Acute cholecystitis 

Introduction 

The gallbladder, liver, bile duct and stomach

Laparoscopic cholecystectomy
  1. Liver
  2. Gallbladder
  3. Bile duct
  4. Bile duct enters duodenum
  5. Stomach

 

The gallbladder

The gallbladder is a small, pear-shaped organ located beneath the liver. The main purpose of the gallbladder is to store and concentrate bile.

Bile is a liquid produced by the liver that helps digest fats and carries toxins that are excreted by the liver. It is passed from the liver through a series of channels, called bile ducts, into the gallbladder, where it is stored.

Over time, bile becomes more concentrated, which increases its effectiveness at digesting fats. The gallbladder releases bile into the digestive system when it is needed.

The gallbladder is a useful, but not essential, organ. The gallbladder can safely be removed without interfering with your ability to digest food.

Acute cholecystitis is swelling (inflammation) of the gallbladder. It is a potentially serious condition that usually needs to be treated in hospital.

The main symptom of acute cholecystitis is a sudden sharp pain in the upper right side of your tummy (abdomen) that spreads towards your right shoulder.

The affected part of the abdomen is usually extremely tender, and breathing deeply can make the pain worse.

Unlike some others types of abdominal pain, the pain associated with acute cholecystitis is usually persistent, and doesn't go away within a few hours.

Some people may additional symptoms, 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

When to seek medical advice

You should see your GP as soon as possible if you develop sudden and severe abdominal pain, particularly if the pain lasts longer than a few hours or is accompanied by other symptoms, such as jaundice and a fever.

If it's not possible to contact your GP immediately, phone your local out-of-hours service or call NHS 111 for advice.

It's important for acute cholecystitis to be diagnosed as soon as possible, because there is a risk that serious complications could develop if the condition is not treated promptly (see below).  

What causes acute cholecystitis?

The causes of acute cholecystitis can be grouped into two main categories: calculous cholecystitis and acalculous cholecystitis.

Calculous cholecystitis

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

Calculous cholecystitis 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 produced by the liver that helps digest fats) and small crystals of cholesterol and salt.

The blockage in the cystic duct results in a build-up of bile in the gallbladder, increasing the pressure inside it and causing it to become inflamed. In around one in every five cases, the inflamed gallbladder also becomes infected by bacteria.

Acalculous cholecystitis

Acalculous cholecystitis is a less common, but usually more serious, type of acute cholecystitis. It usually develops as a complication of a serious illness, infection or injury that damages the gallbladder.

Acalculous cholecystitis is often associated with problems such as accidental damage to the gallbladder during major surgery, serious injuries or burns, blood poisoning (sepsis), severe malnutrition or AIDS.

Who is affected

Acute cholecystitis is a relatively common complication of gallstones.

It is estimated that around 10-15% of adults in the UK have gallstones. These don't usually cause any symptoms, but in a small proportion of people they can cause infrequent episodes of pain (known as biliary colic) or acute cholecystitis.

In England, around 28,000 cases of cholecystitis were reported during 2012-13.

Diagnosing cholecystitis

To diagnose acute cholecystitis, your GP will examine your abdomen.

They will probably carry out a simple test called Murphy’s sign. You will be asked to breathe in deeply with your GP's hand pressing gently but firmly on your tummy, just below your rib cage.

Your gallbladder will then move downwards as your breathe out and, if you have cholecystitis, you will experience sudden pain as your gallbladder reaches your doctor’s hand.

If your symptoms suggest you have acute cholecystitis, your GP will refer 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  such as an X-ray, a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan  may also be carried out to examine your gallbladder in more detail if there is any uncertainty about your diagnosis.

Treating acute cholecystitis

If you are diagnosed with acute cholecystitis, you will probably need to be admitted to hospital for treatment.

Initial treatment

Initial treatment will usually involve:

  • fasting (not eating or drinking) to take the strain off your gallbladder
  • receiving fluids through a drip directly into a vein (intravenously) to prevent dehydration
  • taking medication to relieve your pain

If you have a suspected infection, you will also be given antibiotics. These often need to be continued for up to a week, during which time you may need to stay in hospital or you may be able to go home.

With this initial treatment, any gallstones that may have caused the condition usually fall back into the gallbladder and the inflammation often settles down.

Surgery

In order to prevent acute cholecystitis recurring, and reduce your risk of developing potentially serious complications, the removal of your gallbladder will often be recommended at some point after the initial treatment. This type of surgery is known as a cholecystectomy.

Although uncommon, an alternative procedure called a percutaneous cholecystostomy may be carried out if you are too unwell to have surgery. This is where a needle is inserted through your abdomen to drain away the fluid that has built up in the gallbladder.

If you are fit enough to have surgery, your doctors will need to decide when the best time to remove your gallbladder may be. In some cases, you may need to have surgery immediately or in the next day or two, while in other cases you may be advised to wait for the inflammation to fully resolve over the next few weeks.

Surgery can be carried out in two main ways:

  • laparoscopic cholecystectomy  a type of keyhole surgery where the gallbladder is removed using special surgical instruments inserted 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

Although some people who have had their gallbladder removed have reported symptoms of bloating and diarrhoea after eating certain foods, you can lead a perfectly normal life without a gallbladder.

The organ can be useful but it's not essential, as your liver will still produce bile to digest food.

Read more about recovering from gallbladder removal.

Possible complications

Without appropriate treatment, acute cholecystitis can sometimes lead to potentially life-threatening complications.

The main complications of acute cholecystitis are:

  • the death of the tissue of the gallbladder, called gangrenous cholecystitis, 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 one in every five cases of acute cholecystitis, emergency surgery to remove the gallbladder is needed to treat these complications.

Preventing acute cholecystitis

It's not always possible to prevent acute cholecystitis, but you can reduce your risk of developing the condition by cutting your risk of gallstones.

One of the main steps you can take to help lower your chances of developing gallstones is adopting a healthy, balanced diet and reducing the number of high-cholesterol foods you eat, as cholesterol is thought to contribute to the formation of gallstones.

Being overweight, particularly being obese, also increases your risk of developing gallstones. You should therefore control your weight by eating a healthy diet and exercising regularly.

However, low-calorie, rapid weight loss diets should be avoided, because there is evidence they can disrupt your bile chemistry and actually increase your risk of developing gallstones. A more gradual weight loss plan is best. 

Read more about preventing gallstones.


Page last reviewed: 06/08/2014

Next review due: 06/08/2016

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Comments

The 10 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Gelxx said on 16 August 2014

I have been diagnosed with this for the second time in 2 weeks. It is so painful and debilitating I can empathise with you all. Originally the doctor at the hospital said I would need to have the gall bladder removed but now have decided not to do it and I have got to live with it. I really think I should have an operation but what do I know. They don't have the pain and missing time off work.

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tru81 said on 21 March 2014

Hi everyone, I can empathise with all of you. Last year I was diagnosed with Gallstones following many tests suggested by my GP for my symtoms, for me an attack was like i was being squeezed really tight and I just couldn't get comfy, my attacks would last from 1-5 hours in general and scared the life out of my the first time i had one! I only ever had the attacks at night time also!
When i knew that it was Gallstones I was referred straight away for surgery but after meeting with a consultant I was told it would be approx 18 weeks until I could have the routine outpatient operation!
I managed ok by eating a really low fat diet as any fatty foods made me have an attack. Then one day when i was at work i noticed that i was starting to get an attack, which i instantly thought was weird as i hadn't had one for a few weeks and never in the daytime before.
It gradually got worse, i called 111 a few times, eventually they made arrangements for me to see a Dr who told me that i was suffering with Biliary Colic and so gave my Buscopan (for IBS) rather than the pain relief i was asking for! I tried this and it had no effect whatsoever so we ended up at A&E, by this time it was getting on for 24hrs after the pain started so i knew that something wasn't right, my bloods were abnormal and showed infection so they admitted me, the next 5 days were a blur, i was on a constant IV cocktail of anti-biotics, various Dr's saw me and kept changing their minds about whether they would operate or not, It wasn't until i turned yellow (jaundice) that they decided that maybe i did actually need the op!... i was then operated on very swiftly! turned out that i had gangrenous Cholecystitis and as one surgeon put it "a very nasty gallbladder", the immediate relief following surgery was amazing!
I think I just happened to have a really bad experience during my crisis, don't be put off by intimidating doctors, demand that you have the appropriate tests etc and good luck!

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Rotciv Werdlem said on 17 March 2014

@sallyb1231 - my wife had the same problem as you. She was sent for an ultrasound scan which showed nothing, and was told to take painkillers. She then had severe pains again so was readmitted and this time X-rayed which showed nothing so sent away again. Soon after, she was rushed to hospital severely ill with a very high temperature and blood pressure of 210/110. This time we insisted on a full MRI scan which showed a huge gallstone and she was diagnosed with acute cholecystitis - 6 weeks later she had her gallbladder removed and has now made a full recovery. A similar thing happened to a friend of mine and his gallbladder turned gangrenous and he nearly died.
Please insist on seeing a consultant and have another MRI scan - I wish we had done this much earlier!

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sallyb1231 said on 06 March 2014

Hi, I am just looking for some advice from people really, I was addmitted into hospital about a month ago withnacute right sidded upper abdo pain which radiated into the middle of my stomach I also had extreme pain in my right shoulder they thought it was my gallbladder so scanned me but they said nothing showed on the scan however my bloods showed that my inflammatory marker was high, they discharged me after a week, I have still been suffering nd I have tried everything eating healthy etcbut ended up back in a&e last night with exactly the same problem nd nausea to which my bloods showed the exact same but still sent me home I cant keep carrying on like this can anyone offer any suggestions please im getting desperate, thank you for reading x

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painfreeplease said on 24 September 2013

I have had one off attacks of upper abdominal pain over the past few years, usually lasted about 5 hours(starts at night) then would pass, leaving me tender.I went to the GP a couple of times about this but they always said they had no idea what the problem was . They variously told me to keep a food diary, or thought it was irritable bowel. I knew it wasn't, & now it seems obv it was gallstones
Then I had a terrible episode where I hung on til 4.30 am then I did the nhs symptom checker which said I shld call a dr.I rang out of hours and got Nhs direct who asked more questions then said they'd get a dr to call me.He rang in 10 mins and said I had to get myself to a&e or a walkin centre. This was hard as my kids were asleep in bed. I got there after 5.30 am and was ready to bang my head on the wall.In a&e I saw a gp then dr and finally got pain relief. I was then admitted and spent 5 days with pain and high temp. Discharged with promise of gall bladder removal in 6 weeks. Hospital was fantastic, if I get another episode b4 op I'll go straight to a&e

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Potzy said on 22 September 2012

I awoke one morning with intense chest pain emanating from my lower sternum to shoulder blade. Initially moved to foetal position to counteract the pain, I got up and walked downstairs to get a hot drink. The pain subsided within the hour. Later that afternoon on leaving the bathroom the intense pain returned only this time I couldn't breathe through it or move my body into any comfortable position. I self presented to my local A&E where after waiting 4 hours for pain relief, was moved to an observation ward and given a rectal morphine suppository. I managed to fall asleep until I was awoken at 6.30am and told I could go home. A 'Doctor' told me I had suffered acid reflux and gave me some co-codamol and omeprazole advising me to contact my GP for an endoscopy referral. I was not happy with this diagnosis having suffered indigestion before I knew he was wrong. Fast forward less than 12 hours, I'm being rushed into A&E under blue lights after collapsing in pain at home. I was placed on an ECG, had blood taken and was shortly admitted for what became a 6 day stay. During this bed bound period I was placed on 2 drips and received copious morphine, oramorph, tramadol and antibiotics which me very sick (vomited within an hour of receiving the antibiotic intravenously). Acute Cholecystitis with Biliary Colic confirmed after Ultrasound scan. I was told I was too ill to have gall bladder surgically removed and was told to see the consultant within 6 weeks of discharge. 6 months later after several letters of complaint from my GP and telephone calls to consultant secretary I'm finally admitted for Laparoscopic Cholesystectomy. Surgery revealed chronically infected gall bladder (Empyema) and I was pulled about quite a bit leaving some heavy bruising around my belly button. I was fitted with a drain and kept in for another day. My experience with the Hospital side of the NHS has been atrocious apart from a few very compassionate nurses. My GP has been fantastic.

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User80559 said on 29 August 2011

Suffered with attacks for about 18 months, GP kept telling me it was indigestion. Finally a new GP had an ultrasound done which detected gallstones, attacks were becoming more frequent about every 2 weeks and for 3-4 hours at a time plus 3 vistis to A&E who just fobbed me off with painkillers.
Got myself referred to a specialist, booked to have a laparoscopy 4 weeks later however had another violent attack. Local hospital were awful and left me in severe pain and vomiting for 4 hours and tried to discharge me back to GP. I refused, made them send me to Margate who were brilliant. Initially consultant said treat with antibiotics and wait for gallbladder to calm down but it never did and white blood count and CRP readings went through the roof with only morphine stopping the pain.
I insisted they take the Gallbladder out straight away and surgeon said it had been the worst he'd seen and was 4 times it's size and full of pus (empyema). Miraculously he still managed to use keyhole to get it out (although it's quite a big cut) and I can't thank the consultant enough in taking that pain away!
Moral of this story, stick to your guns, don't be fobbed off by GP's who can't be bothored to take notice of the symptoms and insist on being referred.
I'm very cross still that I had to wait until mine was fit to burst and had months of pain before being seen and even then this was because I was lucky enough to have private health cover and just told the GP to refer me because he wouldn't have to pay!
A good outcome thanks to a brilliant surgeon in Margate QEQM and some fantastic nurses there too.

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tinawaynebrown said on 19 June 2011

I have been having severe abdominal pain for about 6 weeks,and my tummy has swollen, severe pain under my rib cage into my right shoulder and back so i went to our local A and E who did an xray and blood tests and gave me co-codimal and told me to go to my gp so they could arrange a scan for me as hospital couldn,t do it on a sunday, i went to my gp and she has requested am urgent scan for me and its been a week now and i havn,t heard anything as yet, my pain is worse at night and i sometimes cry with pain, my gp told me to keep going to A and E if pain gets too much as the surgeons in this country don,t like to intervene with gall bladder unless it is severe, I personally think it is disgusting that a human being has to suffer in this way if i was an animal i would of been put down with pain like this as its inhumane to suffer like this, i have worked all my life and have never been one to go to the gp and hospital and now i need help i can,t get it, our hospitals are like the ones in the 3rd world now.

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Sweetchic said on 16 May 2011

I have been suffering from pains in my stomuch now for about a year now. And everytime I went to the Dr. Them send me home with painkillers. A few days ago I phoned the Dr and told them that I'm in lots of pain again in my stomuch and told me that them don't any appointments for a week and that I must go to drop in clinic at the hospital. So off I went and the Dr I saw said to me that I need to go and see my own Dr and not it have to be an emergency appointment and that I would need a scan and some blood test done. I went to the Dr this morning (monday 15th May) and told her what the other Dr have said. She examing me and told me that it looks like gallbaddler. I now have to wait about 2 weeks before I can have a scan done and have to get some blood test done. So It's going to take at least another 3-4 weeks before I know for sure. All this time i'm in lots of pain and now I'm getting lots of rash all over my skin. What can I do and what if It's got really bad??

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Skyecastle said on 25 January 2011

Ok, I have had gall bladder removal, not in the UK. My first 'attack' was severe, and caused the blood levels of my pancreas to go up (amylase) to 880. A stone had blocked, then did pass, however, my doctors in America wanted to remove it quickly to avoid another episode that could prove fatal. I ultimetely did have it removed with excellent success. Now I have a friend there in the UK, with symptoms similar to mine, and she went and saw her GP, he didnt even draw blood for a simple test! He sent her home with pain killers (I hear this a lot), and said they would "send a letter" to schedule an ultra sound! Amazing! A women presents with acute symptoms,in pain, and they didnt even draw blood! A simple blood test would have given a much better picture of what was going on now, instead she has to wait for a letter to schedule a test? Just amazing, in the lack of true care and treatment of your people. A week has almost gone by and no letter yet, and the pain worsening. She could crash at any moment, but lets be sure to do it "by the book"! Unreal..

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