Acute cholecystitis

What is acute cholecystitis?

Acute cholecystitis is inflammation of the gallbladder. The NHS and NICE CKS explain that it usually happens when a gallstone blocks the cystic duct (the main opening of the gallbladder). Bile builds up, pressure rises, and the gallbladder becomes inflamed; it can sometimes become infected.

The NHS describes acute cholecystitis as potentially serious because of the risk of complications, and it usually needs to be treated in hospital.

How it differs from gallstones and biliary colic

• Gallstones are very common — the NHS says they affect more than 1 in 10 adults in the UK — and most do not cause symptoms. Having gallstones does not mean you have, or will develop, acute cholecystitis.
• Biliary colic is episodic pain when a gallstone temporarily blocks the duct, usually settling within hours, without ongoing inflammation of the gallbladder.
• Acute cholecystitis is ongoing inflammation: the NHS notes the pain is usually persistent and does not go away within a few hours, and there may be a high temperature.
• Chronic cholecystitis is long-standing, lower-grade gallbladder inflammation and is a different picture from a sudden acute attack.

Types

• Calculous cholecystitis — caused by a gallstone or biliary sludge blocking the cystic duct. The NHS says this accounts for around 95% of cases.
• Acalculous cholecystitis — inflammation without gallstones. Less common but usually more serious, and typically seen in people who are already critically unwell (NHS; NICE CKS).

Symptoms

The NHS describes the main symptom as a sudden, sharp pain in the upper right-hand side of the tummy that can spread towards the right shoulder. The area is usually very tender and breathing in deeply can make it worse. Other symptoms can include:

• A high temperature
• Feeling sick or being sick
• Sweating
• Loss of appetite
• Yellowing of the skin and whites of the eyes (jaundice)
• A bulge in the tummy

The NHS advises seeing a GP as soon as possible if you develop sudden, severe abdominal pain, particularly if it lasts longer than a few hours or comes with jaundice or a high temperature. If you cannot contact a GP immediately, phone your local out-of-hours service or call NHS 111.

How it is diagnosed

• Examination — a GP may check for Murphy's sign (sudden pain on breathing in while the doctor presses below the right ribs). If acute cholecystitis is suspected, NICE CKS advises hospital admission.
• Abdominal ultrasound is the first-line imaging test, looking for gallstones and signs of gallbladder inflammation (NHS; NICE CKS; NICE CG188).
• Blood tests check for signs of inflammation and infection.

Possible complications

Without prompt treatment, acute cholecystitis can lead to serious complications, including:

• Gangrene — death of gallbladder tissue (gangrenous cholecystitis)
• Perforation — the gallbladder splitting open, which can cause peritonitis or an abscess
• Empyema — a collection of pus in the gallbladder (NICE CG188)

These need urgent surgical or interventional hospital care (NHS; NICE CKS; NICE CG188).