Calculous cholecystitis: what it is, acute and chronic

The entry "chronic calculous cholecystitis" in a report means inflammation of the gallbladder in which stones are present in the organ. Below is what this condition is, how the acute form differs, which examinations confirm the diagnosis, and which signs require emergency care.

What calculous cholecystitis means

Cholecystitis is inflammation of the gallbladder. Calculous (from the Latin calculus — "stone") means that the inflammation is associated with stones. Stones are small formations, usually of cholesterol, that form in the gallbladder. Gallstone disease is common: stones are detected in more than 1 in 10 adults. Most carriers have no symptoms, but sometimes attacks of pain (biliary colic) or acute cholecystitis occur. The calculous form accounts for about 95% of all cases of acute cholecystitis. The acalculous variant — inflammation without stones — is less common but usually more severe.

How stones are linked to gallbladder inflammation

The cystic duct is the main opening of the gallbladder, through which bile enters and leaves the gallbladder. Stones and biliary sludge — a mixture of bile with small cholesterol crystals and salts — block the lumen. Outflow is impaired, bile accumulates, pressure inside the organ rises, and the wall becomes inflamed. The inflamed gallbladder is sometimes infected with bacteria. Impaired blood supply to the wall and the damaging effect of pancreatic juice when it refluxes into the bile ducts are of secondary importance.

Factors predisposing to stones:

• female sex;
• pregnancy and hormone therapy;
• older age;
• obesity, rapid weight loss or rapid weight gain;
• diabetes mellitus.

Acute calculous cholecystitis: signs and risks

The main symptom is sudden severe pain in the upper abdomen on the right, radiating to the right shoulder. The area under the right rib is tender on pressure, and a deep breath intensifies the pain. Unlike other types of abdominal pain, the pain in acute cholecystitis is constant and does not resolve within a few hours; it lasts at least 30 minutes and more often appears after eating, especially fatty food. In addition, there may be high fever, nausea, vomiting, sweating, decreased appetite, yellowing of the skin and whites of the eyes (jaundice), and pale stools.

Acute calculous cholecystitis is potentially dangerous because of complications, so treatment usually takes place in a hospital. With complications, emergency surgery is required in approximately 2–3 cases out of 10.

Chronic calculous cholecystitis: how it progresses

If the cystic duct is blocked temporarily and repeatedly, the inflammation persists for a long time. The gallbladder wall thickens and becomes firm, and the organ stores and releases bile less well. The manifestations are vague: nausea, dull pain in the right upper quadrant, and other discomfort after eating. Chronic calculous cholecystitis may be a consequence of an acute attack, but it often develops on its own as well. The presence of stones complicates treatment and worsens the prognosis.

How calculous cholecystitis is detected

The examination sequence is usually as follows:

1. Examination: the doctor notes tenderness in the right upper quadrant and checks Murphy's sign — on a deep breath, with the doctor's hand under the costal arch, the gallbladder moves downward and presses against the palm, causing sudden pain.

2. Blood tests: amylase and lipase, bilirubin, complete blood count, liver function tests — signs of inflammation and impaired bile outflow.

3. Imaging: abdominal ultrasound, computed tomography or magnetic resonance imaging, abdominal radiography, radionuclide scanning of the gallbladder, and in some cases cholecystocholangiography.

Complications and when emergency medical help is needed

Without treatment, acute cholecystitis leads to necrosis of the gallbladder tissue (gangrenous cholecystitis) with spread of infection, rupture of the wall (perforation) with peritonitis or abscess, pancreatitis, cholangitis, and accumulation of pus in the gallbladder (empyema). The most formidable complication of calculous cholecystitis is hepatic colic: a stone smaller than 1 cm enters the biliary tract, bile outflow is blocked, and subhepatic jaundice develops. The pain in colic is stronger than usual and occurs more often at night or early in the morning; then the sclera and skin turn yellow, the urine darkens, and the stool lightens. Such patients require emergency hospitalization.

Calculous cholecystitis by itself is not a reason to call an ambulance. 103 or 112 — if, against a background of severe pain in the right upper quadrant, yellowing of the skin and whites of the eyes, dark urine, and pale stools appear (signs of hepatic colic with subhepatic jaundice), as well as in case of a sharp deterioration in the condition.

This material is for reference: it explains terms and examinations but does not replace a doctor's consultation — the decision in each case is made by the doctor.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer