Acute cholecystitis
Acute cholecystitis
Acute cholecystitis means the gallbladder has become swollen and inflamed. It can turn serious, and it usually needs to be treated in a hospital.
The main symptom is a sudden, sharp pain in the upper right part of your tummy (abdomen) that spreads towards your right shoulder.
The affected area is usually very tender to the touch, and breathing deeply can make the pain worse.
Unlike some other kinds of abdominal pain, the pain from acute cholecystitis is usually constant and doesn't ease off within a few hours.
Some people also get other symptoms, such as:
- a high temperature (fever)
- nausea and vomiting
- sweating
- loss of appetite
- yellowing of the skin and the whites of the eyes (jaundice)
- a bulge in the abdomen
Common Symptoms
Symptom information is not available for this condition yet.
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
When to See a Doctor
Contact your GP practice if you suddenly develop severe abdominal pain, especially if it goes on for more than a few hours, or if you notice other symptoms like yellowing of the skin and eyes (jaundice) or fever. If your GP practice is closed, call 111.
It's important to get acute cholecystitis diagnosed as early as possible. Left untreated, there is a risk that serious complications could develop.
Causes
What causes acute cholecystitis?
The causes of acute cholecystitis can be grouped into 2 main categories: calculous cholecystitis and acalculous cholecystitis.
Calculous cholecystitis
Calculous cholecystitis is the most common, and usually less serious, type of acute cholecystitis. It accounts for around 95% of all cases.
Calculous cholecystitis develops when the main opening to the gallbladder, called the cystic duct, gets blocked by a gallstone or by a substance known as biliary sludge.
Biliary sludge is a mixture of bile (a liquid produced by the liver that helps digest fats) and small crystals of cholesterol and salt.
The blockage in the cystic duct results in a build-up of bile in the gallbladder, increasing the pressure inside it and causing it to become inflamed. In around 1 in every 5 cases, the inflamed gallbladder also becomes infected by bacteria.
Acalculous cholecystitis
Acalculous cholecystitis is a less common, but usually more serious, type of acute cholecystitis. It usually develops as a complication of a serious illness, infection or injury that damages the gallbladder.
Acalculous cholecystitis is often associated with problems such as accidental damage to the gallbladder during major surgery, serious injuries or burns, blood poisoning (sepsis), severe malnutrition or AIDS.
Who is affected
Acute cholecystitis is a relatively common complication of gallstones.
It’s estimated that around 10% to 15% of adults in the UK have gallstones. These don’t usually cause any symptoms, but in a small proportion of people they can cause infrequent episodes of pain (known as biliary colic) or acute cholecystitis.
Diagnosis
To find out if you have acute cholecystitis, your GP will start by examining your abdomen.
They will likely carry out a simple check called Murphy's sign. For this, you will be asked to breathe in deeply while your GP presses a hand on your tummy, just below your rib cage.
As you breathe in, your gallbladder moves downwards, and if you have cholecystitis, you will feel a sudden, sharp pain as your gallbladder reaches your doctor's hand.
If your symptoms point to acute cholecystitis, your GP will refer you to hospital immediately for further tests and treatment.
In hospital, you may be given tests such as:
- blood tests, to check for signs of inflammation in your body
- an ultrasound scan of your abdomen, to look for gallstones or other signs of a problem with your gallbladder
If there is any uncertainty about your diagnosis, other scans, such as an X-ray, a CT (computerised tomography) scan or an MRI (magnetic resonance imaging) scan, may also be carried out to examine your gallbladder in more detail.
Treatment
If you are diagnosed with acute cholecystitis, you will probably need to be admitted to hospital for treatment.
Initial treatment
At first, treatment will usually involve:
- fasting (not eating or drinking) to take the strain off your gallbladder
- receiving fluids through a drip directly into a vein (intravenously) to prevent dehydration
- taking medication to relieve your pain
If doctors suspect an infection, you will also be given antibiotics. These often need to be continued for up to a week. During that time you may need to stay in hospital, or you may be able to go home.
With this initial treatment, any gallstones that may have caused the condition usually fall back into the gallbladder, and the inflammation often settles down.
Surgery
To stop acute cholecystitis from coming back, and to reduce your risk of developing potentially serious complications, doctors will often recommend removing your gallbladder at some point after the initial treatment. This type of surgery is known as a cholecystectomy.
Although uncommon, an alternative procedure called a percutaneous cholecystostomy may be carried out if you are too unwell to have surgery. In this procedure, a needle is inserted through your abdomen to drain away the fluid that has built up in the gallbladder.
If you are fit enough to have surgery, your doctors will need to decide when the best time to remove your gallbladder may be. In some cases, you may need to have surgery immediately or in the next day or 2, while in other cases you may be advised to wait for the inflammation to fully resolve over the next few weeks.
Surgery can be carried out in two main ways:
- laparoscopic cholecystectomy, a type of keyhole surgery where the gallbladder is removed using special surgical instruments inserted through a number of small cuts (incisions) in your abdomen
- open cholecystectomy, where the gallbladder is removed through a single, larger incision in your abdomen
Although some people who have had their gallbladder removed have reported bloating and diarrhoea after eating certain foods, you can lead a perfectly normal life without a gallbladder.
The organ can be useful, but it is not essential, as your liver will still produce bile to digest food.
Prevention
It's not always possible to prevent acute cholecystitis, but you can lower your risk by taking steps to reduce your chances of developing gallstones in the first place.
One of the most useful things you can do is eat a healthy, balanced diet and cut back on high-cholesterol foods, since cholesterol is thought to play a part in how gallstones form.
Carrying extra weight, especially being obese, also raises your risk of gallstones. So it helps to keep your weight in check through a healthy diet and regular exercise.
That said, steer clear of low-calorie, crash weight loss diets. There is evidence that losing weight too quickly can upset the chemical balance of your bile and actually raise your risk of gallstones. A slower, more gradual approach to weight loss works best.
Read more about preventing gallstones.
Complications
Without proper treatment, acute cholecystitis can sometimes lead to complications that may be life-threatening.
The main complications of acute cholecystitis are:
- death of the gallbladder tissue, called gangrenous cholecystitis, which can cause a serious infection that spreads through the body
- the gallbladder splitting open, known as a perforated gallbladder, which can spread infection within the abdomen (peritonitis) or cause a build-up of pus (abscess)
About 1 in every 5 people with acute cholecystitis needs emergency surgery to remove the gallbladder to treat these complications.