Cholecystitis · CIL Genève

Definition of Cholecystitis

Cholecystitis is an inflammation of the gallbladder that leads to an accumulation of bile, causing an inflammatory reaction. This condition can manifest in an acute form, with sudden episodes, or become chronic if it persists. Cholecystitis requires medical management to prevent potential complications and preserve gallbladder function.

Epidemiology

In Switzerland, cholecystitis affects about 10 to 15% of adults, mainly due to gallstones. It is more common in women and the elderly. With high-fat dietary habits and an aging population, cases are gradually increasing.

Globally, cholecystitis is a common cause of acute abdominal pain. It affects about 10 to 20% of the adult population, with a higher prevalence in Europe, North America, and developed countries. Gallstone-related cholecystitis remains less common in Asia and Africa, where the incidence of this condition is lower.

Causes of Cholecystitis

The main causes of cholecystitis include:

Gallstones: stones block the cystic duct, preventing bile from flowing and causing inflammation.
Infections: bacterial or viral infections can cause inflammation of the gallbladder.
Tumors: certain tumors can block the flow of bile, leading to accumulation and inflammation.
Trauma or abdominal surgery: trauma or interventions can alter the gallbladder and increase the risk of cholecystitis.
Prolonged fasting: the absence of bile stimulation during prolonged fasting can promote bile stagnation and inflammation.
Vascular conditions: vascular disorders reducing blood flow to the gallbladder can also cause cholecystitis.

Risk Factors

The main risk factors for cholecystitis include:

Advanced age: the risk of cholecystitis increases with age.
Female gender: women are more likely to develop gallstones, increasing the risk of cholecystitis.
Obesity: excess weight promotes the formation of gallstones, the main cause of cholecystitis.
Pregnancy: hormonal changes increase the formation of gallstones in pregnant women.
High-fat diet: a diet high in fats and cholesterol promotes stone formation.
Family history: genetic predispositions can play a role in the development of gallstones.
Prolonged fasting or rapid weight loss: these conditions cause bile stagnation and promote stones.

Symptoms of Cholecystitis

Symptoms of cholecystitis include:

Severe abdominal pain: sudden and persistent pain in the upper right part of the abdomen, sometimes radiating to the right shoulder.
Fever: mild to moderate fever may accompany gallbladder inflammation.
Nausea and vomiting: often associated with pain, they may intensify after a fatty meal.
Abdominal tenderness: increased pain upon touching the gallbladder area.
Loss of appetite: a lack of appetite is common due to abdominal discomfort.
Jaundice: in severe cases, yellowing of the skin and eyes may occur if a stone blocks the main bile duct.

These symptoms require medical evaluation to confirm cholecystitis and establish appropriate treatment.

Radiological Imaging

Medical imaging to diagnose cholecystitis includes several techniques to identify signs of inflammation and underlying causes:

Abdominal ultrasound: the reference technique for visualizing the gallbladder, it detects gallstones, wall thickening, and gallbladder distension. It is non-invasive and quick.
CT scan: used to confirm cholecystitis or identify complications such as an abscess. The scan allows visualization of surrounding tissues and detection of advanced signs of inflammation.
Magnetic Resonance Imaging (MRI) with cholangiography: this technique (MRCP) visualizes the bile ducts and detects blockages or anomalies without requiring contrast agents.
Cholescintigraphy (HIDA scan): injects a radioactive tracer to evaluate bile flow. It confirms the diagnosis of acute cholecystitis, especially if other tests are inconclusive.

Each technique provides useful information to diagnose and assess the severity of cholecystitis.

Prevention of Cholecystitis

Prevention of cholecystitis involves measures to reduce the risk of gallstone formation and maintain gallbladder health:

Maintain a healthy weight: avoids excess cholesterol in bile and reduces the risk of stones.
Adopt a balanced diet: favor fibers, vegetables, and low-fat foods to limit stone formation.
Avoid drastic diets and rapid weight loss: losing weight too quickly can cause gallstones.
Engage in regular exercise: helps maintain a stable weight and promotes healthy digestion.
Limit saturated fats: animal fats and processed foods increase the risk of gallstones.
Consult in case of frequent digestive symptoms: monitor abdominal pain or digestive issues for early diagnosis.

These measures help prevent gallbladder inflammation and maintain digestive health.

Conclusion

Cholecystitis, inflammation of the gallbladder, often results from gallstones and requires prompt management to avoid complications. Accurate diagnosis, through medical imaging, allows confirmation of the disease and selection of the best treatment. Preventing cholecystitis involves a balanced diet, healthy weight management, and regular physical activity. By adopting these habits, one reduces the risk of stones and promotes gallbladder health.

Finally, if you have symptoms or concerns, consulting a general practitioner provides an accurate diagnosis and appropriate advice.

Source: UpToDate