Gall bladder inflammation (cholecystitis)

Gallbladder inflammation occurs when the gallbladder, which is located below the liver and measures approximately twelve by four centimetres, is inflamed. Normally, the gallbladder is responsible for storing bile produced by the liver.

Gallbladder inflammation is common in the general population, with women being affected slightly more often on average. Gallstones (cholelithiasis) are considered the cause in 90 percent of cases.

As already mentioned, stones in the gallbladder are the main trigger for gallbladder inflammation. This inflammation occurs when bacteria from the duodenum, where part of the bile duct (ductus choledochus) opens, migrate via the bile duct into the gallbladder and attach themselves to the stones there.

In some cases, cholecystitis develops without the presence of stones. In this case, it can be the result of a circulatory disorder and is more common in older people.

Characteristic symptoms of gallbladder inflammation are pain in the right upper abdomen, as well as fever. Occasionally, the enlarged gallbladder is palpable or visible.

Other symptoms include:

• yellowing of the skin (jaundice)
• Loss of appetite
• Nausea and vomiting

To diagnose an inflammation of the gallbladder, the attending physician palpates the patient's abdomen and takes a medical history. Normally, a blood sample is also taken, as altered blood values can be signs of inflammation in the biliary system. If the inflammation values (leucocytes, CRP), as well as certain liver values are elevated, one can assume an inflammation.

With the help of ultrasound (sonography), an enlarged gallbladder and the typical inflammatory thickening of the wall can be detected. Any stones that may be present can also be seen.

With the help of a so-called ERCP (endoscopic retrograde cholangiopancreatography), the bile duct, gallbladder and the excretory duct of the pancreas can be easily visualised.

If the patient suffers from acute gallbladder inflammation caused by gallstones, surgery is usually performed. If the operation is performed as early as possible, there is also the prospect of a better therapeutic outcome. During the operation, the entire gallbladder is usually removed (cholecystectomy).

In some cases, the gallbladder may be enlarged due to the inflammation. If this is the case, surgery by means of laparoscopy is not possible, which is why the surgeon must then operate conventionally with an incision through the abdominal wall. If the patient has a suppurating inflammation, antibiotics are also used.

If the ultrasound examination shows that the stone is located in the draining bile ducts, an attempt can be made to remove it using ERCP. Occasionally, stones can also be dissolved with the help of medication (systemic litholysis) or crushed by shock waves. The resulting fragments are excreted through the intestine.

Since the gallbladder is not a vital organ, it can be kept alive without any problems. Only an intolerance to fatty or strongly spiced foods can become noticeable. However, this reaction diminishes over the years.

Surgery on the gallbladder is an everyday operation and is generally well tolerated. However, if the patient suffers from a massive inflammation or there is a risk of perforation of the gallbladder, the course of the disease can be delayed.

One of the possible complications of cholecystitis is perforation. This can lead to inflammation of the peritoneum (peritonitis), which can be life-threatening. In addition, gallbladder obstruction, suppuration of the gallbladder, fluid retention (edema), and tissue death (necrosis) can occur.

The risks associated with surgery, in addition to the usual ones such as wound healing problems, bleeding and the formation of a blood clot (thrombosis), include the risk of a bile duct injury.