Gallbladder inflammation, or cholecystitis, is a painful condition usually caused by the obstruction of the cystic duct. Cholecystitis can be classified as acute or chronic, depending on the course of the disease. Symptoms include pain located in the right upper quadrant of the abdomen, vomiting, weakness, and fatigue. Some patients develop fever and chills. Treatment of this condition generally involves hospitalization, antibiotics, pain relievers, and surgical removal of the gallbladder.
There are various causes of gallbladder inflammation, but the most common cause is the obstruction of the cystic duct due to gallstones or choleliths. When the cystic duct is obstructed, stasis of bile occurs and infection may follow. This leads to release of inflammatory mediators, such as prostaglandins, and irritation of the gallbladder mucosa, resulting in gallbladder swelling and wall thickening. When the inflammation is not immediately addressed, the gallbladder may undergo necrosis and rupture, leading to irritation of nearby structures such as the pancreas, intestines, and diaphragm. This series of events leads to the typical symptoms.
Acute cholecystitis symptoms start with severe pain in the right upper part of the abdomen or in the area of the stomach, and may extend to the area under the right scapular or to the back. The pain is similar to the biliary colic due to gallstones, but is typically greater in severity and longer in duration. It is constant and can last from six hours to more than 12 hours. When the doctor tries to press on the patient’s affected area, the patient usually experiences a sharp pain, which is known in medical parlance as Murphy’s sign. Deep breathing usually aggravates the pain.
The pain of gallbladder inflammation is usually accompanied by a mild fever, decreased appetite, increased heart rate, increased sweating, nausea, and vomiting. Most of the time, a person with acute cholecystitis does not suffer from jaundice. Some people suffer from an acute attack that resolves within 24 hours, or after seven to ten days. For people who suffer from symptoms in a sudden manner and without resolution, immediate surgery may be required to prevent contamination of the other abdominal organs.
A form of acute inflammation of the gallbladder that is not associated with gallstones is called acute acalculous cholecystitis. Symptoms may not be prominent in this case because the underlying disease obscures the symptoms. Predisposing factors to this condition include sepsis, immunosuppression, trauma, burns, and diabetes.
Chronic gallbladder inflammation may occur after repeated instances of acute cholecystitis, but often has no precedent symptoms. Nonspecific chronic gallbladder inflammation symptoms include diffuse abdominal pain, frequent belching, nausea, and diarrhea. Surgical removal of the gallbladder is also the definitive treatment of chronic cholecystitis.
