What Is Cholecystitis?

The gallbladder lies beneath the liver on the upper right side of the belly. Between meals it stores bile, and when you eat it squeezes bile into the small intestine to break down fat. When the tube that drains it, the cystic duct, is blocked, bile backs up and the gallbladder becomes inflamed. Infection can follow.

Cholecystitis comes in two forms:

• Acute cholecystitis starts suddenly, most often because a gallstone blocks the cystic duct. It needs prompt attention.
• Chronic cholecystitis develops when the gallbladder is inflamed again and again, often from gallstones. Over time the wall of the gallbladder can thicken and harden, and it stops working as well.

Gallstones and cholecystitis are related but not the same thing. Gallstones are hardened deposits, usually of cholesterol, that range from the size of a pebble to a golf ball. Cholecystitis is the inflammation that can result when a stone blocks the flow. Many people have gallstones for years and never have symptoms, and those stones usually need no treatment.

Symptoms of Cholecystitis

Acute cholecystitis causes:

• Pain in the upper right belly, or in the middle just below the ribs, that is constant and may last for hours. It can spread to the back or below the right shoulder blade, and it often follows a large or fatty meal.
• Nausea and vomiting.
• Fever and chills.
• A tender belly, especially on the upper right when you press or take a deep breath.
• Yellowing of the skin and eyes (jaundice), or pale, clay-colored stools, if a stone is blocking the bile duct.

Chronic cholecystitis is milder and may come and go, with bloating, gas, indigestion, heartburn, discomfort after fatty or greasy food, and tiredness. Symptoms that do not ease with over-the-counter pain relievers, a change of position or passing gas deserve a medical visit.

When to Get Help Now

Call 911 or go to the emergency department for:

• Severe belly pain that comes on suddenly.
• Fever with yellowing of your skin or eyes.
• Vomiting along with being unable to pass gas or have a bowel movement.
• Vomiting blood, or black, tarry or bloody stools.
• Chest pain or sudden shortness of breath.

Call rather than driving; care begins when paramedics arrive.

Call your care team the same day for:

• Constant pain in the upper right belly that lasts longer than 30 minutes.
• Pain after fatty meals that keeps coming back.
• Nausea or vomiting that is getting worse, or that keeps you from holding down fluids.
• Pale, clay-colored stools or dark urine, which can mean a blocked bile duct.

When you cannot tell which list you are in, call and describe what is happening; if nobody can be reached and it looks like the first list, go.

Causes of Cholecystitis

Most cholecystitis comes from gallstones. A stone lodges in the cystic duct, bile backs up behind it, and the gallbladder swells, causing pain, inflammation and sometimes infection. Stones form when substances in bile, especially cholesterol, clump and harden, or when the gallbladder does not empty often enough.

Less often, cholecystitis results from:

• Infection of the gallbladder.
• Injury to the gallbladder.
• Tumors or other problems with the cystic duct.
• Acalculous cholecystitis, a rare form that occurs without gallstones, usually in people who are very ill or who have conditions such as diabetes or HIV.

Risk Factors for Cholecystitis

The risk factors for cholecystitis are mostly the risk factors for gallstones:

• Age over 40.
• Being female.
• Excess weight, or losing weight very fast.
• A diet high in fat and cholesterol, and low in fiber.
• Diabetes, liver disease and some blood disorders.
• A family history of gallstones.
• American Indian or Mexican American ancestry.

Prevention of Cholecystitis

Because gallstones are the main cause, the steps that lower your chance of gallstones also help here. Eat plenty of fruits, vegetables and whole grains, limit high-fat and fried foods, keep a regular eating schedule, drink enough water, and stay active. If you need to lose weight, aim for gradual loss rather than a fast drop, since rapid weight loss can raise the risk of gallstones. These steps lower the risk without removing it.

Diagnosis of Cholecystitis

Your doctor will ask about your pain, what brings it on, and your health history, and will examine your belly. Tests that help confirm cholecystitis and rule out other causes:

• Abdominal ultrasound. A painless scan that shows gallstones and swelling of the gallbladder wall. It is often the first test.
• Blood tests. They check for signs of infection or inflammation, and for liver or pancreas involvement.
• CT scan. A detailed scan used when the picture is unclear or complications are suspected.
• HIDA scan. A scan that follows a tracer through the liver and gallbladder to see whether bile flows normally.

Treatment Options for Cholecystitis

The plan depends on whether the condition is acute or chronic, how severe it is and your overall health, and you decide together with your surgeon.

Medicines and Hospital Care

Acute cholecystitis is often treated in the hospital with fluids through a vein, pain medicine, and antibiotics if infection is suspected. Eating is paused to rest the gallbladder. Milder chronic cases may be managed with diet changes and watching for flare-ups.

Procedures and Surgery

Removing the gallbladder, called a cholecystectomy, is the standard treatment for acute cholecystitis, often during the same hospital stay, and for repeated attacks or complications. Most gallbladder removals are done through several small incisions with a camera. Read more about gallbladder removal, laparoscopic surgery and robotic surgery. When a person is too ill for surgery, a drain placed through the skin can relieve the swelling until they are stronger.

Treating cholecystitis prevents complications such as infection that spreads, a gallbladder that ruptures, or pancreatitis. Your plan is your own, and a second opinion is welcome.

Living With Cholecystitis

If you have gallstones that cause no trouble, you can keep your usual routine, and know the warning signs. Pay attention to which foods bring on pain and adjust. Lean proteins, vegetables, fruit and whole grains are easier on the gallbladder than fried and fatty food, and regular meals and water help. If your gallbladder is removed, most people return to a normal diet, and some notice looser stools for a while at first.

When to Talk to Your Care Team

Tell your team if attacks of pain come more often, if foods you used to tolerate now cause pain, or if you have fever or yellowing. Before a visit, note when each attack started, how long it lasted and what you had eaten. After surgery, ask what to expect for eating and activity and when to call.

What Is a Hernia?

Your abdominal wall is made of layers of muscle and connective tissue that hold the organs inside. When one spot in that wall weakens or opens, tissue from inside, such as a loop of intestine or a piece of fat, can push through and form a bulge. Hernias are named for where they form:

• Inguinal hernia: in the groin. The most common kind.
• Femoral hernia: in the upper thigh, just below the groin.
• Umbilical hernia: at the navel.
• Epigastric hernia: in the upper middle belly, between the navel and the breastbone.
• Incisional hernia: along the scar of an earlier operation.
• Ventral hernia: a general term for a hernia in the front wall of the belly, including umbilical, epigastric and incisional hernias.
• Hiatal hernia: inside the body, where part of the stomach pushes up through the diaphragm. It can cause reflux and heartburn.

Some hernias are complex. Complex hernias have come back after earlier repairs, are very large, involve infected mesh from an earlier repair, form next to an ostomy (a parastomal hernia), or come with an abnormal connection between the intestine and the skin. They have a higher chance of complications and recurrence, and they often need a team experienced in rebuilding the abdominal wall.

Symptoms of Hernia

• A bulge in the groin, belly or along a scar that may appear when you stand, cough or strain and may flatten when you lie down.
• Aching, burning or pressure at the spot, often worse with lifting, bending or at the end of the day.
• A heavy or dragging feeling in the groin.
• Heartburn or reflux, with a hiatal hernia.
• Belly pain, constipation or nausea, with larger hernias.

Some hernias cause no symptoms at all. The size of the bulge does not always match how much it hurts.

When to Get Help Now

Call 911 or go to the emergency department for:

• A hernia that is hard, red, purple or dark, or that will not go back in.
• Severe or sudden belly pain.
• Vomiting along with being unable to pass gas or have a bowel movement.
• Chest pain or sudden shortness of breath.

These can be signs that tissue is trapped or has lost its blood supply, which needs surgery right away. Call rather than driving; care begins when paramedics arrive.

Call your care team the same day for:

• A bulge that is new or getting bigger but still goes back in when you lie down.
• Pain or aching that is increasing or keeping you from your usual activities.
• Redness, warmth or drainage at an incision after a repair.
• A fever over 101 degrees after surgery, or chills.

When you cannot tell which list you are in, call and describe what is happening; if nobody can be reached and it looks like the first list, go.

Causes of Hernia

A hernia occurs when pressure inside the belly meets a weak spot in the wall. Some spots are weak from birth. Others weaken over time or after surgery. Things that raise the pressure or wear down the tissue include:

• Aging, as muscle and connective tissue lose strength.
• Straining from chronic constipation, or from heavy lifting done again and again.
• Long-term coughing, such as with COPD or smoking.
• Added pressure from obesity or pregnancy.
• Earlier surgery, where the healed wall is not as strong as before, or a past repair that did not hold.

Risk Factors for Hernia

You are more likely to develop a hernia if you:

• Smoke.
• Have extra weight.
• Have a job or hobby that involves heavy lifting.
• Have had belly surgery before, or a hernia repair that failed.
• Have a family history of hernias.
• Have a chronic cough or ongoing constipation.

Having a risk factor does not mean you will have a hernia.

Prevention of Hernia

Not every hernia can be prevented, especially those that come from the way the body is built. A few steps lower the chances and help a repair last.

• Reach and keep a healthy weight.
• Stop smoking, which supports healing and eases the cough that strains the wall.
• Lift with your legs and ask for help with heavy loads.
• Treat constipation with fiber and fluids rather than straining.
• After surgery, follow your surgeon's activity limits so the incision can heal.

Diagnosis of Hernia

Most hernias are found with an exam. Your doctor looks at the area while you stand, and asks you to cough or bear down, which makes a bulge easier to see and feel. Tell your doctor when you first noticed it.

When the exam is not clear, or the hernia is deep, your doctor may order imaging:

• Ultrasound. A painless scan using sound waves, often used for groin and belly wall hernias.
• CT scan. An X-ray scan that shows the belly wall in detail, useful for large, recurrent or complex hernias and for planning repair.
• Upper GI series or endoscopy, for a suspected hiatal hernia.

Treatment Options for Hernia

There is no medicine that closes a hernia. The choice is between watching it and repairing it, and the decision belongs to you and your surgeon.

Monitoring and Support

For a small hernia with few or no symptoms, a surgeon may suggest watching it over time. Many hernias eventually grow or start to ache, so you will learn the warning signs and have regular checks. Treating a cough or constipation helps too.

Procedures and Surgery

Repair is the standard treatment for hernias that cause symptoms, and it is considered for others based on type and risk. The surgeon returns the tissue to its place and strengthens the wall, most often with a piece of surgical mesh for support. A repair can be done through one incision (open) or through several small incisions with a camera. Learn more about laparoscopic surgery, robotic surgery and minimally invasive surgery. Many repairs are outpatient. Complex hernias may require a longer operation and an overnight stay, and open surgery is sometimes the safer choice for a hard-to-reach hernia.

Your plan is your own, made with your surgeon, and it may include a visit with other specialists before surgery to lower risks such as smoking or high blood sugar.

Living With Hernia

If you are watching a hernia, learn how it normally looks and feels so that a change stands out. Avoid heavy lifting and straining where you can, and bring up any new pain. After a repair, light activity returns within days to weeks, and full recovery often takes several weeks; avoid heavy lifting and strenuous exercise until your surgeon clears you. Keep follow-up visits, since a repair is checked as it heals.

When to Talk to Your Care Team

Contact your team if a bulge grows, pain increases, or a repaired area looks different. Bring a list of your medicines, details of any past surgeries, and your questions: which approach is best for you and why, how pain is managed, the chance of recurrence, whether mesh is used and what the risks and benefits are, and when to call after surgery.

What Is a CT Scan?

A CT scanner is a large, open ring with a table that slides through it. Inside the ring, an X-ray tube turns around you and sends thin beams through the body. Detectors on the other side measure how much of each beam passes through. Dense tissue such as bone blocks more X-rays than soft tissue, fat or air, and the computer uses those differences to build the images.

The images can be viewed slice by slice or combined into three-dimensional pictures. A radiologist, a doctor who specializes in reading imaging tests, studies them and writes a report.

Kinds of CT Scans

• CT with contrast. A contrast dye, usually given through a vein in your arm, makes blood vessels, organs and some tumors stand out more clearly. For a scan of the belly, you may also drink a contrast liquid.
• CT without contrast. Some questions, such as looking at the lungs or for kidney stones, are answered without dye.
• Low-dose CT. A scan that uses less radiation, used to screen for lung cancer in people at high risk. See lung cancer screening.
• CT-guided biopsy. The scanner shows the doctor where to place a needle to take a sample. See biopsy.
• PET-CT. A CT scan combined with a PET scan, which shows how active tissue is. See PET-CT scan.

Why a CT Scan Is Ordered

A CT scan can help your care team:

• Look for the cause of symptoms, such as pain, a lump or unexplained weight loss.
• Find and measure a tumor, including its exact location and size.
• Stage cancer, which means learning whether it has spread to lymph nodes or other organs. Staging guides the treatment plan.
• Plan treatment, such as surgery or radiation therapy.
• Check how treatment is working and watch for cancer coming back afterward.
• Find related problems, such as a blood clot in the lungs, which people with cancer have a higher chance of developing.

Who Needs One

Your doctor orders a CT scan when the answer to a question depends on a detailed picture. A CT scan is helpful in many conditions, and it has limits. It does not replace a colonoscopy for finding colon cancer or polyps, for example, and a mammogram remains the test used to screen for breast cancer. Your doctor will choose the test that fits your question, which may be an MRI or ultrasound instead.

How to Prepare

Follow the instructions your care team or the imaging center gives you, since they depend on the part of the body being scanned and whether contrast is used.

• Food and drink. If you will receive contrast, you may be asked not to eat for a few hours beforehand. Clear liquids are often allowed.
• Allergies. Tell your care team if you have ever reacted to contrast dye or have other serious allergies. You may receive medicine beforehand to lower the chance of a reaction.
• Kidney health and diabetes. Contrast is cleared by the kidneys. Say if you have kidney disease or diabetes, or take metformin, since you may need a blood test first or a change in your medicines.
• Pregnancy. Tell your care team if you are pregnant or might be.
• Clothing. Wear loose clothes and leave jewelry at home. You may change into a gown, since metal can blur the images.
• Belly scans. If you need to drink contrast, you may be asked to arrive early to finish it.

What Happens During the Test

A technologist will bring you to the scanner room and help you lie on the table, usually on your back. If you are having contrast through a vein, a small IV line is placed in your arm.

The table moves slowly through the ring. The technologist watches from the next room, can see and hear you the whole time, and will talk you through each step. You may hear buzzing or clicking. You will be asked to hold still and to hold your breath for a few seconds at a time, because movement blurs the pictures.

When contrast goes in, you may feel warm all over or notice a metallic taste. Some people feel as if they need to urinate. These feelings pass within a minute or two.

The scan itself usually takes only a few minutes. The whole visit, including any contrast you drink, can take longer. Afterward, you can usually go back to your normal activities right away. Drink plenty of fluids to help your body clear the contrast.

Risks

• Radiation. A CT scan uses more radiation than a plain X-ray. Your care team weighs this small risk against the value of the information, and uses the lowest dose that gives clear images.
• Contrast reactions. Most people have no reaction. A mild reaction can cause itching, a rash or hives. Serious reactions are rare, and the staff is trained to treat them right away.
• Kidney effects. In people whose kidneys already work less well, contrast can affect kidney function, which is why your care team may check a blood test first.
• Pregnancy. Radiation can affect a developing baby, so a different test may be chosen.

Call your care team the same day for a rash, hives or itching that starts after your scan, or swelling or pain where the IV was placed.

Call 911 or go to the emergency room for trouble breathing, swelling of your face or throat, chest pain, or fainting.

Understanding Your Results

A radiologist reads your images and sends a report to the doctor who ordered the scan. Your doctor will share the results with you and explain what they mean. Results are often ready within a few days. Many patients can also see the report in the patient portal, sometimes before their doctor has reviewed it, so it is fine to wait for your appointment to talk it through.

The report describes what the radiologist saw: the size and location of any area of concern, and whether lymph nodes or organs look normal. A scan can show that something is there, and often what it is likely to be. Confirming cancer usually takes a biopsy.

During cancer care, your scans are compared over time to see whether a tumor is shrinking, stable or growing. Your care team reviews your scans together and uses them to plan your next step.

What Is an Appendectomy?

An appendectomy removes the whole appendix. The surgeon closes off the base of the appendix where it joins the large intestine, closes off its blood supply, and lifts it out. If the appendix has burst, the surgeon also washes out the belly and may leave a small drain.

The operation is done under general anesthesia, so you are asleep and feel nothing. A simple laparoscopic appendectomy usually takes about an hour.

Kinds of Appendectomy

• Laparoscopic appendectomy. The surgeon makes two or three small incisions in the belly and works with a thin camera and slim instruments. This is the most common approach, with less pain and a quicker return home. See laparoscopic surgery.
• Robotic appendectomy. The surgeon controls the instruments from a console using a robotic system, through the same kind of small incisions. See robotic surgery.
• Open appendectomy. The surgeon makes one incision in the lower right belly. It may be used when the appendix has burst, when there is an abscess, or when scarring from past surgery makes small incisions unsafe.
• Appendectomy with more extensive surgery. For some tumors of the appendix, the surgeon also removes the nearby part of the large intestine and lymph nodes, an operation called a right hemicolectomy. See colectomy.

Why an Appendectomy Is Performed

The most common reasons are:

• Appendicitis, an infection and swelling of the appendix. Its classic sign is pain that starts around the navel and moves to the lower right belly, with fever, nausea and loss of appetite.
• A burst appendix or an abscess. Sometimes the infection is treated first with antibiotics and drainage, and the appendix is removed weeks later, called an interval appendectomy.
• A tumor of the appendix, such as a neuroendocrine tumor or a mucinous growth, found on a scan, during another operation, or when the removed appendix is examined. See appendiceal cancers and neuroendocrine tumors.

Who Is a Candidate

Most people with appendicitis are advised to have surgery. For some adults with mild appendicitis that has not burst, antibiotics alone are an option, though the appendicitis returns for some people and they then need surgery. Your surgeon will talk through which choice fits your scans, your health and your preferences. For a tumor, the type and size decide whether an appendectomy alone is enough.

How to Prepare

For appendicitis, preparation happens quickly in the hospital: you stop eating and drinking, an IV is placed, and you receive fluids, pain medicine and antibiotics. For a planned operation:

• Medicines. Give your team a full list, including blood thinners and supplements, and ask which to pause.
• Food and drink. You will be told not to eat or drink for a set number of hours before surgery.
• Smoking. Stopping smoking before surgery helps healing.
• A ride home. Arrange for someone to drive you and stay with you the first night.
• Questions. For a tumor, ask whether more surgery or tests may be needed after the pathology results.

Your surgical team will give you written instructions that fit your situation.

What to Expect

During the Procedure

You meet your surgical team and anesthesia puts you to sleep. In a laparoscopic or robotic operation, the surgeon fills the belly with gas to make room to see, removes the appendix through one of the small incisions in a protective bag, then closes the incisions with stitches or glue.

After the Procedure

You wake in a recovery area where nurses watch your breathing and pain. After a laparoscopic appendectomy for appendicitis that has not burst, many people go home the same day or the next day. After a burst appendix, the stay is often several days, with antibiotics through an IV.

Recovery

Soreness at the incisions, and shoulder pain from the gas, are common for a few days. Most people walk the same day and return to light activity and desk work within one to two weeks. Avoid heavy lifting for a few weeks, or as your surgeon advises; recovery takes longer after open surgery or a burst appendix. Eat light meals at first.

Call 911 for chest pain or trouble breathing, vomiting blood or black, tarry stools, bleeding that will not stop, or fainting. Call your care team the same day for a fever of 100.4 degrees or higher, belly pain that is getting worse, redness, swelling or drainage at an incision, vomiting that keeps you from drinking, or no bowel movement for several days.

Risks and Complications

Appendectomy is a common operation with a low rate of serious problems. The risks include:

• Infection at an incision, or an abscess inside the belly, more often after a burst appendix.
• Bleeding.
• Injury to the bowel or nearby organs, which is uncommon.
• A slow return of bowel function for a few days after surgery.
• Hernia at an incision, later on.
• Blood clots and reactions to anesthesia.
• Switching to open surgery when the operation cannot be finished safely through small incisions, which keeps you safe.

Your surgeon will talk through the risks as they apply to you.

Results of Appendectomy

Removing the appendix cures appendicitis, and it almost never comes back. Digestion and the immune system work normally without the appendix. The pathology report usually confirms simple inflammation. If it finds a tumor, your surgeon will explain the type and size; a small neuroendocrine tumor fully removed often needs no more treatment beyond follow-up, while others may need more surgery or other care planned with a cancer team.

What Is Gallbladder Removal?

Gallbladder removal, called a cholecystectomy, is an operation that takes out the entire gallbladder, a small pouch under the liver. The surgeon closes off the duct and the blood vessel that serve it, then lifts the gallbladder out. A person does not need a gallbladder to digest food, because bile still reaches the intestine from the liver by other routes.

The operation is done under general anesthesia, so you are asleep and feel nothing. Most gallbladder removals take about an hour or two, though the time varies.

Kinds of Gallbladder Removal

• Laparoscopic gallbladder removal. The surgeon makes several small incisions in the belly and places a thin tube with a camera and slim instruments through them. This is the most common approach. See laparoscopic surgery.
• Robotic gallbladder removal. The surgeon operates from a console using a robotic system that gives a magnified 3D view and precise instrument control, through the same kind of small incisions. See robotic surgery.
• Open gallbladder removal. The surgeon makes one larger incision under the ribs on the right. It is used when minimally invasive surgery cannot be done safely, for example because of scarring from earlier operations or inflammation, or when the surgeon decides during the operation to switch.

You can read more about the minimally invasive approaches at minimally invasive surgery.

Why Gallbladder Removal Is Performed

Surgery is recommended for gallbladder problems that keep coming back or cause complications, including:

• Gallstones that cause symptoms, such as repeated attacks of pain in the upper right belly.
• Stones in the bile duct, which can block the flow of bile.
• Cholecystitis, inflammation of the gallbladder, especially after repeated attacks. See cholecystitis.
• Pancreatitis caused by gallstones.
• Gallbladder cancer, where surgery is usually the main treatment.

For mild or occasional symptoms, your doctor may first suggest diet changes and medicine for pain while you decide about surgery. Gallstones often return and cause worse symptoms over time, so removal may be the most effective long-term answer.

Who Is a Candidate

You may be a candidate if gallstones or gallbladder inflammation cause symptoms that affect your life, if you have had a serious attack, or if testing shows a complication. Gallstones found by chance that cause no symptoms generally do not need removal. Your surgeon will review your symptoms, scans and overall health, and the decision is yours to make together.

How to Prepare

• Medicines. Give your team a full list, including blood thinners and supplements. Ask which to take or pause before surgery.
• Food and drink. You will be asked not to eat or drink for a set number of hours before the operation, and your team will tell you exactly how long.
• Smoking and alcohol. Stopping smoking before surgery supports healing.
• A ride home and help at home. Anesthesia makes driving unsafe for the rest of the day, so arrange for someone to take you home and stay with you the first evening.
• What to bring. Photo ID, insurance cards and your medicine list.

Your surgical team will give you written instructions that fit your situation, and you can call with any question before the day.

What to Expect

During the Procedure

You meet your surgical team, an IV is placed, and anesthesia puts you to sleep. In a laparoscopic or robotic operation, the surgeon fills the belly with gas so there is room to see, makes small incisions, frees the gallbladder and removes it through one of them. In some cases the surgeon takes X-ray pictures of the bile ducts during the operation to look for stones. The incisions are closed with stitches or glue.

After the Procedure

You wake in a recovery area where nurses watch your breathing, pain and nausea. Most people having a laparoscopic or robotic removal go home the same day, and some stay overnight. An open removal usually means a longer stay of a few days.

Recovery

Soreness at the incisions and shoulder pain from the gas used during surgery are common for a day or two. Most people are walking the same day and return to desk work and light activity within about a week. Avoid heavy lifting until your surgeon says it is safe, and expect a full return to usual activities in a few weeks, and up to six weeks after an open operation. Start with light, low-fat meals and add other foods as you feel able. Some people have looser stools for a few weeks, and it usually resolves.

Call 911 for chest pain, sudden shortness of breath, severe belly pain, vomiting blood or black stools, bleeding that will not stop, or fainting. Call your care team the same day for a fever over 101 degrees, redness, swelling or drainage at an incision, pain that is getting worse, nausea or vomiting that keeps you from drinking, or dark urine and pale stools.

Risks and Complications

Gallbladder removal is a common operation with a low rate of problems. The risks include:

• Bleeding and infection at the incisions or inside the belly.
• Bile leak, where bile escapes from the duct stump or a small duct, which may need a drain or a second procedure.
• Injury to the bile duct, which is uncommon, and sometimes needs repair.
• Injury to nearby organs, such as the intestine or a blood vessel.
• A stone left in the bile duct.
• Blood clots in the legs, and reactions to anesthesia.
• Switching to open surgery if the surgeon cannot finish safely through small incisions. This is not a failure and keeps you safe.

Your surgeon will talk through the risks as they apply to you.

Results of Gallbladder Removal

For most people, removal ends the attacks of pain and the risk of the complications that gallstones cause. Digestion changes little, and most people eat a regular diet. A small number have lasting digestive symptoms such as bloating or loose stools, which can be managed with diet and treatment. Your surgeon will go over what to expect for the problem that led to your operation and arrange follow-up.

The First Hours

An acute attack is usually treated in the hospital. Expect fluids through a vein, pain medicine, antibiotics if infection is suspected, and a pause on eating so the gallbladder can rest. The person in the bed may be hungry, cranky and frightened all at once, and none of it is personal.

Your useful jobs in this stretch are small ones:

• Answer for them when they are too sore to. When did the pain start, what had they eaten, has it happened before.
• Bring the lists. Their medicines, allergies and any earlier surgeries.
• Hold the questions. Do they need surgery, and when? Many people do, particularly after repeated attacks or complications, and the surgeon explains which fits. Write down what you hear, because hospital hours blur.
• Accept the empty stomach. Skip the snack you brought until you are asked. Eating is paused on purpose.

While You Wait for the Surgeon

Removing the gallbladder, called a cholecystectomy, is the standard treatment for acute cholecystitis. It is often done during the same hospital stay, and most removals use several small incisions and a camera. Open surgery, with a larger incision, is sometimes the safer route for a gallbladder that is badly inflamed, infected or scarred, and it means a longer stay.

If the operation is planned for a later date, as it can be after a milder attack, use the wait well:

• Keep the food they are tolerating on hand and note the ones that bring on pain.
• Know the warning signs below by heart. A second attack before surgery is the reason that list exists.
• Arrange a ride home and a second pair of hands for the first night.

A second opinion is welcome.

Home From Surgery

NIDDK describes many laparoscopic gallbladder removals as outpatient, with a return to normal physical activity in about a week, and open surgery as closer to a month. MedlinePlus notes many people are discharged the same day or the next morning.

For the first days, you are the person who:

• Drives and stays. Anesthesia and pain medicine leave people tired and forgetful. Treat the first night as a night someone else should be in the house.
• Looks at the small cuts each day. A few small incisions is a small number of places to check. Look for redness, warmth, drainage or a spreading bruise, and report what you see.
• Keeps the walking going. Ask the surgeon how much walking to build up to, and walk with them.
• Handles what is heavy. Until the surgeon clears them, the groceries and the laundry are yours.

Eating Again

Eating is the part of this recovery that touches every meal in the house, and it is the part most families worry about. The reassuring facts are that the body copes well without the gallbladder, bile still reaches the intestine, and most people return to a normal diet. Some notice looser stools for a while at first, which NIDDK describes as usually temporary. Tell the care team if it continues.

What helps at home:

• Start with light food. Broth, rice, toast, fruit and lean protein are easier on a digestive system that is waking up than a plate of fried food.
• Cook one dinner for the table. A lighter meal for everyone is easier than a separate plate and spares them from watching you eat something rich.
• Let them lead. If a food bothers them, it gets set aside and tried again later. You are the cook, and you do not need to be the diet monitor.

When to Call 911, and When a Same-Day Call Is Enough

Most gallbladder days are ordinary. A few signs mean the gallbladder, the bile ducts, the liver or the pancreas need attention fast, and they do not wait for a call back.

Call 911 right away for:

• Severe belly pain that comes on suddenly.
• Fever with yellowing of the skin or eyes.
• Vomiting along with being unable to pass gas or have a bowel movement.
• Vomiting blood, or black, tarry or bloody stools.
• Chest pain or sudden shortness of breath.
• Fainting.

Let the ambulance come to you rather than driving.

Call their surgeon or care team the same day for:

• Constant pain in the upper right belly that lasts longer than 30 minutes.
• Pain after fatty meals that keeps coming back.
• Nausea or vomiting that is getting worse or keeps them from holding down fluids.
• Pale, clay-colored stools or dark urine.
• Yellowing of the skin or eyes without a fever.
• Redness, warmth or drainage at an incision after surgery.
• A fever over 101 degrees after surgery, or chills.

When you are unsure, phone and tell them what you are seeing. If you reach no one and it reads like the first list, go. You will not be wrong for asking.

Take Care of Yourself, Too

A gallbladder attack can come on suddenly, and the first one can send a household through a night in the emergency department. Then comes the week of cooking differently, driving to appointments and listening for the next bout of pain.

Sleep when they sleep. Let a friend bring a dinner that is not fried. And ask yourself when you last had your own checkup, since people who cook, drive and worry for someone else often put that off. The three-minute check-in for caregivers is a fair place to start.

A Pain Diary Is Worth a Page

You are in the kitchen when the pain starts, which makes you the best witness the surgeon will ever have. Jot the time an attack began, how long it lasted and what was on the plate. Add any change since surgery: stools, appetite, how the incisions look.

Bring the page to the visit and use it to ask the questions that fit this household: what to expect for eating and activity, and when to call. The surgeon works from what the notes show, and the notes are yours.

For where gallbladder removal is done and who does it, see Orlando Health Medical Group Surgery and Florida Medical Clinic Orlando Health General Surgery.

The Weeks Before

Most of the useful work happens in the days before surgery day, and none of it needs medical training.

• Go to the visit if they want company. A surgeon visit covers a lot: which approach, whether mesh is used, how pain is managed, when to call. Two people hear more than one. Write the answers down.
• Gather the lists. A current list of their medicines and a short list of any earlier operations. The surgeon asks for both.
• Help with the health work the surgeon may ask for. Some plans include a visit before surgery to lower risks such as smoking or high blood sugar. If they are working on either, make it easier at home rather than keeping score.
• Stock the kitchen for easy digestion. Straining is the thing to avoid while a repair heals. Fruit, beans, whole grains and a full water jug are the cheapest insurance in the house.
• Plan the ride and the first two days. Someone needs to drive them home and stay for the first stretch.

Follow the instructions the surgery team gives for food, drink and medicines on the morning of the operation. Those instructions are theirs to set.

The Day Itself

Many repairs are outpatient, so the person leaves within hours. Large or complex repairs can mean an overnight stay, and the Comprehensive Hernia Center notes that most people having a complex hernia repair stay at least one night.

You are the driver, the note taker and the person who asks the one extra question. When the nurse reviews the discharge instructions, listen for four things and write them down: the lifting limit, how to care for the incision, which pain medicines to take and when, and the number to call.

Anesthesia and pain medicine can leave a person tired and forgetful for a day or two. The American College of Surgeons advises no driving, alcohol or big decisions for at least two days after surgery. If they agree to something that sounds odd on the ride home, that is the medicine talking.

The First Weeks at Home

The first few days are for rest. Families often tell us the stretch to watch comes later, when the pain has faded, they feel fine and they go for the heavy thing. Your job is to get there first.

Lifting. Surgeons set a limit for each person and each repair. The American College of Surgeons describes avoiding anything over 10 pounds for at least six weeks after a ventral hernia repair, and a longer limit after a complex or recurrent repair. The Comprehensive Hernia Center describes a return to daily activities two to five weeks after surgery and to regular exercise after about six weeks. Ten pounds is a little more than a gallon of milk. Take the groceries, the laundry basket, the grandchild, the bag of dog food and the suitcase.

Walking. Short walks several times a day lower the risk of blood clots and keep the bowels moving. Walk with them.

The incision. Showering is usually fine in a day or two, with water running over the incision and no scrubbing. No bathtub soaking until the stitches, strips or staples are out. Skin glue flakes off by itself. A little drainage is normal.

Eating and the toilet. Fiber and fluids, and no straining. If three days pass with no bowel movement, call the surgeon's office.

The mood. Pain, a hard-to-reach itch and a body that will not do what it did last month wear on a person. Let them be irritable, and let them be bored.

When to Call 911, and What Can Wait for a Same-Day Call

A hernia can become an emergency when tissue gets trapped and loses its blood supply. That needs surgery right away, and it cannot wait for a callback.

Call 911 right away for:

• A hernia that is hard, red, purple or dark, or that will not go back in.
• Severe or sudden belly pain.
• Vomiting along with being unable to pass gas or have a bowel movement.
• Vomiting blood, or black, tarry or bloody stools.
• Chest pain or sudden shortness of breath.
• Fainting.

Do not drive them yourself. The paramedics start care when they reach you.

Call the surgeon's office the same day for:

• A bulge that is new or getting bigger but still goes back in when they lie down.
• Pain that keeps climbing or keeps them from usual activities.
• Redness, warmth or drainage at an incision.
• A fever over 101 degrees after surgery, or chills.
• Three days with no bowel movement after surgery.

If the two lists blur, call and say what is happening. When no one answers and the signs match the first list, go. A call that turns out to be nothing is a good outcome.

Take Care of Yourself, Too

The extra lifting lands on you, along with the driving, the meals and the worry, and it lands during the same weeks you may be at work. Two trips beat one hero trip, and a sore back on your side of the house helps nobody.

Say aloud when the load is too much, so a neighbor, a sibling or a friend can take the school run or a dinner. When did you last see your own doctor? Our short self-check for the person doing the helping takes a few minutes and is only about you.

What Only You Will Notice at the Kitchen Counter

The surgeon sees the repair for a few minutes at a follow-up visit. You see the walk to the mailbox, how they get out of a chair, what they skipped at dinner and whether the bulge looks the way it did last week. Say what you have seen, with their blessing, when you call or at the checkup.

The follow-up visit exists because a repair is checked as it heals. Get them there, and ask the one question that decides where your help goes next: what is the next thing they are cleared to do, and what should you still lift for them?

Orlando Health surgeons repair every kind of hernia. If you are looking for the team, start with the Comprehensive Hernia Center, Orlando Health Medical Group Surgery or Florida Medical Clinic Orlando Health General Surgery.