Acute cholecystitis
Cholecystitis - acute; Gallstones - acute cholecystitisAcute cholecystitis is sudden swelling and irritation of the gallbladder. It causes severe belly pain.
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.
Bile
Bile is a fluid that is made and released by the liver and stored in the gallbladder. Bile helps with digestion. It breaks down fats into fatty acid...
Read Article Now Book Mark ArticleGallstone
Gallstones are hard deposits that form inside the gallbladder. These may be as small as a grain of sand or as large as a golf ball.
Read Article Now Book Mark ArticleOther 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.
Long-term (chronic) cholecystitis
Chronic cholecystitis is swelling and irritation of the gallbladder that continues over time. The gallbladder is a sac located under the liver. It s...
Read Article Now Book Mark ArticleSymptoms
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)
Jaundice
Jaundice is a yellow color of the skin, mucus membranes, or eyes. The yellow coloring comes from bilirubin, a byproduct of old red blood cells. Jau...
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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:
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Amylase and lipase
Amylase
Amylase is an enzyme that helps digest carbohydrates. It is made primarily in the pancreas and the glands that make saliva, and can be found at low ...
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Bilirubin
Bilirubin
The bilirubin blood test measures the level of bilirubin in the blood. Bilirubin is a yellowish pigment found in bile, a fluid made by the liver. Bi...
Read Article Now Book Mark Article - Complete blood count (CBC)
CBC
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
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Liver function tests
Liver function tests
Liver function tests are common tests that are used to see how well the liver is working. Tests include:AlbuminAlpha-1 antitrypsinAlkaline phosphata...
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Imaging tests can show gallstones or inflammation. You may have one or more of these tests:
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Abdominal ultrasound
Abdominal ultrasound
Abdominal ultrasound is a type of imaging test. It is used to look at organs in the abdomen, including the liver, gallbladder, spleen, pancreas, and...
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Abdominal CT scan or MRI scan
Abdominal CT scan
An abdominal CT scan is an imaging method. This test uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomog...
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Abdominal x-ray
Abdominal x-ray
An abdominal x-ray is an imaging test to look at organs and structures in the abdomen. Organs include the liver, spleen, stomach, and intestines. Wh...
Read Article Now Book Mark Article - Oral cholecystogram
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Gallbladder radionuclide scan
Gallbladder radionuclide scan
Gallbladder radionuclide scan is a test that uses radioactive material to check gallbladder function. It is also used to look for bile duct blockage...
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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.
Surgery to remove your gallbladder
Open gallbladder removal is surgery to remove the gallbladder through a large cut in your abdomen. The gallbladder is an organ that sits below the li...
Read Article Now Book Mark ArticleNonsurgical 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)
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Inflamed pancreas (pancreatitis)
Inflamed pancreas
Acute pancreatitis is sudden swelling and inflammation of the pancreas.
Read Article Now Book Mark Article - 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.
Surgery
Open gallbladder removal is surgery to remove the gallbladder through a large cut in your abdomen.
Read Article Now Book Mark ArticleOutlook (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)
Empyema
Empyema is a collection of pus in the space between the lung and the inner surface of the chest wall (pleural space).
Read Article Now Book Mark Article - Gangrene
- Injury to the bile ducts draining the liver (may occur after gallbladder surgery)
- Pancreatitis
- Perforation
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Peritonitis (inflammation of the lining of the abdomen)
Peritonitis
Peritonitis is an inflammation (irritation) of the peritoneum. This is the thin tissue that lines the inner wall of the abdomen and covers most of t...
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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.
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Gallstones
Animation
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Digestive system - illustration
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.
Digestive system
illustration
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Cholecystitis, CT scan - illustration
This is a CT scan of the upper abdomen showing cholecystitis (gall stones).
Cholecystitis, CT scan
illustration
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Cholecystitis - cholangiogram - illustration
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).
Cholecystitis - cholangiogram
illustration
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Cholecystolithiasis - illustration
Cholecystolithiasis. CT scan of the upper abdomen showing multiple gallstones.
Cholecystolithiasis
illustration
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Gallstones, cholangiogram - illustration
A cholecystogram in a patient with gallstones.
Gallstones, cholangiogram
illustration
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Gallbladder removal - Series
Presentation
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Digestive system - illustration
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.
Digestive system
illustration
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Cholecystitis, CT scan - illustration
This is a CT scan of the upper abdomen showing cholecystitis (gall stones).
Cholecystitis, CT scan
illustration
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Cholecystitis - cholangiogram - illustration
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).
Cholecystitis - cholangiogram
illustration
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Cholecystolithiasis - illustration
Cholecystolithiasis. CT scan of the upper abdomen showing multiple gallstones.
Cholecystolithiasis
illustration
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Gallstones, cholangiogram - illustration
A cholecystogram in a patient with gallstones.
Gallstones, cholangiogram
illustration
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Gallbladder removal - Series
Presentation
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Gallstones and gallbladder disease - InDepth
(In-Depth)
Review Date: 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.