Chronic cholecystitis

Chronic cholecystitis (Chronic cholecystitis)

1) Disease description (causes and symptoms)

• Cause: In most cases, gallstones (cholelithiasis) repeatedly irritate the gallbladder mucosa, causing the condition. Recurrent acute or subacute inflammation leads to lymphocytic infiltration and fibrosis, thickening of the gallbladder wall, and, in some cases, accompanying calcification.
• Pathophysiology: Frequent inflammation continues due to mechanical irritation from gallstones and impaired gallbladder drainage, resulting in chronic inflammation and fibrosis of the gallbladder wall. This reduces gallbladder contraction and impairs the smooth release of bile.
• Main symptoms:
  • Often asymptomatic.
  • When symptoms are present, right upper quadrant (right upper abdomen) pain or biliary colic (pulsating or intermittent pain) may occur, possibly radiating to the right shoulder or back.
  • Upper abdominal discomfort, bloating, indigestion, nausea, and vomiting after eating fatty foods.
  • Intermittent fever or jaundice may occur during acute exacerbation (acute cholecystitis).

2) Treatment methods

• Conservative management (asymptomatic or mild cases):
  • No separate treatment is necessary. If there are no symptoms, observation is appropriate.
  • Lifestyle management: weight control (avoid rapid weight loss), limiting overeating and fatty foods, and eating regular meals.
• Medication and symptom relief:
  • Pain control (analgesics); antiemetics for nausea and vomiting.
  • Antibiotics are administered during acute exacerbation (when infection is suspected).
  • Gallstone dissolution therapy (ursodeoxycholic acid) is selective—used on a limited basis depending on the composition and size of the gallstones and when there is no indication for surgery.
• Procedures/surgery:
  • If symptoms recur, interfere with daily life, or there is a risk of complications, the standard treatment is cholecystectomy (usually laparoscopic cholecystectomy).
  • If surgery is not possible because of a severe systemic condition, percutaneous gallbladder drainage (as a preoperative measure) may be considered as a temporary treatment.
  • Open surgery may be required when laparoscopic surgery is difficult because of anatomical or inflammatory findings.
• Precautions and complications:
  • The condition may progress to acute cholecystitis (severe pain, fever, increased white blood cell count, jaundice, etc.).
  • Rarely, the incidence of gallbladder cancer may increase (particularly with certain findings, such as a calcified gallbladder).
  • Postoperative complications: bleeding, infection, bile duct injury, etc. (consult a doctor before and after surgery).
• Follow-up:
  • Review changes in symptoms and follow-up abdominal ultrasound or, if necessary, CT/MRI.
  • Preoperative evaluation: blood tests (liver function and blood coagulation) and imaging tests.

3) Outpatient visit checkpoints (items to prepare and example questions)

• Items to prepare/bring:
  • List of medications currently being taken (including prescription drugs, over-the-counter medications, and health functional foods), including dosages and times of administration
  • Previous test results (abdominal ultrasound, CT, and MRI reports; recent blood test results)
  • Symptom diary (when symptoms began, frequency, triggers such as fatty foods and overeating, pain characteristics, and areas of radiation)
  • Allergy history (medications, foods, etc.) and history of previous surgery
• Important information to tell the doctor during an outpatient visit:
  • Whether fever, jaundice, or severe pain has occurred recently
  • Possibility of pregnancy (women)
  • Whether anticoagulants are being taken (important if surgery is planned)
• Examples of questions the doctor may ask during the consultation:
  • Where is the pain located, how severe is it, and how long does it last?
  • What foods or situations make the symptoms worse?
  • Have you had any recent weight changes or fever?

4) Examples of general questions to ask the doctor

• "What are the side effects of this medication (such as the prescribed analgesic or antibiotic)?"
• "What is the prognosis for my condition? When is surgery necessary?"
• "Are there any dietary or exercise habits that I should pay particular attention to in daily life?"

5) Examples of condition-specific questions

• "Based on my gallstones (or imaging findings), is cholecystectomy absolutely necessary? When would it be acceptable to postpone surgery?"
• "If my symptoms continue to recur, how high is the risk of progressing to acute cholecystitis or gallbladder cancer? How often are regular checkups recommended?"

Note: This information is general medical information. Please consult your treating doctor to determine a diagnosis and treatment plan based on your individual condition.