Care of Patient with Cholecystitis

[Major points]

Acute cholecystitis can be diagnosed by abdominal ultrasounds, CT scan and MRI.
Common clinical presentations: pain in the upper right area of abdomen, fever, nausea, vomiting and jaundice.
Avoid overeating and consuming foods that are high in fat content, as well as pan-fried or deep-fried foods.

What is cholecystitis?

Inflammation that occurs in the gallbladder. When being palpated, patients may experience pain over upper or right area of abdomen. Laboratory blood tests may show increased white blood cell counts (inflammation reaction) and elevation of liver function index. The diagnosis is made through abdomen ultrasonography, CT and MRI. It can be classified into two types based on the cause of occurrence: calculous cholecystitis and acalculous cholecystitis.

Calculous cholecystitis: an inflammation process mostly occurs in the setting of cystic duct obstruction caused by gallstone, resulting in bile can not being excreted from gallbladder. Blockage of bile flow leads to thickening and buildup of bile causing an enlarged and red gallbladder. The gallbladder becomes infected by bacteria.
Acalculous cholecystitis: it happens when bacteria go through blood stream or lymph into gallbladder. This disease usually occurs in patients with diabetes mellitus, sepsis, using peripheral parenteral nutrition, obesity, etc.

What are the common symptoms of cholecystitis?

Acute cholecystitis:
1. Pain: the location of pain often presented over upper or right portion of abdomen and sometimes radiating to the right scapular region.
2. Fever、chills (referring to the body shaking involuntarily due to some reasons such as cold).
3. Jaundice (yellowish of skin)
4. Nausea and vomiting.
Chronic cholecystitis (due to unrecovery from long-standing acute cholecystitis):
1. Right upper quadrant appearing abdomen distension and repeated pain, it’s might be associated with high-fat foods.
2. Poor appetite and nausea.
  Experiencing above symptoms do not indicate the cholecystitis diagnosis. Please visit Gastroenterology and Hepatology clinic for diagnosis.

How to treat cholecystitis?

During the acute inflammatory period, antibiotic treatment is administered according to the doctor's orders, and no food is allowed. Intravenous infusion supplement for maintain body fluid and electrolyte balance.
Use pain killer if necessary.
A procedure for percutaneous transhepatic biliary drainage to drain bile may be needed upon doctor's assessment .
Consult surgeon for removal of gallbladder if cholecystectomy is indicated.

How to take care of myself if I have been diagnosed with cholecystitis?

Diet:
1. Intake more frequently and keep small amount each time. Avoid overeating.
2. Take low-fat diet, and avoid high-fat food including organ meats, fatty meat, fried food, nut, cake, ice cream, chocolate, and whole fat milk, etc.
3. Choose lean meats. Selection of meats in the following order: skinless chicken, fish(without fish belly), skinless duck, beef, lamb and pork.
4. Cooking method: baking, stewing, steaming are better methods than fried. Using water to wash the gravy food while dining out.
5. Refrigerating the soup then removing the upper layer fatty before eating.
6. Take fat-soluble vitamins under doctor’s or dietician’s order when the long-term low-fat diet is necessary(vitamin A, D, E, K).
Do some activity that you can tolerance, e.g. take a walk, etc.
If you have a biliary drainage tube, please record the amount of drainage daily.
After you’re discharged, please see a doctor as soon as possible if you notice any of the following :
1. Dark brown and tea-color urine.
2. Clay-colored stool.
3. Yellowish of skin or eyes.
4. Fever、chillness
5. Abdomen presents unusual pain.
6. If you notice any changes in your biliary drain output — like the amount suddenly becoming a lot more or less, or if the fluid turns red or black.

References

Fico, V., La Greca, A., Tropeano, G., Di Grezia, M., Chiarello, M. M., Brisinda, G., & Sganga, G. (2024). Updates on Antibiotic Regimens in Acute Cholecystitis. Medicina, 60(7), 1040. https://doi.org/10.3390/medicina60071040
Fok, J. C. Y., Teoh, A. Y. B., & Chan, S. M. (2025). Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis. Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society, 37(1), 93–102. https://doi.org/10.1111/den.14946
Gallaher, J. R., & Charles, A. (2022). Acute cholecystitis: A review. Journal of American Medical Association, 327(10), 965-975. https://doi.org/10.1001/jama.2022.2350
Tufo, A., Pisano, M., Ansaloni, L., De Reuver, P., Van Laarhoven, K., Davidson, B., & Gurusamy, K. S. (2021). Risk prediction in acute calculous cholecystitis: A systematic review and meta-analysis of prognostic factors and predictive models. Journal of Laparoendoscopic and Advanced Surgical Techniques, 31(1), 41-53. https://doi.org/10.1089/lap.2020.0151.

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