CHOLECYSTITIS OR CHOLANGITIS

General Information

DEFINITION--Infection or inflammation of the gallbladder (cholecystitis) or the ducts (cholangitis) that drain bile from the gallbladder to the small intestine. May be confused with hepatitis, pancreatitis or duodenal ulcer.

BODY PARTS INVOLVED--Gallbladder (located under the liver); bile ducts in the liver, leading to the gallbladder.

SEX OR AGE MOST AFFECTED

• Both sexes, but more common in women.
• Adults; rarely in children or adolescents.

SIGNS & SYMPTOMS

• Cramping pain in the upper right of the abdomen. Pain may also occur in the chest (imitating a heart attack), in the upper back or the right shoulder. These symptoms frequently follow a meal rich in fats.
• Tenderness in the upper abdomen.
• Nausea and vomiting.
• Belching.
• Slight fever. If high fever and chills occur, a bacterial infection is present.
• Jaundice (yellow skin or eyes) (sometimes).
• Pale stools (sometimes).
• Skin itching (sometimes).

CAUSES--Inflammation or bacterial infection, which are usually caused by gallstone formation and blockage of bile ducts.

RISK INCREASES WITH

• Diet that is high in fat and low in fiber.
• Chronic or acute pancreatitis.
• Coronary-artery disease.
• Family history of gallbladder disease.
• Obesity.
• Oral contraceptives.
• Rapid weight loss.
• Diabetes or cirrhosis.
• Female, middle age (40 to 50); or female with previous gallstones who takes estrogens.

HOW TO PREVENT--Avoid risk factors.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and exam by a doctor.
• Laboratory blood studies.
• X-rays of the gallbladder.
• Ultrasonography (See Glossary) of the gallbladder and bile ducts.
• Radioisotope studies (See Glossary) of liver and pancreas.

APPROPRIATE HEALTH CARE

Specific treatment will depend on degree of severity, infection, size of stones, and your general health. > Nonsurgical treatment methods include: medication to dissolve the stones or extracorporeal shock wave lithotripsy that will shatter the stones.

• Surgical treatment is usually a cholecystectomy done by laparoscopic technique or an open surgical procedure (see Surgery section for both).

POSSIBLE COMPLICATIONS

• Gallbladder rupture and peritonitis, or abscess.
• Hepatitis or cancer.
• Choledocholithiasis (stones pass from gallbladder into common bile duct obstructing flow of bile).

PROBABLE OUTCOME--

• Symptoms of some mild attacks subside spontaneously in 1 to 4 days, if no complications develop.
• May require hospitalization and treatment.
• Recurrences are common. Attacks will cease with surgery to remove the gallbladder.

How To Treat

GENERAL MEASURES--

• Be sure you know and understand all your treatment options.
• See Resources for Additional Information.

MEDICATION--

• Don't medicate yourself with non-prescription pain relievers during an attack. These may mask symptoms of a bacterial infection--allowing it to worsen--and delay treatment.
• Your doctor may prescribe: Analgesics, including narcotics, to relieve pain. Ursodiol (brand name Actigall) to dissolve gallstones (will take about 2 years and works in 50% of patients). Antibiotics in acute cases.

ACTIVITY--Rest in bed until symptoms disappear or recovery from surgery is complete. While in bed, move your legs often to reduce the likelihood of deep-vein blood clotting.

DIET--Because of nausea and vomiting, intravenous fluids are usually necessary during attacks. Begin taking clear liquids or a soft diet as soon as you can tolerate solid foods.

Call Your Doctor If

• You have symptoms of cholecystitis or cholangitis; if accompanied by shortness of breath, sweating and nausea, call immediately!
• The following occurs during an attack: Fever. Jaundice (yellow skin or eyes). Recurrent vomiting. Intolerable pain.