Does cholecystitis require surgery?

Written by Zhao Xin Lan
Endocrinology
Updated on September 19, 2024
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Whether cholecystitis requires surgery depends on the acute or chronic status of the inflammation and its severity. If it is acute suppurative cholecystitis, emergency surgery is needed to avoid gallbladder perforation and resultant peritonitis, which could lead to serious septic shock, thus emergency surgical treatment is necessary. If it is mild chronic cholecystitis, elective surgery can be considered, and there is no need for emergency treatment. If it is asymptomatic chronic cholecystitis, it can also be managed with dietary adjustments and symptomatic medical treatment, and surgery may not be strictly necessary.

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Written by Zhang Jun Jun
Endocrinology
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Which department should I go to for cholecystitis?

Firstly, it is necessary to determine the cause of the cholecystitis. The most common type of cholecystitis is caused by gallstones. If the cholecystitis is an acute episode caused by gallstones, leading to pain, nausea, vomiting, or even high fever, surgical intervention is usually indicated. It is generally recommended to consult with departments such as general surgery or hepatobiliary surgery, as emergency surgery may be needed. The second scenario involves cases where cholecystitis is detected during routine physical examinations without symptoms. Ultrasound may show gallstones or gallbladder polyps. In symptom-free situations, it is possible to consult general departments like gastroenterology, and regular follow-ups and checks of inflammation indicators, as well as abdominal ultrasonography, can be performed to monitor the dynamic changes of the cholecystitis. The third scenario pertains to cholecystitis where new techniques such as MRCP are available. With this technology, gallstones can be removed under endoscopic guidance. Generally, these procedures are performed in the gastroenterology department. Thus, for acute cholecystitis with choledocholithiasis and concurrent biliary pancreatitis, it may be treated with endoscopic techniques under gastroenterology, avoiding the need for traditional or minimally invasive surgery. Therefore, patients with cholecystitis may visit either the hepatobiliary surgery or gastroenterology departments.

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Written by Wu Hai Wu
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What should I do if cholecystitis does not improve?

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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Written by Liu Wu Cai
Hepatobiliary Surgery
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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 Zhao Xin Lan
Endocrinology
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Gallblitis Symptoms

The symptoms of cholecystitis are divided into chronic cholecystitis and acute cholecystitis, and they present differently clinically. During acute cholecystitis, there is pain in the right upper abdomen in the gallbladder area, accompanied by fever, fatigue, decreased appetite, and even jaundice. Physical examination can reveal obvious tenderness and rebound pain in the right upper abdomen at the gallbladder. In contrast, chronic cholecystitis may not have obvious symptoms. Occasional pain may occur in the gallbladder area, but it is bearable. Typically, there is no obvious tenderness in the area, and the condition usually requires diagnosis through examinations such as an ultrasound.

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Written by Zhang Jun Jun
Endocrinology
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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.