Gallbladder Infection (Cholecystitis)

What is gallbladder infection (cholecystitis)?

Cholecystitis is defined as gallbladder inflammation, a small organ vital to digestion. The gallbladder's primary function is to store bile, a digestive enzyme the liver produces. There are different terminologies of cholecystitis; these are:

• Acute cholecystitis: acute cholecystitis occurs suddenly and usually due to a blocked outflow of the gallbladder with infection.
• Chronic cholecystitis: chronic cholecystitis is a chronic or long-term condition caused by recurrent acute cholecystitis or prolonged irritation from gallstones.
• Calculus cholecystitis: calculus cholecystitis occurs when a gallstone or biliary sludge blocks the main opening of the gallbladder.
• Acalculus cholecystitis: acalculus cholecystitis is a gallbladder infection without gallstones or bile duct stones. 

What causes (gallbladder infection) cholecystitis?

Cholecystitis usually occurs when a blockage prevents bile from flowing out of the gallbladder properly, leading to bile accumulation, distension of the gallbladder, and gallbladder inflammation. The most common culprit behind this blockage is gallstones, small, hard deposits that form when substances in the bile harden. While many people with gallstones do not experience symptoms, they become a problem when they obstruct the cystic duct, the main pathway between the gallbladder and the bile duct.

Other causes of a gallbladder infection or cholecystitis, though less frequent, can include:

• Tumours: tumours such as those in gallbladder cancer can prevent bile from draining out of the gallbladder properly, resulting in cholecystitis.
• Sepsis: Severe infection of other sources can lead to inflammation and cholecystitis, particularly in people with weakened immune systems.

Additionally, some cases of cholecystitis don't involve gallstones, known as acalculous cholecystitis, which can occur due to:

• Severe illnesses or infections which reduce blood flow to the gallbladder.
• Severe sepsis, e.g. those with septicaemia.

What are the symptoms of cholecystitis?

The symptoms of acute cholecystitis can range from mild to severe and often emerge without warning. Symptoms of acute cholecystitis include:

• Sharp and sudden pain in the upper right portion of the abdomen, which can spread to the back or right shoulder blade area. This pain usually intensifies after eating, especially after meals high in fats. Pain is constant and doesn't disappear.
• Abdominal tenderness, particularly when pressing on the upper right side of the abdomen.
• Nausea and vomiting are common responses to the intense pain and inflammation in the gallbladder.
• Fever and chills, which indicate that the body is fighting an infection.

Chronic cholecystitis involves repeated episodes of irritation and mild inflammation of the gallbladder. Symptoms are similar to acute cholecystitis but less intense and intermittent rather than persistent.

Understanding these symptoms and their causes is crucial for early detection and treatment of cholecystitis. It reduces the risk of complications such as gallbladder perforation, which can lead to serious, life-threatening infections.

Who is at risk of gallbladder infection (cholecystitis) in Singapore?

Understanding the risk factors for cholecystitis is essential for prevention and early detection. In Singapore, as elsewhere, certain groups of people are more susceptible to developing cholecystitis, primarily due to lifestyle, genetic, and demographic factors. The risk factors for developing cholecystitis are similar to risks of gallstone formation, and they include:

• Gender: women, especially those over 40, have a higher incidence of gallstones and cholecystitis. This is partly due to hormonal factors, such as those related to pregnancy, which can increase cholesterol concentration in bile.
• Diet: a diet high in fat and cholesterol and low in fibre can increase the risk of gallstone formation, which is a leading cause of cholecystitis.
• Obesity: being significantly overweight increases the body's cholesterol levels, which can lead to the formation of cholesterol gallstones.
• Rapid weight loss: while obesity is a risk factor, rapid weight loss can also lead to gallstone formation. This is often seen in individuals undergoing bariatric surgery or following low-calorie diets.

How is gallbladder infection (cholecystitis) diagnosed in Singapore?

Diagnosing cholecystitis in Singapore usually involves a combination of patient history, physical examination, and diagnostic tests:

• Ultrasound: an ultrasound is the most common and effective tool for diagnosing gallstones, the primary cause of cholecystitis. It is non-invasive and can quickly identify abnormalities in the gallbladder.
• Blood tests: blood tests can detect signs of infection or inflammation, such as elevated white blood cell counts, and liver function tests can show abnormalities related to bile flow.
• Computed tomography scan (CT scan): CT scans provide detailed images of the gallbladder and can help identify the presence of gallstones, inflammation, or complications of cholecystitis. It can also rule out other causes of pain that may mimic cholecystitis.

What are the treatment options for gallbladder infection (cholecystitis) in Singapore?

The treatment for cholecystitis aims to reduce inflammation, manage pain, and address the underlying cause, typically gallstones:

• IV treatment: intravenous fluids or medications will help prevent dehydration and alleviate symptoms of cholecystitis.
• Medications: antibiotics may be prescribed if a bacterial infection of the gallbladder is suspected. Pain medications may also be prescribed to reduce pain and discomfort. 
• Cholecystectomy: a cholecystectomy is the surgical removal of the gallbladder. In Singapore, laparoscopic cholecystectomy is the preferred method due to its minimally invasive nature, resulting in shorter hospital stays and faster recovery times. 
• ERCP: ERCP may remove stones blocking the bile duct if there is a concurrent stone in the bile duct.

Frequently asked questions

What is the main cause of cholecystitis?

The main and most common cause of cholecystitis is gallstones.

What are the symptoms of early cholecystitis?

Symptoms of early cholecystitis are acute and sharp pain in the top right corner of the abdomen, which may spread towards your right shoulder and upper back. 

Can gallbladder inflammation be cured?

Yes, treatment for cholecystitis includes fasting, IV treatment, or oral medications. Definite treatment of cholecystitis will be laparoscopic cholecystectomy.