Acute cholecystitis

Acute cholecystitis is swelling (inflammation) of the gallbladder. It can be a serious condition, and it usually needs to be treated in hospital.

The main symptom is a sudden, sharp pain in the upper right side of your tummy (abdomen), which spreads towards your right shoulder. That part of the abdomen is usually extremely tender, and breathing deeply can make the pain worse.

Some other kinds of abdominal pain ease off, but this one doesn't. The pain of acute cholecystitis usually persists and doesn't go away within a few hours.

Some people have other symptoms as well, 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

• You develop sudden and severe abdominal pain, particularly if the pain lasts longer than a few hours or you have other symptoms, such as jaundice and a fever.

If you can't reach your doctor, call a doctor or the 16263 health line.

Acute cholecystitis needs to be diagnosed as soon as possible. If it isn't treated promptly, there is a risk that serious complications could develop.

Acute cholecystitis has 2 main kinds of cause: calculous cholecystitis and acalculous cholecystitis.

Calculous cholecystitis is the most common type of acute cholecystitis, and it's usually the less serious one. It accounts for around 95% of all cases.

It 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 made by the liver that helps digest fats) and small crystals of cholesterol and salt.

Once the cystic duct is blocked, bile builds up in the gallbladder. This raises the pressure inside it and the gallbladder becomes inflamed. In around 1 in every 5 cases, bacteria also infect the inflamed gallbladder.

Acalculous cholecystitis is a less common type of acute cholecystitis, but it's usually more serious. It tends to develop as a complication of a serious illness, infection or injury that damages the gallbladder.

You often see acalculous cholecystitis alongside problems such as accidental damage to the gallbladder during major surgery, serious injuries or burns, blood poisoning (sepsis), severe malnutrition or AIDS.

Acute cholecystitis is a fairly common complication of gallstones. It's estimated that around 10% to 15% of adults in the UK have gallstones. Usually these don't cause any symptoms, but in a small proportion of people they can bring on occasional episodes of pain (known as biliary colic) or acute cholecystitis.

To diagnose acute cholecystitis, your doctor will start by examining your abdomen. They will probably do a simple test called Murphy's sign. You'll be asked to breathe in deeply while your doctor presses a hand on your tummy, just below your rib cage.

Your gallbladder moves downwards as you breathe in. If you have cholecystitis, you will feel a sudden pain when your gallbladder reaches your doctor's hand.

If your symptoms suggest acute cholecystitis, your doctor will send you to hospital immediately for further tests and treatment.

Tests you may have in hospital include:

• blood tests to check for signs of inflammation in your body
• an ultrasound scan of your abdomen to check for gallstones or other signs of a problem with your gallbladder

Other scans may also be done to look at your gallbladder in more detail if there is any uncertainty about your diagnosis. These could be an X-ray, a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan.

If a doctor diagnoses you with acute cholecystitis, you will probably need to be admitted to hospital for treatment.

Treatment for acute cholecystitis usually starts with a few things:

• fasting (not eating or drinking), so your gallbladder isn't under strain
• fluids given through a drip straight into a vein (intravenously), to prevent dehydration
• medicine to relieve your pain

If an infection is suspected, you will also be given antibiotics. These often need to carry on for up to a week. During that time you may have to stay in hospital, or you may be able to go home.

With this first treatment, any gallstones that caused the problem usually fall back into the gallbladder, and the inflammation often settles down.

To stop acute cholecystitis coming back, and to lower your risk of serious complications, doctors will often recommend removing your gallbladder at some point after the first treatment. This operation is called a cholecystectomy.

If you are too unwell for surgery, there is another option, though it's uncommon. It's called a percutaneous cholecystostomy. A needle is put through your abdomen to drain off the fluid that has built up in the gallbladder.

If you are fit enough for surgery, your doctors will decide the best time to take the gallbladder out. Some people need the operation straight away, or within a day or 2. Others are advised to wait a few weeks, until the inflammation has fully settled.

There are two main ways to do the surgery:

• laparoscopic cholecystectomy: a type of keyhole surgery, where the gallbladder is removed with special instruments passed 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

Some people report bloating and diarrhoea after eating certain foods once the gallbladder is gone. Even so, you can lead a perfectly normal life without it. The organ can be useful but it's not essential, because your liver will still make the bile you need to digest food.

If acute cholecystitis isn't treated properly, it can sometimes lead to complications that may threaten your life.

The main complications are:

• the tissue of the gallbladder dying, which is called gangrenous cholecystitis, and which can cause a serious infection that could spread throughout the body
• the gallbladder splitting open, known as a perforated gallbladder, which can spread the infection within your abdomen (peritonitis) or lead to a build-up of pus (abscess)

In about 1 in every 5 cases of acute cholecystitis, emergency surgery to remove the gallbladder is needed to treat these complications.

You can't always prevent acute cholecystitis, but you can lower your risk by cutting your risk of gallstones.

One of the main things you can do is eat a healthy, balanced diet and cut down on foods high in cholesterol, because cholesterol is thought to contribute to the formation of gallstones.

Being overweight, and particularly being obese, also raises your risk of gallstones. So you should control your weight by eating a healthy diet and exercising regularly.

Avoid low-calorie, rapid weight loss diets, though. There is evidence they can disrupt your bile chemistry and actually increase your risk of gallstones. A more gradual weight loss plan is best.