Acute cholecystitis (patient information)

Acute cholecystitis
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Overview

Acute cholecystitis is a sudden inflammation of the gallbladder that causes severe abdominal pain.

What are the symptoms of Acute cholecystitis?

The main symptom is pain in the upper right side or upper middle of the abdomen. The pain may:

• Sharp, cramping, or dull
• Steady
• Radiating to the back or below the right scapula

Other symptoms that may occur include:

• Clay-colored stools
• Fever
• Nausea and vomiting
• Yellowing of skin and whites of the eyes (jaundice)

What causes Acute cholecystitis?

• In 90% of cases, acute cholecystitis is caused by gallstones in the gallbladder.
• Other causes include severe illness and (rarely) tumors of the gallbladder.
• Acute cholecystitis occurs when bile becomes trapped in the gallbladder. The buildup of bile causes irritation and pressure in the gallbladder. This can lead to infection and a hole (perforation) in the organ.

Who is at highest risk?

• Gallstone disease
• Women are at more risk than men.
• Native Americans and Hispanics have a higher rate of gallstones than most other people.

Diagnosis

Physical Examination

• Abdomen is tender to the touch.

Laboratory Tests

Blood tests

• Amylase and lipase
• Bilirubin
• Complete blood count -- increased white blood cell count
• Liver function tests

Imaging tests - show gallstones or inflammation

• Abdominal ultrasound
• Abdominal CT scan
• Abdominal x-ray
• Oral cholecystogram
• Gallbladder radionuclide scan

When to seek urgent medical care?

• Severe abdominal pain
• If symptoms of cholecystitis return after a previous episode

Treatment options

• In emergency room, patients are administered with fluids and antibiotics.
• It may resolve on its own.

Medical therapy

• Antibiotics
• Low-fat diet
• Pain medicines

Surgical therapy

• Surgery to remove the gallbladder (cholecystectomy).
• Surgery is considered gallstones are present.
• Emergency surgery for gangrene, perforation, pancreatitis, or inflammation of the common bile duct.

In very ill patients, a tube may be placed through the skin to drain the gallbladder until the patient gets better and can have surgery.

Prevention of Acute cholecystitis

Removal of gallstones will prevent attacks of acute cholecystitis.

What to expect (Outlook/Prognosis)?

Patients who have surgery to remove the gallbladder usually do very well.

Possible complications

• Empyema (pus in the gallbladder)
• Gangrene (tissue death) of the gallbladder
• Injury to the bile ducts draining the liver (an occasional complication of cholecystectomy)
• Pancreatitis
• Peritonitis (inflammation of the lining of the abdomen)