Write down any questions for the healthcare provider. Topics might include the reason for symptoms, risk factors, possible treatments, need for surgery, recovery time, and if a specialist is needed.
Below is an example of questions to ask:
| Suggested Questions |
|---|
| Is gallbladder inflammation causing my symptoms? |
| What can raise my risk for gallstones? |
| What tests will I need, like ultrasound? |
| Will I have to have my gallbladder removed? |
| Are there non-surgical options? |
| How does diabetes or weight impact my condition? |
| What is the recovery process after surgery? |
| Should I change my diet or activity level? |
What Your Healthcare Provider May Ask
During the appointment, doctors ask questions to learn more about symptoms and possible causes. Patients should be ready to answer clearly and honestly. Typical questions include:
- When did pain or other symptoms begin?
- Has this pain happened before, and how often does it return?
- Are the symptoms steady, or do they come and go?
- How severe is the pain or discomfort?
- Does anything make the pain feel better or worse, such as eating fatty foods?
- Is there a family history of gallbladder or bile duct issues, high cholesterol, or diabetes mellitus?
- Have you noticed jaundice, fever, or vomiting?
