Acute cholecystitis

Acute cholecystitis is inflammation of the gallbladder. It usually happens when a gallstone

blocks the cystic duct.

Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. The cystic
duct is the main opening of the gallbladder.

Gallstones are very common, affecting about 1 in 10 adults in the UK.

They do not usually cause symptoms, but can occasionally cause episodes of pain (biliary colic)
or acute cholecystitis.

Acute cholecystitis is potentially serious because of the risk of complications.

It usually needs to be treated in hospital with rest, intravenous fluids and antibiotics.

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

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

Unlike other types of abdominal pain, the pain of acute cholecystitis is usually persistent and
does not go away within a few hours.

Some people may have additional symptoms, such as:

• a high temperature (fever)

• feeling sick
• being sick
• sweating
• loss of appetite
• yellowing of the skin and the whites of the eyes (jaundice)
• a bulge in the tummy
When to seek medical advice
See a GP as soon as possible if you develop sudden and severe abdominal pain, particularly if it
lasts longer than a few hours or is accompanied by other symptoms, such as jaundice and a high
temperature.

If you're unable to contact a 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, as there's a risk serious
complications could develop if it's not treated promptly.

What causes acute cholecystitis?

The causes of acute cholecystitis can be grouped into 2 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, the cystic duct, gets
blocked by a gallstone or 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
cholesterol and salt crystals.

The blockage in the cystic duct causes bile to build up in the gallbladder, increasing the pressure
inside it and causing it to become inflamed.

In around 1 in every 5 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 can be caused by accidental damage to the gallbladder during major
surgery, serious injuries or burns, sepsis, severe malnutrition or HIV/AIDS.

Diagnosing acute cholecystitis

If you have severe tummy pain, a GP will probably carry out a simple test called Murphy's sign.

You'll be asked to breathe in deeply with the GP's hand pressed on your tummy, just below your
rib cage.

Your gallbladder will move downwards as you breathe in. If you have cholecystitis, you'll
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 tummy – to check for gallstones or other signs of a problem with
your gallbladder
Other scans, such as an X-ray, CT scan or MRI scan, may also be carried out to examine your
gallbladder in more detail if there's any uncertainty about your diagnosis.

Treating acute cholecystitis

If you're diagnosed with acute cholecystitis, you'll probably need to be admitted to hospital for
treatment.