What should I do if cholecystitis does not improve?

Written by Wu Hai Wu

Gastroenterology

Updated on January 28, 2025

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If cholecystitis does not improve over time, it is crucial to actively identify the reasons behind this persistent issue. For instance, it could be due to improper diet, such as frequently consuming greasy foods or overeating. It might also be due to an acute exacerbation of chronic cholecystitis, or possibly because of the presence of polyps or stones in the gallbladder, which can lead to persistent cholecystitis. In such cases, it is important to pay closer attention to the diet, opting for lighter meals, and to take oral anti-inflammatory and bile-promoting medications for treatment. If necessary, gallbladder removal surgery may be required.

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Symptoms of cholecystitis

Appendicitis symptoms generally manifest as sudden onset of severe pain in the upper right abdomen, which can radiate to the right shoulder, scapula, and back. The initial pain is typically a feeling of distension, which gradually develops into intermittent, colicky pain. This usually occurs suddenly after a full meal or consuming a large amount of fatty foods. The pain is persistent and may worsen in episodes. There is also usually accompanying fever, ranging from mild to moderate, but high fevers with chills, abdominal muscle rigidity, and stiffness can occur, along with tenderness; pain intensifies when pressed. Symptoms also include nausea, vomiting, constipation, and indigestion.

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Does cholecystitis hurt?

Whether cholecystitis is painful depends on the nature of the inflammation. If it is acute cholecystitis, it often causes severe pain in the gallbladder area, which is persistent and accompanied by chills, fever, poor spirit, loss of appetite, and even jaundice. If it is chronic cholecystitis, there may not be obvious symptoms of gallbladder pain. However, it can lead to an acute attack of chronic cholecystitis under the conditions of chills, high-fat diet, or other causes, which then causes pain in the gallbladder area.

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What are the serious consequences of cholecystitis?

The severe consequences of cholecystitis include gangrene and perforation of the gallbladder, leading to obvious signs of peritonitis throughout the abdomen, with noticeable tenderness and rebound pain. For patients with recurrent cholecystitis, it is advisable to use antibiotics for anti-infection treatment as soon as possible, as the condition can only be alleviated after the inflammation is under control. During recurrent episodes, surgical treatment should also be considered promptly. Removal of the gallbladder through surgery is the only way to achieve a radical cure. In most cases, laparoscopic cholecystectomy is chosen because it has the advantages of smaller incisions, less damage, and faster recovery, and is therefore often the preferred option in clinical settings. Patients who have undergone surgery should also avoid spicy and irritating foods to reduce inflammation and better facilitate recovery.

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Written by Huang Ya Juan

Gastroenterology

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Symptoms and Treatment of Cholecystitis

Cholecystitis is divided into acute cholecystitis and chronic cholecystitis. Acute cholecystitis typically presents very typical and obvious clinical symptoms, primarily manifesting as acute abdominal pain. Acute cholecystitis often occurs after eating greasy food, mainly presenting as severe colicky pain in the upper right abdomen, which is episodic and worsens. The pain may radiate to the right shoulder or back, followed by nausea, vomiting, and in severe cases, fever. Some severe cases may also present with jaundice and symptoms of systemic infection and toxicity. Acute simple cholecystitis is often treated non-surgically, and most cases can be cured. If the patient has a history of multiple attacks or the presence of stones, elective cholecystectomy is usually performed later. For suppurative or gangrenous cholecystitis, surgery should be performed promptly after appropriate preparation to remove the diseased gallbladder, typically within three days of onset. If the patient's condition is critical at the time of surgery, or if there is severe local infection and the anatomy is unclear, the doctor will not forcibly remove the gallbladder to avoid major bleeding and damage. Instead, a cholecystostomy may be performed first, followed by cholecystectomy after three months. Chronic cholecystitis, besides occasional upper abdominal discomfort and indigestion, usually shows no prominent symptoms, and most patients only learn about their condition through ultrasound examination. However, for recurrent acute attacks or symptomatic chronic cholecystitis, especially those with stones larger than 1 cm or multiple stones, cholecystectomy should be performed. Elderly or frail individuals with other serious illnesses, such as cardiovascular disease, diabetes, kidney disease, or liver disease, may receive medical treatment, including general digestive aids and antispasmodic medications. Bile preparations have choleretic effects, can increase the secretion of bile, promote the digestion and absorption of fats, and facilitate the excretion from the gallbladder, which can alleviate symptoms and stabilize the condition. Considering that acute attacks of chronic cholecystitis in elderly people progress rapidly and that emergency surgery has a much higher mortality rate than elective surgery, it is advisable to perform surgery during a remission period. Whether treated with medication or surgery, it is important to follow medical advice.

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The difference between acute cholecystitis and chronic cholecystitis

Chronic cholecystitis clinically manifests as recurrent dull pain in the upper abdomen and biliary colic, which the patient can quickly relieve on their own; acute cholecystitis involves more severe pain that cannot be relieved without intervention, and is usually accompanied by fever, nausea, and vomiting. In chronic cholecystitis, pressing on the right upper abdomen elicits no special reaction; in acute cholecystitis, pressing on the right upper abdomen causes obvious pain, known as a positive Murphy's sign. Acute cholecystitis is accompanied by a significant increase in white blood cells, and an ultrasound can reveal a marked enlargement and thickening of the gallbladder wall; chronic cholecystitis does not show these specific characteristics.