Acute cholecystitis
Cholecystitis - acute; Gallstones - acute cholecystitis
Acute cholecystitis is sudden swelling and irritation of the gallbladder. It causes severe belly pain.
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
This is a CT scan of the upper abdomen showing cholecystitis (gall stones).
Cholelithiasis can be seen on a cholangiogram. Radio-opaque dye is used to enhance the x-ray. Multiple stones are present in the gallbladder (PTCA).
Cholecystolithiasis. CT scan of the upper abdomen showing multiple gallstones.
A cholecystogram in a patient with gallstones.
The gallbladder is located in the abdomen on the underside of the liver. The gallbladder stores bile (digestive fluid) from the liver.
Causes
The gallbladder is an organ that sits below the liver. It stores bile, which is produced in the liver. Your body uses bile to digest fats in the small intestine.
Acute cholecystitis occurs when bile becomes trapped in the gallbladder. This often happens because a gallstone blocks the cystic duct, the tube through which bile travels into and out of the gallbladder. When a stone blocks this duct, bile builds up, causing irritation and pressure in the gallbladder. This can lead to swelling and infection.
Other causes include:
- Serious illnesses, such as HIV or diabetes
- Tumors of the gallbladder (rare)
Some people are more at risk for gallstones. Risk factors include:
- Being female
- Pregnancy
- Hormone therapy
- Older age
- Being Native American or Hispanic
- Obesity
- Losing or gaining weight rapidly
- Diabetes
Sometimes, the bile duct becomes blocked temporarily. When this occurs repeatedly, it can lead to long-term (chronic) cholecystitis. This is swelling and irritation that continues over time. Eventually, the gallbladder becomes thick and hard. It does not store and release bile as well as it did.
Stones are great for tossing into a stream or using to line your flowerbeds. But they're not so great when they're trapped inside your gallbladder. If you've got pain in the upper part of your belly, a fever, or yellow skin, they could be signs that you've got gallstones. The stones that form in your gallbladder aren't made of rock. Usually, they're made of cholesterol, a type of fat in your blood. Or, they could be made from a substance called bilirubin, which is processed in your liver. Gallstones can be as small as a grain of sand, or as big as a golf ball. You're more likely to get gallstones if you're over age 40, or if you have a chronic condition like diabetes, anemia, or cirrhosis of the liver. People who've had weight-loss surgery, or who went on a crash diet and lost weight very quickly can also develop gallstones. Gallstones are more common in women than in men, and they may run in families. So, how do you know if you have gallstones? Well, you might not realize it, because often gallstones don't cause any pain. They're often found accidentally during an x-ray or surgery to treat another condition. If the gallstone is very large, though, it may get stuck in one of the tubes, called ducts, which connect to the gallbladder. Then you'll probably feel a sharp or cramping pain in the upper right or middle part of your abdomen. You may also have a fever and feel sick to your stomach. Your doctor can do an ultrasound, or other scan of the gallbladder area to find out if gallstones are causing your pain. You may also have blood tests to check your liver function and to see if your bilirubin levels are too high. You may not need to treat gallstones, unless they're causing symptoms. If that's the case, your doctor will recommend treatment which is usually surgery to remove them. Often, this is done with a laparoscopic procedure that removes the gallstone through very small cuts or incisions. Normally, you can go home the same day as your surgery, or the next day. Most people don't need to have their whole gallbladder removed, unless they have complications, like a blocked duct. There is also medicine that can dissolve cholesterol gallstones, but it isn't that effective because it can take two years or more to work, and often the stones form again after you're done taking it. You can't really prevent gallstones, except by avoiding rapid weight loss or health conditions that can cause gallstones such as obesity, diabetes, or cirrhosis. But if you do get them, gallstones are pretty easy to treat. Most people don't have any symptoms or complications from them, and those who do have symptoms usually recover completely and don't get gallstones again after their surgery. It's important that you call your doctor if you are having abdominal pain, yellow skin or eyes, so you can find out for sure whether you have gallstones, and get them treated.
Symptoms
The main symptom is pain in the upper right side or upper middle of your belly that usually lasts at least 30 minutes. You may feel:
- Sharp, cramping, or dull pain
- Steady pain
- Pain that spreads to your back or below your right shoulder blade
Other symptoms that may occur include:
- Clay-colored stools
- Fever
- Nausea and vomiting
- Yellowing of skin and whites of the eyes (jaundice)
Exams and Tests
Your health care provider will perform a physical exam and ask about your symptoms. During the physical exam, you will likely have pain when the provider touches your belly.
Your provider may order the following blood tests:
- Amylase and lipase
- Bilirubin
- Complete blood count (CBC)
- Liver function tests
Imaging tests can show gallstones or inflammation. You may have one or more of these tests:
- Abdominal ultrasound
- Abdominal CT scan or MRI scan
- Abdominal x-ray
- Oral cholecystogram
- Gallbladder radionuclide scan
Treatment
If you have severe belly pain, seek medical attention right away.
In the emergency room, you'll be given fluids through a vein. You also may be given antibiotics to fight infection.
Cholecystitis may clear up on its own. However, if you have gallstones, you will probably need surgery to remove your gallbladder.
Nonsurgical treatment includes:
- Antibiotics you take at home to fight infection
- Low-fat diet (if you are able to eat)
- Pain medicines
You may need emergency surgery if you have complications such as:
- Tissue death (gangrene) of the gallbladder
- A hole that forms in the wall of the gallbladder (perforation)
- Inflamed pancreas (pancreatitis)
- Persistent bile duct blockage
- Inflammation of the common bile duct
If you are very ill, a tube may be placed through your belly into your gallbladder to drain it. Once you feel better, your provider may recommend that you have surgery.
Outlook (Prognosis)
Most people who have surgery to remove their gallbladder recover completely.
Possible Complications
Untreated, cholecystitis may lead to any of the following health problems:
- Empyema (pus in the gallbladder)
- Gangrene
- Injury to the bile ducts draining the liver (may occur after gallbladder surgery)
- Pancreatitis
- Perforation
- Peritonitis (inflammation of the lining of the abdomen)
When to Contact a Medical Professional
Contact your provider if you have:
- Severe belly pain that does not go away
- Symptoms of cholecystitis return
Prevention
Removing the gallbladder and gallstones will prevent further attacks.
References
Glasgow RE. Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 66.
Radkani P, Hawksworth J, Fishbein T. Biliary system. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 55.
Wang DQ-H, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 65.
Version Info
Last reviewed on: 8/7/2023
Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
