Cholecystitis (Gallbladder Inflammation)

How cholecystitis develops

Bile flows from the gallbladder through the cystic duct into the common bile duct. When a gallstone wedges in the cystic duct, bile is trapped. The gallbladder swells and its wall becomes irritated by concentrated bile. Blood supply can be compromised, and bacteria can secondarily infect it.

If the stone falls back, the pain settles within a few hours: this is biliary colic. If the blockage persists, inflammation sets in: this is acute cholecystitis.

Types of cholecystitis

Cholecystitis vs biliary colic

Symptoms

Acute cholecystitis

• constant, severe pain in the upper right or upper middle abdomen, often after a fatty meal or at night
• pain spreading to the right shoulder blade or back
• tenderness when the area is pressed; pain when breathing in deeply
• nausea and vomiting
• fever and chills
• loss of appetite
• mild yellowing of the skin occasionally

Older adults and people with diabetes may have few symptoms, sometimes only confusion or fever.

Chronic cholecystitis

• repeated episodes of upper abdominal pain after meals
• bloating, belching, and indigestion-like discomfort
• nausea, especially with fatty food

Causes and risk factors

Gallstones are the main cause. Risk factors for gallstones include:

• female sex, pregnancy, and estrogen therapy
• age over 40
• obesity, and rapid weight loss including after bariatric surgery
• family history and some ethnic backgrounds, such as Indigenous American heritage
• diabetes and metabolic syndrome
• some medicines, such as ceftriaxone and octreotide
• blood disorders causing pigment stones, such as sickle cell disease

Acalculous cholecystitis is linked to critical illness, prolonged fasting or IV nutrition, major trauma or burns, and some infections (such as cytomegalovirus in people with weakened immunity).

Diagnosis

1. Examination: Murphy's sign, where a deep breath stops abruptly as the examiner presses under the right ribs, is typical.
2. Blood tests: raised white cell count and CRP; liver tests and lipase to look for bile duct stones or pancreatitis.
3. Abdominal ultrasound: the first-choice test. It shows stones, a thickened gallbladder wall, fluid around it, and pain when the probe presses over it.
4. HIDA scan: a nuclear scan used when ultrasound is unclear; a gallbladder that does not fill confirms a blocked cystic duct.
5. CT scan: for complications such as perforation or abscess.
6. MRCP: if a stone in the common bile duct is suspected.

Treatment

In hospital

• fasting or a light diet initially
• IV fluids
• pain relief (NSAIDs and other medicines)
• antibiotics for infection or more severe cases

Gallbladder removal

Laparoscopic cholecystectomy (keyhole surgery) is the standard treatment. Guidelines favor operating early, usually within the first few days of admission and ideally within a week of symptom onset, because it reduces complications, repeat attacks and total hospital time. Most people go home within 1 to 2 days after surgery and return to normal activities in 1 to 2 weeks.

When surgery is too risky

For very frail or critically ill patients, a tube is placed through the skin into the gallbladder (percutaneous cholecystostomy) to drain it, or an endoscopic drain is placed. Surgery may follow later if health allows.

Bile duct stones

If stones are also in the common bile duct, they are removed by ERCP before or during surgery. See biliary obstruction.

Complications

• gangrene of the gallbladder
• perforation, with abscess or peritonitis
• empyema (a pus-filled gallbladder)
• cholangitis and pancreatitis from stones passing into the bile duct
• gallstone ileus, where a large stone erodes into the bowel and blocks it (rare)

Untreated, about a third of people with acute cholecystitis have another attack within months.

Life after gallbladder removal

You can live normally without a gallbladder; bile flows directly from the liver to the intestine. Some people have looser stools or mild bloating for a few weeks, which usually settles. A small number have persistent diarrhea, which can be treated.

Prevention

• Keep a healthy weight and avoid crash diets or very rapid weight loss.
• Stay physically active.
• Eat a diet rich in fiber, fruit and vegetables.
• If you have symptomatic gallstones, planned gallbladder removal prevents cholecystitis. Silent gallstones usually need no treatment.

Frequently asked questions

What are the symptoms of cholecystitis?

The main symptom is constant, severe pain in the upper right abdomen lasting more than a few hours, often spreading to the right shoulder or back. Fever, nausea, vomiting and tenderness under the right ribs are common. Yellow skin, dark urine or confusion suggest complications.

What is the difference between acute and chronic cholecystitis?

Acute cholecystitis is a sudden, severe inflammation of the gallbladder, usually from a gallstone blocking its outlet, needing hospital treatment. Chronic cholecystitis develops from repeated milder attacks, leaving a thickened, scarred gallbladder that causes recurrent pain after meals.

Can cholecystitis go away without surgery?

An attack may settle with antibiotics and supportive care, but gallstone-related cholecystitis often recurs and can lead to complications. Early laparoscopic gallbladder removal is recommended for most people fit for surgery. Drainage is used when surgery is too risky.

How is cholecystitis diagnosed?

Doctors examine the abdomen for tenderness and Murphy's sign, order blood tests for inflammation and liver function, and use an abdominal ultrasound to show gallstones and a thickened, inflamed gallbladder. A HIDA scan or CT may be used if results are unclear.

What should I eat with gallbladder inflammation?

During an acute attack, you will usually fast or eat lightly in hospital. Afterward, smaller, lower-fat meals may reduce symptoms while waiting for surgery. After gallbladder removal, most people return to a normal diet within a few weeks, increasing fat gradually.