Cholecystitis

Diagnosis

Your doctor will review your medical history and ask about any prior episodes of abdominal discomfort, especially those triggered by high-fat meals. Your doctor will ask if you've had any recent rapid weight loss and about medications you currently take, particularly birth control pills and estrogen replacement therapy because these can lead to the formation of gallstones.

During the physical exam, your doctor will pay particular attention to the upper right portion of your abdomen, where your liver and gallbladder are located. Blood tests may reveal higher levels of white blood cells, which suggests an infection, or elevated liver enzymes, which suggest a blockage or irritation of the gallbladder and bile ducts.

Your doctor may order a radiology test to look for gallstones. Because the chemical composition of most gallstones makes them invisible on X-ray, other tests are used, including:

• Ultrasound - This painless procedure uses sound waves to create images of the gallbladder and bile ducts. An ultrasound is usually the first (and often only) test needed to confirm that you have gallstones and cholecystitis. A gallbladder wall with a thickened appearance means you may have acute or chronic cholecystitis. Enlarged bile ducts suggest that a stone may have passed out of the gallbladder and into the common bile duct, causing a blockage.

• Cholescintigraphy - This test looks for a blocked gallbladder or bile ducts. You are given an injection of a radioactive chemical that passes out of the blood into the bile ducts. A special camera takes pictures of the chemical's path and can detect blockages in the flow of the chemical.

Expected Duration

If you have biliary colic, the pain or discomfort may go away or become less severe after one to five hours if a trapped gallstone passes out of the cystic duct on its own. Your abdomen may continue to ache mildly for about 24 hours.

If you have acute cholecystitis, however, and infection and inflammation continue, your symptoms may get worse and you may develop complications, including a hole in the inflamed gallbladder wall (gallbladder perforation) and an infection that spreads to the lining of the abdomen (peritonitis). This is why people with cholecystitis usually are treated in a hospital until their symptoms improve.

Symptoms of chronic cholecystitis may last for years before a diagnosis is made. Surgery to remove the gallbladder will prevent symptoms from coming back.