Alternative Names

Cholecystitis - acute

Definition

Acute cholecystitis is a sudden inflammation of the gallbladder that causes severe abdominal pain.

Causes

In 90% of cases, acute cholecystitis is caused by gallstones in the gallbladder. Severe illness, alcohol abuse and,
rarely, tumors of the gallbladder may also cause cholecystitis.

Acute cholecystitis causes bile to become trapped in the gallbladder. The build up of bile causes irritation and
pressure in the gallbladder. This can lead to bacterial infection and perforation of the organ.

Gallstones occur more frequently in women than men. Gallstones become more common with age in both
sexes. Native Americans have a higher rate of gallstones.

Symptoms

The main symptom is abdominal pain -- particularly after a fatty meal -- that is located on the upper right side
of the abdomen. Occasionally, nausea and vomiting or fever may occur.

Exams and Tests

A doctor's examination of the abdomen by touch (palpation) may reveal tenderness.

Tests that detect the presence of gallstones or inflammation include:

• Abdominal ultrasound
• Abdominal CT scan
• Abdominal x-ray
• Oral cholecystogram
• Gallbladder radionuclide scan
• A CBC shows infection by an elevated white blood cell count.

Treatment

Although cholecystitis may clear up on its own, surgery to remove the gallbladder (cholecystectomy) is usually
needed when inflammation continues or recurs.

This operation is done as soon as possible, unless the patient is very ill or if the inflammation is thought to have
been present for many days. Emergency surgery may be necessary if gangrene (tissue death), perforation,
pancreatitis, or inflammation of the common bile duct occurs.

Occasionally, in very ill patients, a tube may be placed through the skin to drain the gallbladder until the patient
gets better and can have surgery.

Nonsurgical treatment includes pain medicines, antibiotics to fight infection, and a low-fat diet (when food can
be tolerated). Patients usually need one or more doses of antibiotics.
Outlook (Prognosis)

Patients who have cholecystectomy usually do very well.

Possible Complications

• Empyema (pus in the gallbladder)

• Peritonitis (inflammation of the lining of the abdomen)
• Gangrene (tissue death) of the gallbladder
• Injury to the bile ducts draining the liver (a rare complication of cholecystectomy)

When to Contact a Medical Professional Return to top

Call your health care provider if severe abdominal pain persists.

Call for an appointment with your health care provider if symptoms of cholecystitis recur after an acute episode.

Prevention Return to top

Removal of the gallbladder and gallstones will prevent further attacks. Reduce the fat content in the diet if you
are prone to attacks of cholecystitis.

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Complications of Cholecystitis?

If not treated properly or soon, complications may develop. Common complications of

cholecystitis are:

• pus in the gallbladder

• inflammation of the lining of the abdomen
• tissue death of the gallbladder

Cholecystitis - Overview

What is cholecystitis?

Cholecystitis is inflammation of the gallbladder, a small organ near the liver that plays a part in digesting food.
Normally, fluid called bile passes out of the gallbladder on its way to the small intestine. If the flow of bile is
blocked, it builds up inside the gallbladder, causing swelling, pain, and possible infection.

What causes cholecystitis?

A gallstone stuck in the cystic duct, a tube that carries bile from the gallbladder, is most often the cause of
sudden (acute) cholecystitis. The gallstone blocks fluid from passing out of the gallbladder. This results in an
irritated and swollen gallbladder. Infection or trauma, such as an injury from a car accident, can also cause
cholecystitis.
Acute acalculous cholecystitis, though rare, is most often seen in critically ill people in hospital intensive care
units. In these cases there are no gallstones. Complications from another severe illness, such as HIV or diabetes,
cause the swelling.

Long-term (chronic) cholecystitis is another form of cholecystitis. It occurs when the gallbladder remains
swollen over time, causing the walls of the gallbladder to become thick and hard.

What are the symptoms?

The most common symptom of cholecystitis is pain in your upper right abdomen that can sometimes move
around to your back or right shoulder blade. Other symptoms include:

• Nausea or vomiting.
• Tenderness in the right abdomen.
• Fever.
• Pain that gets worse during a deep breath.
• Pain for more than 6 hours, particularly after meals.

Older people may not have fever or pain. Their only symptom may be a tender area in the abdomen.

How is cholecystitis diagnosed?

Diagnosing cholecystitis begins when you describe your symptoms to your doctor. A physical exam follows.
Your doctor will carefully feel your right upper abdomen looking for tenderness. You may have blood drawn
and an ultrasound, a test that uses sound waves to create a picture of your gallbladder. Ultrasound may reveal
gallstones, thickening of the gallbladder wall, extra fluid, and other signs of cholecystitis. This test also allows
doctors to check the size and shape of your gallbladder.

You could also have a gallbladder scan, a nuclear scanning test that checks how well your gallbladder is
working. It can also help find blockage in the tubes (bile ducts) that lead from the liver to the gallbladder and
small intestine (duodenum).

How is it treated?

Treatment for cholecystitis will depend on your symptoms and your general health. People who have gallstones
but don't have any symptoms may need no treatment. For mild cases, treatment includes bowel rest, fluids and
antibiotics given through a vein, and pain medicine.

The main treatment for acute cholecystitis is surgery to remove the gallbladder (cholecystectomy). Often this
surgery can be done through small incisions in the abdomen (laparoscopic cholecystectomy), though sometimes
it requires a more extensive operation. Your doctor may try to reduce swelling and irritation in the gallbladder
before removing it. Occasionally acute cholecystitis is caused by one or more gallstones becoming stuck in the
main tube leading to the intestine, called the common bile duct. Treatment may involve an endoscopic
procedure (endoscopic retrograde cholangiopancreatography, or ERCP) to remove the stones in the common
bile duct before the gallbladder is removed.

In rare cases of chronic cholecystitis, you may also receive medicine that dissolves gallstones over a period of
time.