Acute and chronic lithiasic and alitiasic cholecystitis: causes, therapy, diet and natural remedies

By Cristiano Antonino Last updated Jun 9, 2023

Cholecystitis is a disease characterized by inflammation of the gallbladder (also called gallbladder) frequently caused by the presence of a stone wedged in the infundibulum of the gallbladder

The calculus, obstructing the outflow of bile as well as giving biliary colic, inflames the gallbladder cholecystitis lithiasica.

Cholecystitis can also be alitiasic, i.e. not caused by gallbladder stones.

Cholecystitis can also be divided into acute or chronic.

Causes of cholecystitis

The most common cause that blocks the flow of bile is gallstones, but biliary dyskinesia can also cause cholecystitis.

Gallbladder stones (or gallbladder lithiasis) represent a situation characterized by the presence of hard formations similar to stones, ranging in size from a few millimeters to a few centimeters, inside the gallbladder (or gallbladder).

It is a very frequent disease, present in 10-15% of the adult population with a greater diffusion in the female sex.

Overweight, type 2 diabetes, constipation, but also rapid weight loss due to highly hypocaloric diets, can predispose to the formation of stones.

Many of the patients with biliary lithiasis remain symptom-free for many years (about 50-70%) and may even never develop any.

In other cases, with a frequency that is difficult to estimate, the stones can cause symptoms or even severe complications, such as acute cholecystitis, empyema of the gallbladder, angiocolitis or acute pancreatitis.

There are several types of gallbladder (bladder) stones; those most frequent in the West are made up of cholesterol.

A correct diet can prevent the formation of stones or, if already present and symptomatic, reduce the episodes of biliary colic and, if indicated, improve the effectiveness of medical therapy with bile acids.

Signs and symptoms of a cholecystitis

Cholecystitis of both lithiasis and alithiasis causes generalized abdominal pain, vomiting, indigestion, jaundice, and fever.

The most common symptom referable with certainty to gallbladder stones is postprandial biliary colic, an acute and intermittent pain that occurs after eating, which corresponds to the attempt to move the stones in the obstructed bile duct.

Diagnosis is made with abdominal ultrasound and blood tests

Blood chemistry tests may be abnormal with white blood cells and fibrinogen rising, and fever may appear.

On abdominal ultrasound, the gallbladder appears thicker than normal and on physical examination, Murphy’s sign often appears (abrupt interruption of a deep inspiration following bidigital pressure on the gallbladder point).

Blumberg’s sign may appear in case of peritoneal irritation.

Complications

Cholecystitis is a frequent complication of cholelithiasis and if left untreated can lead to gallbladder perforation and peritonitis.

The gallbladder is followed by pancreatic cancer, cholangiocarcinoma, and pancreatitis.

Treatment of cholecystitis

For stones smaller than 10 mm, the administration of bile acids 10-15 mg/kg/day is used.

The method of choice is endoscopic retrograde cholangiopancreatography (ERCP).

The use of extracorporeal shock wave lithotripsy is indicated in combination with endoscopic treatment or in cases where the latter has been unsuccessful.

For symptomatic gallstone disease, laparoscopic or laparotomic cholecystectomy is performed.

Dietary and behavioral advice in case of cholecystitis

drink a lot of water;
prefer small and fractionated meals during the day to improve the motility of the gallbladder and reduce the risk of oversaturation in cholesterol of the bile;
prefer simple preparations such as steaming, grilling, grilling, grilling, baking, en papillote;
avoid an unbalanced diet, too rich in fat;
consume foods that help normalize gastric and intestinal transit;
follow the recommendations for a correct diet in the general population regarding the reduction of fats especially of animal origin, drinks and foods rich in sugars and the intake of adequate portions of fruit and vegetables;
In the event of overweight or obesity, it is recommended to reduce the weight and the “waistline”, i.e. the abdominal circumference, an indicator of the amount of fat deposited at the visceral level. Waist circumference values greater than 94 cm in men and 80 cm in women are associated with a “moderate” cardiovascular risk, values greater than 102 cm in men and 88 cm in women are associated with a “high risk”. Returning to a normal weight allows you to reduce the risk of gallbladder stones, but also to reduce other cardiovascular risk factors (such as arterial hypertension, hypercholesterolemia, hypertriglyceridemia, insulin resistance);
avoid fad diets! A too rapid weight loss can lead to the appearance of gallstones and also a too restricted diet prevents good compliance and increases the risk of regaining the lost weight with interest;
make your lifestyle more active (abandon a sedentary lifestyle! Go to work on foot, by bicycle or park far away, if you can avoid using the elevator and walk up the stairs);
exercise at least three times a week. The choice must always be made in the context of sports with aerobic characteristics, moderate intensity and long duration, such as cycling, aerobics, walking at 4 km per hour, swimming, which are more effective for eliminating excess fat and preventing cholelithiasis;
not smoking.

Foods not recommended

Spirits
Animal fats: butter, lard, lard, cream.
Sauces with cream, sauces cooked with large quantities of oil, margarine.
Mayonnaise and other elaborate sauces.
Meat broth, broth extracts, meat extracts, ready-made soups with these ingredients.
Sausages: mortadella, salami, sausage, pancetta, coppa, cracklings, cotechino, zampone, etc.
Oily fish and seafood.
Fatty, smoked, marinated and salted meats. Game and offal.
Spicy and fermented cheeses.
Whole milk.
Visible fat from meats and cold cuts.
Fast-food foods rich in hydrogenated (trans) fats, also present in many industrially prepared products, and ready-made dishes.
Desserts such as cakes, pastries, ice creams, puddings. Especially those filled with creams.
Sugary drinks.

Foods allowed but in moderation

Salt. It is a good rule to reduce the amount added to dishes during and after cooking and limit the consumption of foods that naturally contain large quantities of it (canned foods or brine, stock cubes and meat extracts, soy-type sauces).
Polyunsaturated or monounsaturated vegetable oils such as extra virgin olive oil, rice oil or monoseed oils: soy, sunflower, corn, peanuts (due to their calorific value control consumption by dosing them with a spoon).
Egg.
Dried fruit.

Recommended foods

Bread, rusks, breakfast cereals, dry biscuits, pasta, rice, polenta, barley, possibly wholemeal spelled.
Seasonal ripe fruit and vegetables (varying the colors to favor a suitable intake of vitamins and mineral salts).
Both red and white meats, lean and deprived of visible fat.
Cold cuts, raw ham, cooked ham, speck, bresaola, sliced turkey/chicken, without visible fat (1-2 times a week).
Fish, fresh and frozen.
Semi-skimmed milk and yoghurt.
Fresh and aged cheeses a couple of times a week to replace a second course of meat or eggs, such as 50 grams of Grana Padano, also recommended as a substitute for salt to flavor the first courses (10 grams a spoon). Grana Padano is a milk concentrate, but less fat than whole milk because it is partially skimmed during processing, its consumption increases the protein intake at meals and helps to reach the daily requirement of calcium and vitamins such as B12 and A.
Water, at least 1.5 liters a day to be distributed throughout the day.