Overview

Do you have intense pain in your belly and would like to know a possible cause? Or are you someone interested in learning more about the pathology of gallbladders? In this article, we will explore the condition known as cholecystitis.

So, what is this condition? It is an inflammation of the gallbladder. This inflammation can be either acute (sudden onset) or chronic (long-term). The gallbladder is a small organ found below the liver that stores bile produced by the liver. This bile serves multiple purposes:

• Digestion of fat
• Absorption of fat and fat-soluble vitamins
• Removal of bilirubin and excess cholesterol
• Neutralisation of the acidic pH from the stomach
• Protection against bacteria ingested in food^1,2

Usually, this bile drains into the small intestine, but a blockage or build-up can cause inflammation of the gallbladder.¹ Cholecystitis can lead to other complications if left untreated, for example:

• Infection and pus build-up
• Gangrene, or tissue death in the gallbladder, which can lead to a serious, life-threatening infection throughout the body
• Bile duct injury, which can lead to issues in the liver
• Infection and inflammation in the pancreas (also known as pancreatitis)
• Infection or inflammation in the lining of the belly (also known as peritonitis)^1,3

As mentioned previously, cholecystitis can be either acute or chronic. In the chronic form, it may not present any symptoms; however, there is damage to the gallbladder walls, which leads to them becoming scarred and thickened. Over time, the gallbladder becomes smaller, stores and releases less bile, and will eventually require surgical removal.¹

In acute cholecystitis, some symptoms include:

• Fever
• Nausea and vomiting
• Sweating
• Loss of appetite
• Jaundice, or yellowing of the skin and the whites of the eyes
• Bulging or bloating of the belly
• Severe stomach pain in the upper right quadrant of the belly
• Pain that spreads to the back and below the right shoulder blade^1,4

It is recommended to see a GP if you experience these symptoms, so the case can be diagnosed appropriately. The healthcare provider will perform several tests to confirm the diagnosis, including Murphy’s sign, in which the GP asks you to breathe in deeply while pressing on your belly just below the ribcage, where the gallbladder moves downward as you breathe in. If cholecystitis is present, there will be sudden pain as the gallbladder reaches the GP’s hand. Once this is confirmed, you may be referred for further tests, such as:⁴

• Complete blood count, to assess for signs of infection
• Liver function tests, to check the functionality and health of the liver
• Imaging tests, such as ultrasound, X-ray, or CT scan¹

Once cholecystitis is confirmed, it can be treated in several ways:

• Antibiotics, to fight off infection
• Supportive care, such as fluid hydration and pain management with painkillers
• Surgery to remove the gallbladder (cholecystectomy); gallbladders are not essential for a healthy life, so this surgery is common, and patients can lead a normal life afterwards
• A low-fat diet
• Medicine to prevent gallbladder stones¹

It is important to understand the causes and risk factors of gallbladder inflammation in order to prevent complications and avoid unnecessary pain.

Causes of cholecystitis

Calculous cholecystitis (gallstones or cholelithiasis)

This is the most common cause of cholecystitis, accounting for about 95% of cases. Gallstones develop through an imbalance in the chemical composition of bile inside the gallbladder. Once these stones form, they can block the cystic duct, leading to increased amounts of bile in the gallbladder and increased pressure inside it. This pressure can lead to inflammation of the gallbladder and make it more susceptible to bacterial infection. There are two types of gallstones:

• Cholesterol stones: the most common form, not related to cholesterol levels in the blood
• Pigment or bilirubin stones: caused by the destruction of red blood cells and an increased amount of bilirubin in the bile^4,5,6

Bile duct obstruction

Obstruction in the bile duct can lead to inflammation of the gallbladder; this can be due to gallstones or other causes, such as strictures. Strictures are scars that narrow the ducts after surgery, inflammation, or infection.⁷ Sometimes, tumours and cancers can cause blockages and lead to cholecystitis.⁷

Infection

Infections can occur after bile obstruction, which can be life-threatening. These infections occur secondary to the blockage regardless of origin and require treatment. However, there have been reports of cholecystitis caused by infectious agents, such as the Zika virus, Leptospira, and others.^8,9

Acalculous cholecystitis

Acalculous cholecystitis (also known as acute acalculous cholecystitis, or AAC) is an inflammation of the gallbladder that is not linked to gallstones. It is less common than calculous cholecystitis, making up around 5–10% of acute cholecystitis cases. This form of cholecystitis can result from a range of causes, including surgery, injury, or sepsis. It is more common in critically ill or immunocompromised people, as they are at greater risk.⁹

Tumours

In some cases, tumours, such as pancreatic or liver tumours, can block bile drainage from the gallbladder, which in turn can lead to cholecystitis.¹

Vascular issues

Reduced blood flow to the gallbladder can affect its function, which can in turn cause damage and inflammation. This can occur in certain conditions, such as diabetes.¹

Risk factors for cholecystitis

There are multiple risk factors that can increase the odds of cholecystitis, such as:

Sex

Cholecystitis can be affected by hormones, and hence people assigned female at birth (AFAB) are at higher risk of this condition. To elaborate, individuals who are AFAB tend to have higher oestrogen levels, which increases cholesterol secretion in the bile and, in turn, increases the risk of gallstone formation. This increased risk also applies to hormonal changes caused by birth control pills or pregnancy.^10,11

Age

Age has been identified as a risk factor for developing gallstones.¹² People over the age of 40 have a higher risk of developing gallstones, with the risk increasing further with age.^12,13

Ethnicity

Ethnicity has been linked to cholecystitis. For example, Native Americans have higher rates of gallstones due to a genetic predisposition toward secreting high amounts of cholesterol into the bile, which can lead to gallstone formation.¹

Family history

Cholecystitis and gallstones appear to have a genetic link, with an individual’s risk of developing these conditions increasing if there is a family history.¹⁴

Diabetes

People with diabetes have higher levels of fatty acids, which increase the risk of gallstone formation. Additionally, they are more prone to infections, which can also contribute to gallstone formation.^14,15

Obesity and diet

Studies have shown that obesity has a significant effect on the formation of gallstones; obesity can lead to insulin resistance, which can lead to a range of metabolic disorders. This can affect cholesterol levels and increase the risk of gallstones.

Diet can also play a role in increasing the risk of gallstones. For example, eating foods that are high in fat and cholesterol can increase the risk of gallstones. It is advisable to follow a healthy, balanced diet that includes plenty of fresh fruit and vegetables.^12,16

Rapid weight loss

Rapid weight loss has been linked to an increased risk of gallstones. While losing weight and reducing cholesterol and saturated fat intake is beneficial for health, doing so rapidly can cause the liver to release more cholesterol into the bile and hinder the emptying of the gallbladder, which leads to the formation of gallstones.¹⁷

Long-term fasting

In some cases, long-term fasting can lead to decreased gallbladder movement, which leads to the bile becoming more concentrated with cholesterol. This can then lead to the formation of gallstones.¹

FAQs

Does eating affect cholecystitis?

Eating food high in fat and low in fibre can be a risk factor for cholecystitis. Therefore, it is advisable to follow a diet rich in fibre, such as fruit, vegetables, and other fibre sources like cereals and cereal bars.

What foods should you avoid if you have gallbladder stones?

Avoid eating highly processed foods and full-fat dairy products.

Summary

Cholecystitis refers to inflammation of the gallbladder. It can be a painful experience and may require intervention, such as surgery. The most common cause of gallbladder inflammation is gallstones, although other causes, such as infections and vascular issues, can also be responsible. Cholecystitis is more common in people assigned female at birth, in those over the age of 40, in people with a family history of the condition, and in those with certain lifestyle factors, such as obesity and a high-fat diet, which increase an individual’s risk.