The gallbladder is sac-shaped like a pear, and it is located on the underside of the right lobe of the liver. The Cholecystitis involves a chronic inflammation of the gallbladder wall that may or may not be in response to cystic duct obstruction by gallstones (calculi). The inflammation results in a thick-walled, fibrotic, contracted gallbladder.

Chronic cholecystitis is thought to be caused by chemical or mechanical irritation or both. The irritation is related to stones which put pressure on the mucosa, or from a condition of biliary stasis. The chronic form of cholecystitis is frequently preceded by various acute attacks of modest severity.

Signs and symptoms of chronic cholecystitis may include: a history of intolerance to fatty foods; gaseous eructations (belching) after meals; flatus; colic; diarrhea; dyspepsia; abdominal distention; nausea; and vomiting. In addition, other manifestations may include: pain in the right upper quadrant or referred pain to the right scapula; fever; tachycardia; possible jaundice; clay-colored stools; and leukocytosis.

Diagnostic measures include: ultrasonography; hepatobiliary scanning; percutaneous transhepatic cholangiography tests; HIDA scan; endoscopic retrograde cholangiopancreatography (ERCP); abdominal x-ray; oral cholecystography; laboratory blood tests; and electrocardiogram (EKG).

If stones are present with chronic cholecystitis, then a cholecystectomy or cholecystectomy with cholangiography is performed. Lithotripsy (the ultrasonic breakup of gallstones) may be performed; however, laparoscopic cholecystectomy may be the surgical procedure of choice. Non-surgical interventions may include drug therapy. When stones are not present, treatment may include antispasmodics, low-fat diet, laxatives, rest, and analgesic medications.

Residuals may depend on the extent of measures needed to control symptoms. They may vary from no residuals to any combination of manifestations.

• None.

• Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. [38 CR 4.114]

• There are diseases of the digestive system, particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia and disturbances in nutrition. Consequently, certain coexisting diseases in this area, as indicated in the instruction under the title “Diseases of the Digestive System,” do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in 38 CFR 4.14.  [38 CFR 4.113]