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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Acute cholecystitis

Cholecystitis - acute

Last reviewed: September 20, 2013.

Acute cholecystitis is a sudden swelling and irritation of the gallbladder. It causes severe belly pain.

See also: Chronic cholecystitis

Causes

The gallbladder is an organ that sits below the liver. It stores bile, which your body uses 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. This is the tube that 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
  • 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 chronic cholecystitis. This is swelling and irritation that continues over time. Eventually, the gallbladder becomes thick and hard. It also does not store and release bile as well.

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
  • Nausea and vomiting
  • Yellowing of skin and whites of the eyes (jaundice)

Exams and Tests

A physical exam will show that it hurts to touch your belly.

Your doctor may order the following blood tests:

Imaging tests can show gallstones or inflammation. You may have one of these tests:

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 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:

If you are very ill, a tube may be placed in your gallbladder and through your skin to drain it. Then, once you are feeling better, you may have surgery.

Outlook (Prognosis)

Most people who have surgery to remove their gallbladder recover completely.

Possible Complications

When to Contact a Medical Professional

Call your health care provider if:

  • Severe belly pain does not go away
  • Symptoms of cholecystitis return

Prevention

Removing the gallbladder and gallstones will prevent further attacks.

References

  1. Glasgow RE, Mulvihill SJ. Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Saunders Elsevier; 2010:chap 66.
  2. Jackson P, Evans S. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Saunders Elsevier; 2012:chap. 55.
  3. Siddiqui T. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg. 2008;195:40-47. [PubMed: 18070735]
  4. Wang DQH, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Saunders Elsevier; 2010:chap 65.

Review Date: 9/20/2013.

Reviewed by: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, CA. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitisEarly versus delayed laparoscopic cholecystectomy for people with acute cholecystitis
    The liver produces bile which has many functions including elimination of waste processed by the liver and digestion of fat. The bile is temporarily stored in the gallbladder (an organ situated underneath the liver) before it reaches the small bowel. Concretions in the gallbladder are called gallstones. Gallstones are present in about 10% to 15% of the adult western population. Between 1% and 4% become symptomatic in a year. The symptoms include pain related to the gallbladder (biliary colic), inflammation of the gallbladder (cholecystitis), obstruction to the flow of bile from the liver and gallbladder into the small bowel resulting in jaundice (yellowish discolourisation of the body usually most prominently noticed in the white of the eye, which turns yellow), bile infection (cholangitis), and inflammation of the pancreas, an organ which secretes digestive juices and harbours the insulin secreting cells which maintain blood sugar level (pancreatitis). Removal of the gallbladder (cholecystectomy) is currently considered the best treatment option for people with symptomatic gallstones. This is generally performed by key‐hole surgery (laparoscopic cholecystectomy). Cholecystitis (inflammation) of the gallbladder is one of the indications for laparoscopic cholecystectomy. Cholecystitis can occur suddenly, with symptoms such as fever along with intense pain in the right upper tummy. This is called acute cholecystitis. In comparison, chronic cholecystitis is a smouldering inflammation of the gallbladder which presents with less intense pain in the right upper tummy. For many years, surgeons have preferred to perform laparoscopic cholecystectomy once the inflammation settles down completely (which usually takes about six weeks) because of the fear of higher complication rates including injury to the bile duct (a tube through which the bile flows from the gallbladder to the small bowel). Injury to the bile duct is a life‐threatening condition which requires urgent corrective operation in most instances. In spite of the corrective surgery, people have poor quality of life several years after the operation due to repeated instances of bile infection caused by obstruction to the flow of bile into the small bowel. Another reason for the surgeons' preference for delaying the operation is to avoid an open operation, as there has been a perception that early operation increases the risk of an open operation. However, delaying the surgery exposes the people to the risk of complications related to gallstones. The review authors set out to determine whether it is preferable to perform early laparoscopic cholecystectomy (within seven days of people presenting to doctors with symptoms) or delayed laparoscopic cholecystectomy (more than six weeks after the initial admission). A systematic search of medical literature was performed in order to identify studies which provided information on the above question. The authors obtained information from randomised trials only since such types of trials provide the best information if conducted well. Two authors independently identified the trials and collected the information.
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Figures

  • Digestive system.
    Cholecystitis, CT scan.
    Cholecystitis, cholangiogram.
    Cholecystolithiasis.
    Gallstones, cholangiogram.
    Digestive system organs.

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