Definition of acute cholecystitis

Acute cholecystitis is an inflammation of the gallbladder usually caused by the presence of a gallstone in the cystic duct. This duct carries bile, stored in the gallbladder, to the intestine. When the cystic duct is blocked by a gallstone, bile remains in the gallbladder and causes inflammation.

Symptoms of acute cholecystitis

Symptoms of acute cholecystitis may include pain in the upper right part of the abdomen, vomiting, nausea, fever, and chills. In elderly people, symptoms may be nonspecific such as loss of appetite, a feeling of fatigue or weakness, as well as vomiting.

Diagnosis of acute cholecystitis

The diagnosis of acute cholecystitis is generally made using an abdominal ultrasound which notably allows detection of gallstones. Additionally, other imaging tests may also be used (e.g., cholescintigraphy).

Treatment of acute cholecystitis

The treatment of acute cholecystitis is generally cholecystectomy, which is the removal of the gallbladder. Treatment requires hospitalization during which individuals are kept fasting and receive supportive care including intravenous hydration, analgesics, and antibiotics. Generally, cholecystectomy is performed within 24 to 48 hours following the onset of symptoms. However, it may be delayed or avoided if patients are unstable and/or present an increased surgical risk.

Nutritional approach for acute cholecystitis

In the context of acute cholecystitis, the goal of the nutritional approach is to promote the well-being of individuals by providing a diet that takes into account their clinical condition and tolerance.

• Initially, individuals are kept fasting. This helps limit stimulation of the gallbladder and prevent increased inflammation.
• Next, individuals also receive fluids and electrolytes intravenously. This helps restore hydro-electrolytic balance promoting an optimal clinical state before surgical intervention.
• Finally, oral feeding is gradually reintroduced starting with liquids then a low-fat diet (low in fat).

References

• https://www.merckmanuals.com/en-ca/home/liver-and-gallbladder-disorders/gallbladder-and-bile-duct-disorders/cholecystitis
• https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/gallbladder-and-bile-duct-disorders/acute-cholecystitis?query=Cholecystitis
• https://www.merckmanuals.com/en-ca/home/quick-facts-liver-and-gallbladder-disorders/gallbladder-and-bile-duct-disorders/cholecystitis
• St-Denis, Louise. November 2018. “Nutrition, pancreas and bile ducts.” NUT 3047 – Clinical Nutrition and Chronic Diseases 1. Montreal: University of Montreal.

Article written by:

Marie-Noël Marsan, written in 2021.