Is surgery necessary for cholecystitis with gallstones?

Written by Li Ying
Gastroenterology
Updated on September 09, 2024
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Gallstone cholecystitis primarily has several treatment methods, targeted towards symptomatic and asymptomatic treatments. These include medical treatment and surgical treatment. Not all cases of cholecystitis require surgery. For some asymptomatic gallbladder stones, treatments can be managed through dietary therapy, symptomatic treatment, and preventive treatment for those at high risk, including dietary adjustments or treatments that promote bile flow. Preventive gallbladder removal may be considered for those at high risk of gallbladder cancer. For symptomatic cases, the main goal is to control symptoms and primarily reduce inflammation. For chronic cholecystitis and gallstones, if there is no significant improvement with medical treatment, then surgical treatment may be considered.

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How to Diagnose Cholecystitis

The definitive diagnosis of cholecystitis mainly involves the following aspects: First, clinical manifestations are crucial. The most common symptoms include nausea, vomiting, abdominal distension, and loss of appetite. Regarding physical examination, there is typically pain in the lower right abdomen and mid-lower right abdomen, with tenderness upon palpation. Furthermore, the onset of cholecystitis is characterized by postprandial pain, particularly after consuming fatty foods or feeling overly full. If these symptoms are present, further examination such as gallbladder ultrasound can be conducted to check for thickening of the gallbladder wall. Additionally, blood tests for inflammatory markers like complete blood count and CRP (C-reactive protein) can be performed. The diagnosis of cholecystitis can be confirmed by combining these symptoms and test results.

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Written by Wu Hai Wu
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What are the symptoms when there are problems with the gallbladder?

Gallbladder issues, specifically symptoms of cholecystitis, mainly include chills, fever, persistent dull pain in the upper right quadrant of the abdomen, episodic colic pain that radiates to the right shoulder and back, and may also be accompanied by jaundice, dark urine, nausea, vomiting, and constipation. Patients with cholecystitis often experience sudden pain at night, typically due to overeating or consuming greasy foods. Once cholecystitis occurs, it is advised to seek medical attention at a regular hospital as soon as possible, complete the relevant diagnostic tests, such as imaging studies of the abdomen, consider surgical treatment, and engage in active anti-infection treatment.

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Why is there nothing wrong with the B-ultrasound for cholecystitis?

As for why cholecystitis appears normal in an ultrasound, there are two possible reasons. One possibility is that the medical practitioner conducting the ultrasound may lack sufficient clinical experience to identify an inflamed gallbladder. Another reason could be limitations in the ultrasound equipment itself, which might fail to detect an inflamed gallbladder. There are very few cases where cholecystitis appears normal under ultrasound. The main ultrasound features of cholecystitis include gallbladder wall edema, roughness, and an enlarged gallbladder among other radiological changes. Once cholecystitis is diagnosed, it is crucial to undertake active treatment measures, such as aggressive anti-infection treatment, spasmodic pain relief, etc.

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Can acute cholecystitis recur?

Acute cholecystitis can recur. This condition often results from a bacterial infection leading to an inflammatory response. At this stage, it can be treated with antibiotics to control the inflammation and alleviate the condition. However, if the gallbladder is not surgically removed, the inflammation can repeatedly flare up, potentially leading to chronic cholecystitis. This results in recurrent discomfort and pain in the upper right abdomen, affecting the quality of life. Therefore, for patients with acute cholecystitis, especially those caused by gallstones, it is advisable to undergo surgery as soon as possible. Only through surgical removal of the gallbladder can a complete cure be achieved, preventing recurrence.

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Is hot compress effective for cholecystitis?

The main symptoms of cholecystitis include pain in the upper right abdomen and fever. If this occurs, applying heat to the painful area may temporarily relieve the pain, but it is merely a symptomatic treatment and not a cure, as cholecystitis is caused by an infection and requires antibiotic treatment. Therefore, the fundamental treatment is to reduce inflammation. Merely using heat for relief does not address the root of the disease. Thus, it is essential to receive treatment in a hospital, where a doctor can prescribe medication, which is the most effective and fundamental method.