Cholecystitis
Also known as: Gallbladder inflammation, Acute cholecystitis, Gallbladder attack
Cholecystitis is inflammation of the gallbladder, the small pouch under the liver that stores bile. In most cases it happens when a gallstone blocks the duct that drains the gallbladder, causing bile to build up, the wall to swell, and often infection to set in. It usually announces itself with steady, severe pain in the upper right abdomen that lasts for hours, often with fever and nausea. Cholecystitis is a medical emergency because an inflamed gallbladder can become gangrenous or rupture. Treatment typically involves hospital care with fluids, antibiotics, and removal of the gallbladder, after which most people recover fully and live normally without it.
At a Glance
- Common symptoms
- Severe, steady pain in the upper right or center of the abdomen lasting more than a few hours, Pain that spreads to the right shoulder or back, Tenderness when the upper right abdomen is pressed, especially on breathing in
- Main treatments
- Hospital admission with fasting, intravenous fluids, and pain relief to rest the gallbladder, Intravenous antibiotics to treat or prevent infection, Laparoscopic (keyhole) removal of the gallbladder, usually within a few days of admission
- Category
- Digestive · Common; one of the most frequent reasons for emergency abdominal surgery
- See a doctor if
- Severe abdominal pain that lasts more than a few hours, especially with fever or vomiting (urgent)
Symptoms
Causes
- Gallstones blocking the cystic duct, responsible for the vast majority of cases
- Bile sludge or thickened bile obstructing the outlet
- Acalculous cholecystitis, where no stone is present, often in critically ill people, after major surgery, or during prolonged fasting
- Tumors or scarring narrowing the bile ducts
- Infection spreading to the gallbladder in people with weakened immunity
Risk Factors
- Gallstones, which are more common in women, people over 40, and during pregnancy
- Obesity and rapid weight loss, including after bariatric surgery
- Diabetes
- A family history of gallstones
- Certain medications such as estrogen therapy and some cholesterol drugs
- Severe illness, trauma, burns, or long periods of intravenous feeding
Diagnosis
- Physical examination, including checking for pain when pressing under the right ribs during a deep breath (Murphy's sign)
- Blood tests showing raised white cell count, inflammation markers, and sometimes liver enzymes
- Abdominal ultrasound, the first-line imaging test, to show stones and a thickened gallbladder wall
- HIDA scan (a nuclear medicine test) if ultrasound is inconclusive
- CT or MRI to assess complications or stones in the bile duct
Treatment
- Hospital admission with fasting, intravenous fluids, and pain relief to rest the gallbladder
- Intravenous antibiotics to treat or prevent infection
- Laparoscopic (keyhole) removal of the gallbladder, usually within a few days of admission
- A temporary drainage tube through the skin for people too unwell for surgery, with surgery later if appropriate
- Endoscopic removal (ERCP) of any stones blocking the main bile duct
- Supportive: after recovery or surgery, a lower-fat diet for the first few weeks while digestion adjusts
- Supportive: gradual weight loss and regular meals to reduce the chance of further stone formation if the gallbladder is retained
Prevention
- Maintain a healthy weight and avoid crash diets or very rapid weight loss
- Eat regular meals that include some healthy fat, which helps the gallbladder empty
- Choose a diet high in fiber, vegetables, and whole grains
- Stay physically active
- Discuss gallbladder removal with your doctor if you have had attacks of gallstone pain, since recurrence is likely
When to See a Doctor
- Severe abdominal pain that lasts more than a few hours, especially with fever or vomiting (urgent)
- Pain so intense you cannot sit still or find a comfortable position
- Yellowing of the skin or eyes, dark urine, or pale stools
- High fever with shaking chills, confusion, or a racing heart (emergency, possible sepsis)
- Repeated episodes of upper abdominal pain after fatty meals
Frequently Asked Questions
Related Conditions
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