Cholecystitis

Cholecystitis

What causes cholecystitis?

Cholecystitis happens when your gallbladder becomes inflamed, usually because something is blocking the flow of bile.

Your gallbladder is a small organ that stores bile, a fluid made by the liver to help digest fats. Normally, bile flows out of the gallbladder through a tube called the cystic duct and into the small intestine. However, sometimes small, hard pieces called gallstones form in the bile. If a gallstone gets stuck in the cystic duct, bile can't flow out and starts to build up in the gallbladder. This buildup increases pressure inside the gallbladder, causing it to become inflamed and sometimes infected.

In some cases, instead of gallstones, a thick mixture of bile, cholesterol, and other substances called biliary sludge can block the cystic duct, leading to the same problem.

There is also a less common and more serious type of cholecystitis, called acalculous cholecystitis, which happens without gallstones . This can occur due to severe illnesses, injuries, or infections that damage the gallbladder. It can be a complication from major surgery, serious injuries, burns, severe infections, or conditions that cause severe malnutrition and dehydration.

Other less common causes of cholecystitis include tumours blocking the bile ducts, problems with blood supply to the gallbladder (often seen in people with diabetes), or infections that prevent bile from draining properly.

causes of cholecystitis
Cholecystitis is most commonly caused by gallstones, which are hardened deposits of digestive fluid that can form in your gallbladder.

Who is at risk of cholecystitis in Singapore?

Certain groups of people in Singapore are more likely to develop cholecystitis compared to the rest. Here’s who are at risk:

  • Older adults: People over 50 are more likely to develop cholecystitis because gallstones become more common as we age.
  • Women: Women are generally more prone to cholecystitis due to hormonal factors. However, men who have gallstones are more likely to have severe cases.
  • Overweight individuals: Being overweight or obese increases the risk since higher cholesterol levels can lead to gallstones.
  • Pregnant women: Pregnancy can increase the risk due to hormonal changes and extra pressure on the gallbladder.
  • Hormone therapy users: People using hormone therapies like birth control pills or oestrogen replacement therapy are at higher risk of developing gallstones and cholecystitis.
  • Rapid weight changes: Quickly losing or gaining weight can disrupt the normal function of the gallbladder, increasing the risk of cholecystitis.
  • Family history: If you have a family history of gallbladder disease, you are more likely to develop it too.

Additionally, people with chronic conditions like diabetes, heart disease, or high blood pressure are at higher risk. These conditions can affect the blood supply to the gallbladder or cause other complications that make cholecystitis more likely.

How is cholecystitis diagnosed?

Diagnosing cholecystitis involves several steps to confirm the inflammation of the gallbladder. Here’s how it’s done:

  • Physical Exam and Medical History: Your doctor will start by examining you and asking about your symptoms and medical history. This helps them understand what might be going on.
  • Blood Tests: 
    • Complete Blood Count (CBC): Measures your white blood cells, which can be high if you have an infection.
    • Liver Function Tests: Check if your liver is working properly and can indicate problems with your gallbladder.
  • Imaging Tests: 
    • Ultrasound: The first and most common test. It uses sound waves to produce images and can show inflammation and gallstones.
    • CT Scan: Uses X-rays to create detailed images of your abdomen, showing more detail than a regular X-ray.
    • Hepatobiliary Iminodiacetic Acid (HIDA) Scan: Tracks the flow of bile from your liver to your small intestine using a small amount of radioactive dye. It helps find blockages in the bile ducts.
    • Magnetic Resonance Cholangiopancreatography (MRCP): A special type of MRI that makes detailed images of your liver, gallbladder, and bile ducts, showing gallstones and blockages.
    • Endoscopic Retrograde Cholangiopancreatography (ERCP): Involves using a flexible tube with a camera to look inside your bile ducts. It can also treat some problems by clearing blockages.
  • Other Tests: 
    • Stomach X-ray: Sometimes used to get a general look at your internal organs.
    • Percutaneous Transhepatic Cholangiography (PTC): Involves injecting dye into the bile ducts through a needle in your skin to see blockages on X-rays.

These steps help doctors confirm if you have cholecystitis, understand how severe it is, and decide on the best treatment.

Who is at risk of cholecystitis in Singapore?

Certain groups of people in Singapore are more likely to develop cholecystitis compared to the rest. Here’s who are at risk:

  • Older adults: People over 50 are more likely to develop cholecystitis because gallstones become more common as we age.
  • Women: Women are generally more prone to cholecystitis due to hormonal factors. However, men who have gallstones are more likely to have severe cases.
  • Overweight individuals: Being overweight or obese increases the risk since higher cholesterol levels can lead to gallstones.
  • Pregnant women: Pregnancy can increase the risk due to hormonal changes and extra pressure on the gallbladder.
  • Hormone therapy users: People using hormone therapies like birth control pills or oestrogen replacement therapy are at higher risk of developing gallstones and cholecystitis.
  • Rapid weight changes: Quickly losing or gaining weight can disrupt the normal function of the gallbladder, increasing the risk of cholecystitis.
  • Family history: If you have a family history of gallbladder disease, you are more likely to develop it too.

Additionally, people with chronic conditions like diabetes, heart disease, or high blood pressure are at higher risk. These conditions can affect the blood supply to the gallbladder or cause other complications that make cholecystitis more likely.

How is cholecystitis diagnosed?

Diagnosing cholecystitis involves several steps to confirm the inflammation of the gallbladder. Here’s how it’s done:

  • Physical Exam and Medical History: Your doctor will start by examining you and asking about your symptoms and medical history. This helps them understand what might be going on.
  • Blood Tests: 
    • Complete Blood Count (CBC): Measures your white blood cells, which can be high if you have an infection.
    • Liver Function Tests: Check if your liver is working properly and can indicate problems with your gallbladder.
  • Imaging Tests: 
    • Ultrasound: The first and most common test. It uses sound waves to produce images and can show inflammation and gallstones.
    • CT Scan: Uses X-rays to create detailed images of your abdomen, showing more detail than a regular X-ray.
    • Hepatobiliary Iminodiacetic Acid (HIDA) Scan: Tracks the flow of bile from your liver to your small intestine using a small amount of radioactive dye. It helps find blockages in the bile ducts.
    • Magnetic Resonance Cholangiopancreatography (MRCP): A special type of MRI that makes detailed images of your liver, gallbladder, and bile ducts, showing gallstones and blockages.
    • Endoscopic Retrograde Cholangiopancreatography (ERCP): Involves using a flexible tube with a camera to look inside your bile ducts. It can also treat some problems by clearing blockages.
  • Other Tests: 
    • Stomach X-ray: Sometimes used to get a general look at your internal organs.
    • Percutaneous Transhepatic Cholangiography (PTC): Involves injecting dye into the bile ducts through a needle in your skin to see blockages on X-rays.

These steps help doctors confirm if you have cholecystitis, understand how severe it is, and decide on the best treatment.

Frequently Asked Questions

Mild cases may improve with conservative treatment, but medical intervention is often necessary to prevent complications and recurrence.

If the gallbladder is not removed, there is a risk of recurrence. Cholecystectomy is often performed to minimise the risk for recurrence.

Cholecystitis can be associated with other conditions like gallstones, bile duct problems, and infections. It can also occur in patients with diabetes or severe illness.

Location

Colorectal Care Specialists (CRCS)

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