Acute Cholecystitis
Sudden inflammation of the gallbladder
Quick Facts
- Type: Digestive (biliary) condition
- Usual cause: Gallstone blocking the cystic duct
- Main symptom: Severe upper-right belly pain
- Seek urgent care: Severe pain, fever, jaundice
Overview
Acute cholecystitis is sudden inflammation of the gallbladder, the small pear-shaped organ under the liver that stores bile to help digest fat. In most cases it happens when a gallstone blocks the cystic duct, the tube that drains bile out of the gallbladder. Bile builds up behind the blockage, irritating and inflaming the gallbladder wall, and the trapped fluid can become infected.
The result is steady, often severe pain in the upper-right part of the abdomen, frequently with fever and nausea. Unlike a typical gallstone attack that eases within a few hours, the pain of acute cholecystitis tends to persist. It is a condition that needs prompt medical evaluation, because untreated inflammation can lead to serious complications such as infection or rupture.
Symptoms
The main feature is intense, constant pain in the upper-right abdomen that may spread to the right shoulder or back.
- Severe pain under the right ribs that lasts hours and does not fully settle
- Tenderness when the upper-right belly is pressed
- Fever and sometimes chills
- Nausea and vomiting
- Pain that often worsens after eating fatty foods or with deep breaths
Yellowing of the skin or eyes (jaundice), dark urine, or a high fever with shaking chills may signal that a stone has blocked the main bile duct or that infection is spreading. These warrant urgent care.
Causes
Acute cholecystitis develops when something blocks or irritates the gallbladder. The main causes are:
- Gallstones: by far the most common cause, when a stone lodges in the cystic duct and traps bile.
- Bile sludge: a thick mixture of bile and small crystals that can also block the duct.
- Acalculous cholecystitis: inflammation without stones, which can occur in seriously ill, hospitalized, or fasting patients.
- Tumors or scarring that obstruct bile flow, less commonly.
Once bile is trapped, the gallbladder wall becomes inflamed and may become infected.
Risk Factors
- Having gallstones or a history of gallstone attacks
- Female sex, especially with pregnancy or hormone use
- Older age
- Obesity or rapid weight loss
- Diabetes
- Serious illness, prolonged fasting, or intensive-care stays (for stone-free cases)
Diagnosis
Doctors diagnose acute cholecystitis using the history, exam, and tests:
- Ultrasound: the usual first imaging test, showing gallstones, a thickened gallbladder wall, or fluid around it.
- Blood tests: to check for signs of infection and inflammation and to assess liver and bile function.
- HIDA scan: a nuclear imaging test that checks whether bile can leave the gallbladder normally.
- CT scan: sometimes used to look for complications or other causes of pain.
Treatment
Acute cholecystitis is usually treated in the hospital. Initial care calms the inflammation and infection:
- Supportive care: fluids through a vein, pain relief, and resting the stomach by avoiding food at first.
- Antibiotics: to treat or prevent infection.
- Gallbladder removal (cholecystectomy): the definitive treatment, usually done with minimally invasive (laparoscopic) surgery, often during the same hospital stay.
- Drainage: for people too unwell for surgery, a tube may be placed to drain the gallbladder until they recover.
Removing the gallbladder usually cures the problem and prevents future attacks; the body manages well without it.
Prevention
- Maintain a healthy weight and avoid very rapid weight loss
- Eat a balanced diet with regular meals and limit excess saturated fat
- Stay physically active
- Manage diabetes and cholesterol with your provider
- Discuss treatment of known gallstones if you have repeated attacks
When to See a Doctor
Seek prompt medical care for steady, severe pain in the upper-right or upper-middle abdomen, especially with fever or vomiting. Go to emergency care right away if you have:
- Intense belly pain that lasts more than a few hours
- High fever with shaking chills
- Yellowing of the skin or eyes
- Dark urine or pale stools
- Confusion, rapid heartbeat, or feeling very unwell
These may signal a spreading infection or a blocked bile duct that needs urgent treatment.
Frequently Asked Questions
How is acute cholecystitis different from a gallstone attack?
A typical gallstone attack (biliary colic) causes pain that builds and then eases within a few hours. In acute cholecystitis the gallbladder becomes inflamed, so the pain is steady, lasts longer, and is often joined by fever and tenderness.
Does acute cholecystitis always need surgery?
Most people eventually need their gallbladder removed because it prevents repeat attacks and complications. Surgery is often done during the same hospital stay, though some patients are first stabilized with antibiotics or drainage if they are too unwell.
Can you live without a gallbladder?
Yes. The gallbladder stores bile but is not essential. After it is removed, bile flows directly from the liver into the intestine, and most people digest food normally, though some notice looser stools at first.
When is acute cholecystitis an emergency?
Seek emergency care if severe belly pain lasts more than a few hours or is joined by high fever with chills, yellowing of the skin or eyes, or feeling very unwell. These can signal a spreading infection or blocked bile duct.
References
- Mayo Clinic. Cholecystitis.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Gallstones.
- MedlinePlus, U.S. National Library of Medicine. Acute cholecystitis.
- American College of Surgeons. Cholecystectomy.