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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
  • 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 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
  • Fever
  • 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:

  • Gangrene (tissue death)
  • Perforation (a hole that forms in the wall of the gallbladder)
  • Pancreatitis (inflamed pancreas)
  • Persistent bile duct blockage
  • Inflammation of the common bile duct

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

  • 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

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, California. 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?

  • External drainage of gallbladder for high‐risk surgical patients with acute calculous cholecystitis
    Removal of the gallbladder (cholecystectomy) is generally recommended for people with symptoms related to gallstones. People at high risk of surgical complications ‐ that is, elderly people and people with co‐existing illness ‐ can become very unwell as a result of inflammation of the gallbladder. During anaesthesia and surgery, the body's ability to tolerate stress is lowered, particularly in elderly people and people with co‐existing illness. Thus, surgery can be detrimental to these people who are already unwell. The optimal clinical management of these people is not known. External drainage of gallbladder contents with a tube using guidance from scans (percutaneous cholecystostomy) has been proposed as the one of the ways that these patients can be treated. By draining the contents of gallbladder, any infected material can be removed from the body and this might improve the health. Some consider percutaneous cholecystostomy as the only treatment required and perform cholecystectomy only in those who develop further complications while others recommend routine cholecystectomy following percutaneous cholecystostomy. We sought to review all the information available in the literature on this topic and obtained information from randomised clinical trials (studies designed to lower the risk of arriving at wrong conclusions due to researcher's favouritism or differences in the type of people undergoing the different treatments) to determine the optimal method of managing these people. Two review authors collected data independently as a way of quality control.
See all (8) ...

Figures

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

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