Cholecystitis in Pregnancy

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Alexandra is five months pregnant. She’s been craving nothing but fast food—hamburgers, French fries, and vanilla milkshakes! Lately, though, after eating these foods, she has been experiencing stomach upset and a little pain under her right ribcage that radiates up her back to her right shoulder. She visits her physician who suspects Alexandra may have cholecystitis.

What is Cholecystitis?

Cholecystitis occurs when your gall bladder gets irritated and inflamed. The gall bladder is a small sac attached to your liver that stores bile, a brownish-greenish liquid that helps you digest food. The most common cause of cholecystitis is a stone that may block a duct through which bile is supposed to travel. When this happens, it is called cholelithiasis.

Pregnant women are especially at risk for gall stones because, while pregnant, hormonal changes cause the bile to contain more cholesterol than it would in the non-pregnant state. Furthermore, in pregnancy, the gall bladder doesn’t contract as it normally would (the contractions help keep fluids moving around and less prone to forming stones). Other causes of cholecystitis are tumors, sludge (bile that has thickened as a result of remaining in the gall bladder for too long), or infection.

What is the Gall Bladder?

The gall bladder is a small, hollow sac that resides under your liver and is attached to both the liver and the small intestine via the common bile duct. The gall bladder is considered an accessory organ to the digestive system, meaning that it is not officially considered to be a part of the digestive system. The main function of the gall bladder is to store bile that is produced in the liver. Bile is a substance that helps in the digestion of fats.

As the gall bladder is simply there to store extra bile produced by the liver, it is possible to live without it. Cholecystectomy (or gall bladder removal) is sometimes a treatment for complicated cholecystitis. In that case, instead of excess bile being stored in the gall bladder, bile would continuously be excreted into the small intestine from the liver.

What are the Symptoms of Cholecystitis?

Symptoms of cholecystitis include pain under the right rib cage that does or does not radiate to the right shoulder. Pain is often worse after eating a heavy or fatty meal. Symptoms can also include fever, pain to touch under the right ribcage, and nausea and vomiting.

Symptoms of cholecystitis include:

  • Pain under the right ribcage (could radiate to right shoulder)
  • Pain that worsens after a fatty meal
  • Fever
  • Pain to touch under right ribcage (called Murphy’s Sign)
  • Nausea and vomiting

How is Cholecystitis Evaluated?

Cholecystitis is most often evaluated using an ultrasound, which poses no risk to a pregnant woman. Furthermore, you will be given a blood test to determine if there is an infection.

What are the Risk Factors for Cholecystitis?

Risk factors for cholecystitis include:

  • Pregnancy
  • Being female
  • Obesity
  • Over age 40
  • Fatty diet
  • Rapid weight loss

How is Cholecystitis Treated in Pregnancy?

If your only symptoms are nausea and vomiting, then medications are given to try to decrease those symptoms. Similarly, if you have an infection, antibiotics will be prescribed.

If you’re having unmanageable pain or other complications as a result of gall stones, you may need to have your gall bladder removed via a procedure called a cholecystectomy. This procedure can be minimally invasive and performed by laparoscopy (small incisions through which surgical tools can operate) in the early trimesters of pregnancy. In the later stages of pregnancy, there may not be enough room in the abdomen to operate laparoscopically and a larger incision may need to be made under the right ribcage to visualize and remove the gall bladder.

Does Cholecystitis Pose a Risk to my Pregnancy?

If you’re unable to eat due to nausea and vomiting, that could prevent your baby from getting the proper nutrition to gain weight as she grows, resulting in a low birth weight. Infection of the gall bladder could cause preterm labor. Furthermore, gall stones are a leading cause of pancreatitis (inflammation of the pancreas) which could affect regulation of blood sugar. This could cause harm to both mom and baby.

In Summary

If you are having any of the above symptoms of cholecystitis—pain under the right ribcage that worsens with a heavy or fatty meal, pain under your right rib cage that radiates to your right shoulder, tenderness to touch under your right ribcage, fever, nausea and vomiting—visit your doctor for further evaluation.

Janette DeFelice
Dr. Janette DeFelice is a writer currently focusing on how the changing environment affects our health. She holds a Doctor of Medicine degree from Chicago Medical School where she taught clinical and diagnostic skills to beginning medical students, and a Master’s degree in Humanities from the University of Chicago. She also has a Bachelor’s degree in Political Science. Her writing can be seen online at BeTheChangeMom, ChicagoNow, and Medium, and she’s very excited to have published her first novel, Delia Rising: A Ballet in Three Acts. She lives in Chicago’s west suburbs with her school-age twins, her husband, and a family cat named Clara Barton.

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