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Acute cholecystitis

Cholecystitis - acute

 

Acute cholecystitis is sudden swelling and irritation of the gallbladder. It causes severe belly pain.

Causes

 

The gallbladder is an organ that sits below the liver. It stores bile, which your body uses to digest fats in the small intestine.

Acute cholecystitis occurs when bile becomes trapped in the gallbladder. This often happens because a gallstone blocks the cystic duct, the tube through which bile travels into and out of the gallbladder. When a stone blocks this duct, bile builds up, causing irritation and pressure in the gallbladder. This can lead to swelling and infection.

Other causes include:

  • Serious illnesses, such as HIV or diabetes
  • Tumors of the gallbladder (rare)

Some people are more at risk for gallstones. Risk factors include:

  • Being female
  • Pregnancy
  • Hormone therapy
  • Older age
  • Being Native American or Hispanic
  • Obesity
  • Losing or gaining weight rapidly
  • Diabetes

Sometimes the bile duct becomes blocked temporarily. When this occurs repeatedly, it can lead to chronic cholecystitis. This is swelling and irritation that continues over time. Eventually, the gallbladder becomes thick and hard. It does not store and release bile as well as it did.

 

Symptoms

 

The main symptom is pain in the upper right side or upper middle of your belly that usually lasts at least 30 minutes. You may feel:

  • Sharp, cramping, or dull pain
  • Steady pain
  • Pain that spreads to your back or below your right shoulder blade

Other symptoms that may occur include:

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

 

Exams and Tests

 

Your health care provider will perform a physical exam and ask about your symptoms. During the physical exam, you will likely have pain when the provider touches your belly.

Your provider may order the following blood tests:

  • Amylase and lipase
  • Bilirubin
  • Complete blood count (CBC)
  • Liver function tests

Imaging tests can show gallstones or inflammation. You may have one of these tests:

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

 

Treatment

 

If you have severe belly pain, seek medical attention right away.

In the emergency room, you'll be given fluids through a vein. You also may be given antibiotics to fight infection.

Cholecystitis may clear up on its own. However, if you have gallstones, you will probably need surgery to remove your gallbladder.

Nonsurgical treatment includes:

  • Antibiotics you take at home to fight infection
  • Low-fat diet (if you are able to eat)
  • Pain medicines

You may need emergency surgery if you have complications such as:

  • Gangrene (tissue death)
  • Perforation (a hole that forms in the wall of the gallbladder)
  • Pancreatitis (inflamed pancreas)
  • Persistent bile duct blockage
  • Inflammation of the common bile duct

If you are very ill, a tube may be placed through your belly into your gallbladder to drain it. Once you feel better, you may have surgery.

 

Outlook (Prognosis)

 

Most people who have surgery to remove their gallbladder recover completely.

 

Possible Complications

 

Untreated, cholecystitis may lead to any of the following health problems:

  • Empyema (pus in the gallbladder)
  • Gangrene
  • Injury to the bile ducts draining the liver (may occur after gallbladder surgery)
  • Pancreatitis
  • Perforation
  • Peritonitis (inflammation of the lining of the abdomen)

 

When to Contact a Medical Professional

 

Call your health care provider if:

  • Severe belly pain does not go away
  • Symptoms of cholecystitis return

 

Prevention

 

Removing the gallbladder and gallstones will prevent further attacks.

 

 

References

Glasgow RE, Mulvihill SJ. Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease:Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 66.

Jackson P, Evans S. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap. 55.

Wang DQH, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease:Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 65.

 
  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Cholecystitis, CT scan

    Cholecystitis, CT scan - illustration

    This is a CT scan of the upper abdomen showing cholecystitis (gall stones).

    Cholecystitis, CT scan

    illustration

  • Cholecystitis, cholangiogram

    Cholecystitis, cholangiogram - illustration

    Cholelithiasis can be seen on a cholangiogram. Radio-opaque dye is used to enhance the x-ray. Multiple stones are present in the gallbladder (PTCA).

    Cholecystitis, cholangiogram

    illustration

  • Cholecystolithiasis

    Cholecystolithiasis - illustration

    Cholecystolithiasis. CT scan of the upper abdomen showing multiple gallstones.

    Cholecystolithiasis

    illustration

  • Gallstones, cholangiogram

    Gallstones, cholangiogram - illustration

    A cholecystogram in a patient with gallstones.

    Gallstones, cholangiogram

    illustration

  • Digestive system organs

    Digestive system organs - illustration

    The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

    Digestive system organs

    illustration

  • Gallbladder removal - series

    Gallbladder removal - series

    Presentation

  • Cholecystogram

    Cholecystogram - illustration

    A cholecystogram is an x-ray procedure used to help evaluate the gallbladder. For the procedure, a special diet is consumed prior to the test and contrast tablets are also swallowed to help visualize the gallbladder on x-ray. The test is used to help in diagnosing disorders of the liver and gallbladder, including gallstones and tumors.

    Cholecystogram

    illustration

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Cholecystitis, CT scan

      Cholecystitis, CT scan - illustration

      This is a CT scan of the upper abdomen showing cholecystitis (gall stones).

      Cholecystitis, CT scan

      illustration

    • Cholecystitis, cholangiogram

      Cholecystitis, cholangiogram - illustration

      Cholelithiasis can be seen on a cholangiogram. Radio-opaque dye is used to enhance the x-ray. Multiple stones are present in the gallbladder (PTCA).

      Cholecystitis, cholangiogram

      illustration

    • Cholecystolithiasis

      Cholecystolithiasis - illustration

      Cholecystolithiasis. CT scan of the upper abdomen showing multiple gallstones.

      Cholecystolithiasis

      illustration

    • Gallstones, cholangiogram

      Gallstones, cholangiogram - illustration

      A cholecystogram in a patient with gallstones.

      Gallstones, cholangiogram

      illustration

    • Digestive system organs

      Digestive system organs - illustration

      The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

      Digestive system organs

      illustration

    • Gallbladder removal - series

      Presentation

    • Cholecystogram

      Cholecystogram - illustration

      A cholecystogram is an x-ray procedure used to help evaluate the gallbladder. For the procedure, a special diet is consumed prior to the test and contrast tablets are also swallowed to help visualize the gallbladder on x-ray. The test is used to help in diagnosing disorders of the liver and gallbladder, including gallstones and tumors.

      Cholecystogram

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Acute cholecystitis

           

             

            Review Date: 8/20/2015

            Reviewed By: Subodh K. Lal, MD, Gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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