Cholecystitis

What are the different types of Cholecystitis?

The condition is broadly divided into four forms. Each has its own characteristics, severity and clinical implications, such as:

What causes Cholecystitis?

Although gallstones are the most common trigger, several other mechanisms can inflame the gallbladder. These processes are distinct and may occur independently or in combination.

This includes, but is not limited to:

• Gallstone obstruction – when a gallstone blocks the cystic duct, bile becomes trapped inside the gallbladder. This stagnant bile irritates the lining of the organ, allowing bacteria to grow and increasing internal pressure.
• Bacterial infection – bacteria from the intestine or bloodstream can enter the biliary system, causing infection-driven inflammation. This is more common in patients with diabetes or weakened immunity.
• Reduced blood flow to the gallbladder – serious illnesses, trauma or circulatory problems can reduce blood supply to the gallbladder. When the tissues do not receive enough oxygen, inflammation can occur even without gallstones.
• Bile sludge or thickened bile – sluggish bile flow or highly concentrated bile can lead to sludge formation, which may block the cystic duct and irritate the gallbladder wall.
• Underlying medical conditions – critical illnesses, prolonged fasting or receiving nutrition through an intravenous line can affect bile movement and increase the risk of cholecystitis.

What are the symptoms of Cholecystitis?

Cholecystitis usually presents with acute symptoms, although the severity can vary. The common symptoms include:

• Fever or chills
• Abdominal tenderness, especially when touched
• Loss of appetite
• Pain that radiates to the right shoulder or back
• Persistent nausea
• Sudden pain in the upper right abdomen, often worsening with movement or deep breaths
• Vomiting

Who is at risk of Cholecystitis?

Certain individuals have a higher likelihood of developing cholecystitis because of how their body processes bile, stores fat or responds to hormonal changes. While anyone can experience gallbladder inflammation, some patterns consistently increase the risk, such as:

• Age – the risk increases steadily with age as the gallbladder becomes less efficient over time. Adults above 40 years old are more prone to gallstone formation, which in turn raises the chance of developing cholecystitis.
• Gender – women experience cholecystitis more frequently than men. This is partly due to hormonal influences that affect bile composition and slow gallbladder emptying.
• Hormonal shifts – pregnancy, hormone replacement therapy and oral contraceptives can alter bile chemistry, increasing its cholesterol content. These shifts make gallstones more likely to form, which can trigger inflammation.
• Medical conditions – diabetes, liver disease, high triglyceride levels and certain infections can influence bile composition or reduce gallbladder motility. These factors create a higher tendency for inflammation to develop.
• Dietary habits – diets high in fat, refined carbohydrates or low in fibre can disrupt healthy bile flow and promote gallstone development. Irregular eating patterns, such as skipping meals, may also contribute to bile stasis.
• Obesity – higher body weight is closely linked to elevated cholesterol levels in bile. When bile becomes oversaturated, gallstones can form more easily, raising the risk of cholecystitis.
• Rapid weight loss – losing weight too quickly can cause the liver to release more cholesterol into bile. This sudden change creates an environment where the stones form rapidly, especially during aggressive dieting.

What are the risks and complications if treatment is delayed?

Untreated cholecystitis can progress from a painful but manageable condition to a medical emergency. When inflammation remains unresolved, the gallbladder can become severely damaged.

Some of the potential risks and complications of delaying treatment are:

• Gallbladder infection (empyema) – bacteria can multiply rapidly within trapped bile, leading to a pocket of pus inside the gallbladder. This can cause high fever, sepsis and severe illness.
• Gangrenous gallbladder – poor blood supply and ongoing inflammation can cause parts of the gallbladder wall to die. This is more common in older adults or those with diabetes and can be life-threatening if not treated promptly.
• Gallbladder perforation – a severely inflamed or gangrenous gallbladder can tear or burst, leaking bile or infected fluid into the abdomen. This leads to widespread infection and requires emergency surgery.
• Bile duct blockage – inflamed tissues or stones may obstruct the bile ducts, causing jaundice or cholangitis, a severe infection of the biliary system.
• Pancreatitis – if the blockage extends to the common channel shared with the pancreas, inflammation can spread and trigger pancreatitis.

Medications

• Pain relief and anti-inflammatory medications – these help ease discomfort during acute episodes. They reduce inflammation and make symptoms more manageable while you prepare for further treatment or surgery.
• Antibiotics – this is only given when infection is suspected or confirmed. They help control bacterial growth and prevent the infection from spreading, especially in cases of acute cholecystitis.
• Oral bile acid tablets (limited use) – these medications dissolve small cholesterol gallstones over several months. They are less commonly recommended because results are slow, stones may return and the treatment is suitable only for a small percentage of patients.

Surgical Treatments

• Laparoscopic cholecystectomy – a keyhole procedure where the gallbladder is removed through a few small incisions. This is the standard and most effective treatment for symptomatic gallstones. It offers faster recovery, less post-operative pain and minimal scarring. Most patients return to normal activities within a week, and the risk of recurrence is eliminated because the gallbladder is no longer present.
• Open cholecystectomy – this procedure is performed through a larger incision in the upper abdomen. This method is used only when laparoscopic surgery is not suitable, for example, in severe inflammation, complex anatomy, extensive scarring from previous surgery or when complications such as perforation are suspected. Recovery is longer, but it remains a safe and reliable option when needed.

Non-Surgical Procedures

• Endoscopic Retrograde Cholangiopancreatography (ERCP) – a specialised endoscopic procedure used to remove stones that are stuck in the bile duct. A flexible tube with a camera is gently passed through the mouth to reach the bile ducts. The trapped stones are removed without removing the gallbladder. ERCP is often combined with surgery or used as an urgent intervention when a stone causes blockage, infection or jaundice.

Supportive Care

• Hydration and rest – adequate fluid intake helps reduce inflammation and supports your body’s natural healing process. Rest allows the gallbladder to settle while medical treatment is underway.
• Dietary adjustments – a temporary low-fat diet may help prevent symptom flare-ups by reducing the gallbladder’s workload. This is often recommended while awaiting surgery or further investigations.