Acute cholecystitis (Gallstones)

Definition

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

Alternative Names

Causes

In 90% of cases, acute cholecystitis is caused by gallstones in the gallbladder. Severe illness, alcohol abuse and, rarely, tumors of the gallbladder may also cause cholecystitis.

Acute cholecystitis causes bile to become trapped in the gallbladder. The build up of bile causes irritation and pressure in the gallbladder. This can lead to bacterial infection and perforation of the organ.

Gallstones occur more frequently in women than men. Gallstones become more common with age in both sexes. Native Americans have a higher rate of gallstones.

Symptoms

The main symptom is abdominal pain -- particularly after a fatty meal -- that is located on the upper right side of the abdomen. Occasionally, nausea and vomiting or fever may occur.

Exams and Tests

A doctor's examination of the abdomen by touch (palpation) may reveal tenderness.

Tests that detect the presence of gallstones or inflammation include:

• Abdominal ultrasound
• Abdominal CT scan
• Abdominal x-ray
• Oral cholecystogram
• Gallbladder radionuclide scan
• A CBC shows infection by an elevated white blood cell count.

Treatment

Although cholecystitis may clear up on its own, surgery to remove the gallbladder (cholecystectomy) is usually needed when inflammation continues or recurs.

This operation is done as soon as possible, unless the patient is very ill or if the inflammation is thought to have been present for many days. Emergency surgery may be necessary if gangrene (tissue death), perforation, pancreatitis

Occasionally, 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.

Nonsurgical treatment includes pain medicines, antibiotics to fight infection, and a low-fat diet (when food can be tolerated). Patients usually need one or more doses of antibiotics.

Outlook (Prognosis)

Patients who have cholecystectomy usually do very well.

Possible Complications

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

When to Contact a Medical Professional

Call your health care provider if severe abdominal pain persists.

Call for an appointment with your health care provider if symptoms of cholecystitis recur after an acute episode.

Prevention

Removal of the gallbladder and gallstones will prevent further attacks. Reduce the fat content in the diet if you are prone to attacks of cholecystitis.