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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Chronic cholecystitis

Cholecystitis - chronic

Last reviewed: January 22, 2013.

Chronic cholecystitis is swelling and irritation of the gallbladder that continues over time.

The gallbladder is a sac located under the liver. It stores bile that is made in the liver. Bile helps the intestines digest fats.

Causes

Most of the time, chronic cholecystitis is caused by repeated attacks of acute (sudden) cholecystitis. Most of these attacks are caused by gallstones in the gallbladder.

These attacks cause the walls of the gallbladder to thicken. The gallbladder begins to shrink. Over time, the gallbladder is less able to concentrate, store, and release bile.

The disease occurs more often in women than in men. It is more common after age 40.

Symptoms

For symptoms of acute cholecystitis, see: Acute cholecystitis.

Acute cholecystitis is a painful condition that leads to chronic cholecystitis. It is not clear whether chronic cholecystitis causes any symptoms.

Exams and Tests

Your health care provider may order the following blood tests:

Tests that reveal gallstones or inflammation in the gallbladder include:

Treatment

Surgery is the most common treatment. Surgery to remove the gallbladder is called cholecystectomy.

  • Laparoscopic cholecystectomy is most often done. This surgery uses smaller surgical cuts, which result in a faster recovery. Patients are often sent home from the hospital on the same day as surgery, or the next morning.
  • Open cholecystectomy requires a larger cut in the upper-right part of the abdomen.

In patients who are too ill to have surgery because of other diseases or conditions, the gallstones may be dissolved with medication taken by mouth. However, this may take 2 years or longer to work. The stones may return after treatment.

Outlook (Prognosis)

Cholecystectomy is a common procedure with a low risk.

Possible Complications

When to Contact a Medical Professional

Call your health care provider if you develop symptoms of cholecystitis.

Prevention

The condition is not always preventable. Eating less fatty foods may relieve symptoms in people. However, the benefit of a low-fat diet has not been proven.

References

  1. Wang DQH, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 65.

Review Date: 1/22/2013.

Reviewed by: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

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Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitisEarly versus delayed laparoscopic cholecystectomy for people with acute cholecystitis
    The liver produces bile which has many functions including elimination of waste processed by the liver and digestion of fat. The bile is temporarily stored in the gallbladder (an organ situated underneath the liver) before it reaches the small bowel. Concretions in the gallbladder are called gallstones. Gallstones are present in about 10% to 15% of the adult western population. Between 1% and 4% become symptomatic in a year. The symptoms include pain related to the gallbladder (biliary colic), inflammation of the gallbladder (cholecystitis), obstruction to the flow of bile from the liver and gallbladder into the small bowel resulting in jaundice (yellowish discolourisation of the body usually most prominently noticed in the white of the eye, which turns yellow), bile infection (cholangitis), and inflammation of the pancreas, an organ which secretes digestive juices and harbours the insulin secreting cells which maintain blood sugar level (pancreatitis). Removal of the gallbladder (cholecystectomy) is currently considered the best treatment option for people with symptomatic gallstones. This is generally performed by key‐hole surgery (laparoscopic cholecystectomy). Cholecystitis (inflammation) of the gallbladder is one of the indications for laparoscopic cholecystectomy. Cholecystitis can occur suddenly, with symptoms such as fever along with intense pain in the right upper tummy. This is called acute cholecystitis. In comparison, chronic cholecystitis is a smouldering inflammation of the gallbladder which presents with less intense pain in the right upper tummy. For many years, surgeons have preferred to perform laparoscopic cholecystectomy once the inflammation settles down completely (which usually takes about six weeks) because of the fear of higher complication rates including injury to the bile duct (a tube through which the bile flows from the gallbladder to the small bowel). Injury to the bile duct is a life‐threatening condition which requires urgent corrective operation in most instances. In spite of the corrective surgery, people have poor quality of life several years after the operation due to repeated instances of bile infection caused by obstruction to the flow of bile into the small bowel. Another reason for the surgeons' preference for delaying the operation is to avoid an open operation, as there has been a perception that early operation increases the risk of an open operation. However, delaying the surgery exposes the people to the risk of complications related to gallstones. The review authors set out to determine whether it is preferable to perform early laparoscopic cholecystectomy (within seven days of people presenting to doctors with symptoms) or delayed laparoscopic cholecystectomy (more than six weeks after the initial admission). A systematic search of medical literature was performed in order to identify studies which provided information on the above question. The authors obtained information from randomised trials only since such types of trials provide the best information if conducted well. Two authors independently identified the trials and collected the information.
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Figures

  • Cholecystitis, CT scan.
    Cholecystitis, cholangiogram.
    Cholecystolithiasis.
    Gallstones, cholangiogram.

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