Acute cholecystitis is inflammation of the gallbladder. It usually happens when a gallstone blocks the cystic duct. The cystic duct is the main opening of the gallbladder.
Gallstones are small crystals that form in the gallbladder. They are usually made of cholesterol. This is a type of fat found in your blood.
Gallstones are very common. About 1 in 10 adults has them.
Gallstones do not usually cause symptoms. But if they block a duct, you can have intense pain (biliary colic).
Acute cholecystitis is serious because of the risk of complications. You usually need treatment in hospital.
Gallstones symptoms and treatment
Symptoms of cholecystitis
The main symptom of acute cholecystitis is sudden, sharp pain. This is usually in the upper right of your abdomen (tummy). It may spread towards your right shoulder. The pain can last longer than 5 hours.
The affected part of the tummy is usually very tender, and taking deep breaths can make the pain worse.
Other symptoms include:
- a fever (high temperature of 38 degrees Celsius or above)
- feeling sick (nausea) or getting sick (vomiting)
- sweating
- loss of appetite
- jaundice (your skin and whites of your eyes turn yellow)
- a bulge in your tummy
Urgent advice: Contact your GP or local out-of-hours GP urgently if:
- you get sudden and severe pain in your tummy
Early treatment reduces the risk of serious complications.
Types of acute cholecystitis
There are 2 types of acute cholecystitis:
- calculous cholecystitis
- acalculous cholecystitis
Calculous cholecystitis
Calculous cholecystitis is the most common type of acute cholecystitis.
It happens when a gallstone or biliary sludge blocks the cystic duct.
Biliary sludge is a mixture of bile and small crystals made of cholesterol and salt. Bile is a liquid produced by the liver that helps digest fats.
The blockage in the cystic duct causes bile to build up in the gallbladder. The pressure inside the gallbladder increases and it becomes inflamed (swollen).
In about 1 in 5 cases, the inflamed gallbladder becomes infected by bacteria.
Acalculous cholecystitis
Acalculous cholecystitis is less common and often more serious than calculous cholecystitis.
It usually develops as a complication of a serious illness, infection or injury.
Acalculous cholecystitis can happen after accidental damage to the gallbladder caused by:
- major surgery
- serious injuries or burns
- sepsis - a life-threatening complication of an infection
- severe malnutrition
- HIV/AIDS
Diagnosing acute cholecystitis
Your GP will do a simple test by asking you to take a deep breath with their hand pressed on your tummy, below your rib cage.
Your gallbladder moves downwards as you breathe in. If you have cholecystitis, you'll feel sudden pain when your gallbladder is near your GP's hand.
If you have symptoms of acute cholecystitis, your GP will refer you to a hospital. You will need more tests and treatment.
Tests include:
- blood tests - to check for signs of inflammation
- an ultrasound scan - to check for gallstones or other problems with your gallbladder
You may need other scans, such as:
- a computed tomography (CT) scan
- a magnetic resonance imaging (MRI) scan
The scans may help your care team confirm your diagnosis.
Treating acute cholecystitis
You usually need to go to hospital for treatment.
To start, you will:
- be asked to fast (not eat or drink) to take the strain off your gallbladder
- get fluids into a vein (intravenously or IV) to prevent dehydration
- get medicine for your pain
- get antibiotics if you have an infection
You may have surgery while you are getting treatment in hospital, or you may have surgery at a later date.
Surgery to remove the gallbladder
Surgery to remove your gallbladder can prevent acute cholecystitis from coming back. It also reduces your risk of developing serious complications.
You may have some bloating or diarrhoea after your gallbladder is removed. But you can lead a normal life without a gallbladder. Your liver still produces bile to digest food.
Keyhole and open surgery to remove your gallbladder
Complications of acute cholecystitis
Without treatment, acute cholecystitis can lead to life-threatening complications.
The main complication of acute cholecystitis is gangrenous cholecystitis.
Gangrenous cholecystitis is when gallbladder tissue dies. This can cause a serious infection that can spread throughout the body.
About 1 in 5 people with acute cholecystitis has emergency surgery to remove the gallbladder.
Other complications of acute cholecystitis include:
- recurrent attacks of acute cholecystitis (1 in 5 chance within a year)
- blocked bile duct
- build-up of pus or a gallbladder abscess
Preventing acute cholecystitis
It's not always possible to prevent acute cholecystitis. But you can reduce your risk by trying to prevent getting gallstones.
To help prevent getting gallstones:
- manage your diet
- if you have excess weight or obesity, try to lose weight in a controlled way - rapid weight loss can increase the risk of gallstones
Ask your doctor for advice about managing your diet.
