Biliary tract disorders

Chronic cholecystitis

Biliary tract disorders
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Chronic cholecystitis
portrait of Fernando Martínez Sáez
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Fernando Martínez Sáez
Medically reviewed by our Medical staff

Last update: 06-06-2022

How else can it be called?

  • Biliary colic

  • Porcelain gallbladder

  • CIE-9: 575.11

  • CIE-10: K81.1

What is chronic cholecystitis?

Chronic cholecystitis is a persistent and long-term inflammation of the gallbladder.

The gallbladder is a pear-shaped organ placed in the upper right hand corner of the abdomen. It is connected by a series of ducts to the liver, pancreas, and duodenum (first part of the small intestine).

The gallbladder stores and concentrates the bile, a substance produced by the liver, and it is essential for the absorption of fats within the small intestine.

The disease is more common in women over 40 years old.

What causes chronic cholecystitis?

Chronic cholecystitis is the result of chronic irritation of the gallbladder wall by recurrent attacks of acute cholecystitis. This lead to the inability of the gallbladder to concentrate and store the bile.

Chronic cholecystitis is often associated with cholelithiasis (gallstones in the biliary tract).

Which are the main symptoms of chronic cholecystitis?

Intermittent or constant right upper quadrant pain is the most common symptom, and may radiate to the shoulder or the back.

Other additional symptoms include:

  • Episodes of biliary colic.
  • Chronic dyspepsia (indigestion).
  • Nausea.
  • Flatulence and belching.
  • Feeling of upper abdominal fullness.

Episodes can be precipitated by heavy meals or fatty foods

How can it be diagnosed?

On examination, there is tenderness in the right upper abdomen with or without a palpable mass. Pain and an arrest in inspiration upon deep palpation underneath the right costal margin (Murphy’s sign) is usually present.

It is also advisable to perform a blood test with the following studies:

  • Blood count
  • Bilirubin
  • Amylase
  • Lipase
  • Hepatic (liver) function panel: (AST, ALT, GGT, alkaline phosphatase)

In addition, imaging tests may be useful:

  • Abdominal ultrasound
  • Abdominal CT (Computed Tomography)
  • Cholescintigraphy
  • Contrast-enhanced CT scan of the gallbladder

Which is the recommended treatment?

Cholecystectomy (gallbladder removal) is the most common treatment as the natural history of chronic cholecystitis is to recur.

It is usually performed by laparoscopic procedures. It is a minimally invasive surgical technique using a thin tube called a laparoscope inserted into the abdomen through a small incision.

Analgesics and a low-fat diet are the appropriate treatment before surgery.

Which are the possible complications?

Long-standing chronic cholecystitis may develop mural calcification (wall is encrusted with calcium) and is referred to as a porcelain gallbladder.

Chronic cholecystitis is strongly associated with gallbladder cancer.

Medically reviewed by our Medical staff on 06-06-2022

Bibliography

  • Textbook of Clinical Gastroenterology and Hepatology (2nd Ed) 2012, Franz Ludwig Dumoulin and Tilman Sauerbruch, ISBN: 978-1-4051-9182-1, Pag. 557.
  • First Aid for the Basic Sciences: Organ Systems (3rd Ed) 2017, Tao Le, William L. Hwang, Vinayak Muralidhar, Jared A. White and M. Scott Moore, ISBN: 978-1-25-958704-7, Pag. 252.
  • Robbins Basic Pathology (10th Ed) 2018, Vinay Kumar, Abul K. Abbas, Jon C. Aster, ISBN: 978-0-323-35317-5, Pag. 674.
  • Abdominal Imaging. 2nd edition. Dushyant V. Sahani , Anthony E. Samir, 2017. ISBN: 978-0-323-37798-0 Pag 615.

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