Acute cholecystitis is a sudden inflammation of the gallbladder that causes severe abdominal pain.
See also: Chronic cholecystitis
Alternative NamesCholecystitis - acute
Causes, incidence, and risk factorsIn 90% of cases, acute cholecystitis is caused by gallstones in the gallbladder. Severe illness and, rarely, tumors of the gallbladder may also cause cholecystitis.
Acute cholecystitis causes bile to become trapped in the gallbladder. The buildup of bile causes irritation and pressure in the gallbladder. This can lead to bacterial infection and perforation of the organ.
Gallstones occur more frequently in women than men. Gallstones become more common with age in both sexes. Native Americans have a higher rate of gallstones.
SymptomsThe main symptom is abdominal pain that is located on the upper right side or upper middle of the abdomen. The pain may:
Other symptoms that may occur include:
A physical exam will show that your abdomen is tender to the touch.
Your doctor may order the following blood tests:
Imaging tests that can show gallstones or inflammation include:
Seek immediate medical attention for severe abdominal pain.
In the emergency room, patients with acute cholecystitis are given fluids through a vein and antibiotics to fight infection.
Although cholecystitis may clear up on its own, surgery to remove the gallbladder (cholecystectomy) is usually needed when inflammation continues or recurs. Surgery is usually done as soon as possible, however some patients will not need surgery right away.
Nonsurgical treatment includes pain medicines, antibiotics to fight infection, and a low-fat diet (when food can be tolerated).
Emergency surgery may be necessary if gangrene (tissue death), perforation, pancreatitis, or inflammation of the common bile duct occurs.
Occasionally, in very ill patients, a tube may be placed through the skin to drain the gallbladder until the patient gets better and can have surgery.
Expectations (prognosis)Patients who have surgery to remove the gallbladder usually do very well.
ComplicationsCall your health care provider if severe abdominal pain persists.
Call for an appointment with your health care provider if symptoms of cholecystitis recur after an acute episode.
PreventionRemoval of the gallbladder and gallstones will prevent further attacks. Follow a low-fat diet if you are prone to gallstone attacks.
ReferencesSiddiqui T. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg. 2008;195(1):40-47.
Chari RS, Shah SA. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap. 54.
Afdhal N. Diseases of the gallbladder and bile ducts. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap. 159.
Acute cholecystitis is a sudden inflammation of the gallbladder that causes severe abdominal pain.
See also: Chronic cholecystitis
Alternative NamesCholecystitis - acute
Causes, incidence, and risk factorsIn 90% of cases, acute cholecystitis is caused by gallstones in the gallbladder. Other causes include severe illness and (rarely) tumors of the gallbladder.
Acute cholecystitis occurs when bile becomes trapped in the gallbladder. The buildup of bile causes irritation and pressure in the gallbladder. This can lead to infection and a hole (perforation) in the organ.
Gallstones occur more often in women than men. Gallstones become more common with age in both sexes. Native Americans and Hispanics have a higher rate of gallstones than most other people.
SymptomsThe main symptom is pain in the upper right side or upper middle of the abdomen. The pain may:
Other symptoms that may occur include:
A physical exam will show that your abdomen is tender to the touch.
Your doctor may order the following blood tests:
Imaging tests that can show gallstones or inflammation include:
Seek immediate medical attention for severe abdominal pain.
In the emergency room, patients with acute cholecystitis are given fluids through a vein and antibiotics to fight infection.
Although cholecystitis may clear up on its own, surgery to remove the gallbladder (cholecystectomy) is usually needed when gallstones are present. Surgery may be done as soon as possible; however, some patients will not need surgery right away.
Nonsurgical treatment includes:
You may need emergency surgery if you have gangrene (tissue death), perforation, pancreatitis, or inflammation of the common bile duct.
In very ill patients, a tube may be placed through the skin to drain the gallbladder until the patient gets better and can have surgery.
See also: Gallstones - discharge
Expectations (prognosis)Patients who have surgery to remove the gallbladder usually do very well.
ComplicationsCall your health care provider if:
Removing the gallbladder and gallstones will prevent further attacks.
ReferencesSiddiqui T. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg. 2008;195(1):40-47.
Chari RS, Shah SA. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap. 54.
Wang DQH, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 65.
Glasgow RE, Mulvihill SJ. Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 66.
Reviewed ByReview Date: 08/11/2011
Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and George F Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The disorder can occur a single time (acute), or can recur multiple times (chronic).
An acute attack of cholecystitis is often associated with the consumption of a large, high-fat meal.
Acute inflammation of the gallbladder without the presence of the gallstone.
K80.01
Clarence J. Schein has written: 'Acute cholecystitis' -- subject(s): Cholecystitis 'The common bile duct' -- subject(s): Bile ducts, Gallstones, Radiography, Surgery
Conservative therapy, narcotic analgesics such as meperidine to relieve the intense pain associated with this condition.
The possible causes of acute abdomen are the following: 1. acute peptic ulcer and its complications; 2. acute cholecystitis; 3. acute pancreatitis; 4. acute intestinal ischemia; 5. acute appendicitis; 6. acute diverticulitis; 7. acute peritonitis; 8. ectopic tubal pregnancy with tubal rupture; 9. acute pyelonephritis; 10. acute ureteral colic; 11. diabetic ketoacidosis.
The withholding of oral feedings, the use of intravenous feedings, and the administration of antibiotics and analgesics are only short-term and is usually followed by a cholecystectomy.
Emphysema is a lung condition. There is nothing called "emphysema of the gallbladder".Perhaps you mean Emphysematous cholecystitis, called clostridial cholecystitis, which is an acute infection of the gallbladder wall. It is caused by Clostridium or Escherichia coli and is generally considered a surgical emergency.
Diagnostically, gallstone disease, which can lead to gallbladder removal, is divided into four diseases: biliary colic, acute cholecystitis, choledocholithiasis, and cholangitis.
The infection with gangrene (from tissue necrosis or specific bacteria) is a complication of acute cholecystitis, and may be called a gangrenous gallbladder or gangrenous gall bladder. Because rupture of the bladder would release toxins into the entire abdomen, this is a critical medical situation.
Sonographic Murphy's sign is a positive finding on ultrasound indicating tenderness and pain when pressure is applied to the gallbladder as the patient breathes in. This can be suggestive of acute cholecystitis, an inflammatory condition of the gallbladder usually caused by gallstones. Additional clinical and imaging studies may be needed to confirm the diagnosis.