Signs and symptoms[edit]

Location of the gallbladder

Most people with gallstones do not have symptoms.[1] When a gallstone lodges in the cystic duct,
they experience biliary colic.[1] Biliary colic is abdominal pain in the right upper quadrant or epigastric
region. It is episodic, occurs after eating greasy or fatty foods, and leads to nausea and/or
vomiting.[13] People who suffer from cholecystitis most commonly have symptoms of biliary colic
before developing cholecystitis. The pain becomes more severe and constant in cholecystitis.
Nausea is common and vomiting occurs in 75% of people with cholecystitis.[14] In addition to
abdominal pain, right shoulder pain can be present.[13]
On physical examination, fever is common.[14] A gallbladder with cholecystitis is almost always tender
to touch.[13] Because of the inflammation, its size can be felt from the outside of the body in 25–50%
of people with cholecystitis.[13] Pain with deep inspiration leading to termination of the breath while
pressing on the right upper quadrant of the abdomen usually causes pain (Murphy's sign). Murphy's
sign is sensitive, but not specific for cholecystitis.[15] Yellowing of the skin (jaundice) may occur but is
often mild. Severe jaundice suggests another cause of symptoms such
as choledocholithiasis.[14] People who are old, have diabetes, chronic illness, or who are
immunocompromised may have vague symptoms that may not include fever or localized
tenderness.[16]

Complications[edit]
A number of complications may occur from cholecystitis if not detected early or properly treated.
Signs of complications include high fever, shock and jaundice. Complications include the following:[13]

 Gangrene
 Gallbladder rupture
 Empyema
 Fistula formation and gallstone ileus
 Rokitansky-Aschoff sinuses
Gangrene and gallbladder rupture[edit]
Cholecystitis causes the gallbladder to become distended and firm. Distension can lead to
decreased blood flow to the gallbladder, causing tissue death and eventually gangrene.[13] Once
tissue has died, the gallbladder is at greatly increased risk of rupture (perforation). Rupture can also
occur in cases of chronic cholecystitis.[13] Rupture is a rare but serious complication that leads
to abscess formation or peritonitis.[14] Massive rupture of the gallbladder has a mortality rate of
30%.[13]
Empyema[edit]
Untreated cholecystitis can lead to worsened inflammation and infected bile that can lead to a
collection of pus surrounding the gallbladder, also known as empyema.[13] The symptoms of
empyema are similar to uncomplicated choleystitis but greater severity: high fever, severe abdominal
pain, more severely elevated white blood count.[13]
Fistula formation and gallstone ileus[edit]
The inflammation of cholecystitis can lead to adhesions between the gallbladder and other parts of
the gastrointestinal tract, most commonly the duodenum.[13] These adhesions can lead to the
formation of direct connections between the gallbladder and gastrointestinal tract,
called fistulas.[13] With these direct connections, gallstones can pass from the gallbladder to the
intestines. Gallstones can get trapped in the gastrointestinal tract, most commonly at the connection
between the small and large intestines (ileocecal valve). When a gallstone gets trapped, it can lead
to an intestinal obstruction, called gallstone ileus, leading to abdominal pain, vomiting, constipation,
and abdominal distension.[13]

Causes

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holecystitis is inflammation of the gallbladder.[8] Symptoms include right upper abdominal
pain, nausea, vomiting, and occasionally fever.[1] Often gallbladder attacks (biliary colic)
precede acute cholecystitis.[1] The pain lasts longer in cholecystitis than in a typical
gallbladder attack.[1] Without appropriate treatment, recurrent episodes of cholecystitis are
common.[1] Complications of acute cholecystitis include gallstone pancreatitis, common bile
duct stones, or inflammation of the common bile duct.[1][8]
More than 90% of the time acute cholecystitis is from blockage of the cystic duct by
a gallstone.[1] Risk factors for gallstones include birth control pills, pregnancy, a family
history of gallstones, obesity, diabetes, liver disease, or rapid weight loss.[4] Occasionally
acute cholecystitis occur as a result of vasculitis, chemotherapy, or during recovery
from major trauma or burns.[9] Cholecystitis is suspected based on symptoms and laboratory
testing.[5] Abdominal ultrasound is then typically used to confirm the diagnosis.[5]
Treatment is usually with laparoscopic gallbladder removal, within 24 hours if
possible.[7][10] Taking pictures of the bile ducts during the surgery is recommended.[7] The
routine use of antibiotics is controversial.[5][11] They are recommended if surgery cannot occur
in a timely manner or if the case is complicated.[5] Stones in the common bile duct can be
removed before surgery by endoscopic retrograde cholangiopancreatography (ERCP) or
during surgery.[7] Complications from surgery are rare.[4] In people unable to have
surgery, gallbladder drainage may be tried.[5]
About 10–15% of adults in the developed world have gallstones.[5] Women more commonly
have stones than men and they occur more commonly after age 40.[4] Certain ethnic
groups are more often affected; for example, 48% of American Indians have gallstones.[4] Of
all people with stones, 1–4% have biliary colic each year.[5] If untreated, about 20% of people
with biliary colic develop acute cholecystitis.[5] Once the gallbladder is removed outcomes are
generally good.[4] Without treatment, chronic cholecystitis may occur.[2] The word is
from Greek, cholecyst- meaning "gallbladder" and -itis meaning "inflammation