Cholecystitis

Cholecystitis is the medical term for inflammation of the gallbladder. The condition tends to be more prevalent among women than men and is more common in older adults. 1

The gallbladder stores bile, which is a liquid produced by the liver to help digest fatty foods. After eating, the gallbladder typically squeezes bile down the bile tract and into the intestines. In most, but not all cases, acute cholecystitis is caused by gallstones from the gallbladder blocking the drainage of bile. The condition often causes sudden, lasting pain in the upper or upper-right areas of the belly. 1 2

Treatment, which often requires going to a hospital, may initially involve pain-relief measures, fluids and antibiotics. In most cases, the gallbladder will need to be removed in a surgical procedure called a cholecystectomy. 3

With appropriate treatment, the outlook for uncomplicated cases of cholecystitis is generally very good, and most people recover well. 4

Severe pain in the upper or upper-right area of the belly is the most common symptom of acute cholecystitis. The pain may radiate into the right shoulder, and breathing in deeply may make it feel worse. It tends to be constant and is long-lasting, typically persisting for several hours. 1 5

Other symptoms associated with gallbladder inflammation may include: 2 3 5

• Loss of appetite
• Nausea
• Vomiting
• Sweating
• Fever
• In some cases, yellowing of the skin and the whites of the eyes, known as jaundice

Symptoms can vary, depending on the individual person and what is causing the cholecystitis. They may be worse after a meal. 1 Elderly people, particularly those who have diabetes, may experience tenderness rather than pain and other vague symptoms, such as feeling unwell and weak. 5 6

Good to know: If fever is present in a case of gallbladder inflammation, it may indicate a bacterial infection, which will typically require treatment with antibiotics. 5

If fever and/or jaundice is present or symptoms are severe, it is recommended that you seek medical care without delay. Gallbladder inflammation can lead to serious complications if left untreated.

There are two main causes of acute gallbladder inflammation: 2 6 7 8

• In cases described as calculous cholecystitis, the cause of inflammation is thought to be the gallbladder being blocked or irritated by gallstones. Calculous cholecystitis accounts for the vast majority, 90-95 percent, of cases of gallbladder inflammation.
• In cases described as acalculous cholecystitis, the cause of inflammation is not gallstones, but a serious underlying illness, infection or injury that affects the gallbladder, causing bile to build up and become stagnant. This type of cholecystitis is less common and is seen more often in people with severe or critical illness. It may be difficult to recognize and can be extremely serious. 4

Gallstones are the main risk factor for developing cholecystitis. Other, related risk factors for gallbladder inflammation may include the following: 2 4 7 9

• Being female
• Increasing age
• A family history of cholecystitis
• Having European, Native American or Hispanic heritage
• Being overweight or obese
• Pregnancy
• Certain medical conditions, including Crohn’s disease
• Rapid weight loss, e.g. as experienced after weight-loss surgery or intense dieting

Cholecystitis without gallstones, which is far less common, is generally associated with factors that include: 1 10 8

• Failure of multiple organs
• Serious burns or other injuries
• Intravenous feeding (parenteral nutrition) for long periods of time
• Being in intensive care
• Cardiovascular disease
• Diabetes
• Sepsis
• Advanced stages of HIV

Good to know: Unlike calculous cholecystitis, acalculous cholecystitis seems to occur slightly more frequently in men than women. It is more prevalent among older adults.

As a first step, a doctor will assess the person’s symptoms, take their medical history and perform a physical examination.

The doctor might press on the upper-right area of the belly, just below the ribcage, and ask the person to take a deep breath, checking for what is known as Murphy’s sign. Pain that is felt during this test may indicate that the gallbladder is inflamed. 1 2 3

The doctor may order a urine test to check for signs of kidney problems and blood tests to check for signs of infection or problems in the liver or pancreas. They may also request that an ultrasound scan computed tomography (CT) scan or other imaging tests be performed to examine the gallbladder and other parts of the abdomen and confirm the diagnosis. 6 11

It is important to rule out other conditions that may sometimes cause symptoms similar to gallbladder inflammation, including: 1

• Appendicitis
• Gastritis
• Pancreatitis
• Kidney stones

Good to know: If, after a full examination, the doctor thinks that you have gallbladder inflammation, they may refer you to hospital to ensure that you receive prompt treatment. 2

Imaging tests for suspected cholecystitis may include the following: 12 2 3 9 11 13 14 15

Abdominal ultrasound. A quick, non-invasive scan that uses sound waves to check for the presence of inflammation and gallstones in the gallbladder. An ultrasound is usually the first imaging test performed if cholecystitis or cholelithiasis (gallstones) is suspected.

CT scan. A scan that uses multiple X-rays in multiple layers to confirm the presence of gallbladder inflammation, as well as check for possible complications, e.g. a rupture.

MRI. A scan that uses powerful magnets and radio waves. An MRI may sometimes be used instead of a CT scan to confirm the diagnosis.

Hepatobiliary scintigraphy. A test that uses a safe, weakly-radioactive substance and a special camera to assess the functioning of the gallbladder and whether it is inflamed. This test is also known as a hydroxy iminodiacetic acid (HIDA) scan or hepatobiliary scan, or cholescintigraphy. It is considered to be highly accurate in the diagnosis of cholecystitis.

Cholangiography. A test that uses dye and X-rays to check for suspected gallstones and problems in the biliary system, i.e. the liver, gallbladder and bile ducts. 16 This test may form part of a procedure called an endoscopic retrograde cholangiopancreatography (ERCP), where a thin, flexible tube called an endoscope is used to diagnose and remove gallstones that have become stuck in bile ducts.

Plain X-rays. These are not considered very accurate in confirming a diagnosis of gallbladder inflammation. However, X-rays may be recommended to check for other possible causes of the person’s symptoms.

While it depends on the cause and severity of the condition, initial treatment of cholecystitis will usually involve pain-relief measures, intravenous fluids to prevent dehydration and sometimes antibiotics. Generally, surgical removal of the gallbladder will be necessary, and it may be recommended that this take place within the next day or two. Prompt arrangement of surgery is generally preferred. 17 1 2 3 6

In mild, uncomplicated cases, it may sometimes be possible for a person to receive initial treatment without a hospital stay and then go to hospital to prepare for surgery on the date determined by their doctor. However, in more severe cases of gallbladder inflammation, immediate hospitalization may be needed. 17 9

Surgery to remove the gallbladder, called cholecystectomy, is the standard treatment for most cases of cholecystitis. It is a common procedure. 2 7

There are two types of gallbladder surgery: 3 9 13 18 19 20 21

Laparoscopic cholecystectomy. A type of keyhole surgery where the gallbladder is removed through a small incision in the abdomen. In some cases, a person may be able to go home on the same day, though they might be kept in hospital for a few days after the surgery for monitoring.

Open cholecystectomy. An older type of surgery that requires a bigger incision in the abdomen to remove the gallbladder. This may be necessary if a laparoscopy is not advisable or complications arise. The recovery time tends to be longer for this type of surgery.

A person can live a normal, healthy life without their gallbladder. When it is removed, bile simply flows directly from the liver into the intestine via the common bile duct, aiding digestion as usual. In some cases, there may be mild cases of loose stools or indigestion for a while as the body adjusts. This is usually temporary. The risk of complications from a cholecystectomy is considered low. 2 9 13 21 22

In cases where a person is unable to undergo surgery because the risks are too great, doctors might insert a catheter into the gallbladder to drain it and reduce the inflammation – this is called a percutaneous cholecystostomy. Surgery to remove the gallbladder will typically then be recommended for when the person is in a more stable condition and able to undergo the operation. 17 1 6

In cases where surgery is not immediately possible, the gallbladder may also be drained using a procedure called an endoscopic ultrasound-guided transmural cholecystostomy. This makes use of an endoscope tube and the guidance of an ultrasound scan to perform the drainage. 17

Read about treatment of gallstones, the most common cause of gallbladder inflammation »

If left untreated, cholecystitis can result in serious complications, some of which may be life-threatening. Possible complications include: 2 23 24

• Gangrenous cholecystitis, where gallbladder tissue dies and becomes susceptible to infection, potentially resulting in sepsis 25
• Gallbladder perforation, where the gallbladder ruptures and bile leaks out, potentially resulting in infection within the abdomen itself or an abscess forming

Read about other possible complications of gallbladder disease »

In these cases, emergency treatment is usually required. If the following symptoms are present, it is important to seek medical help immediately: 6 23

• Sudden, severe pain in the belly, which worsens
• High fever
• Chills, shivering and sweating
• Vomiting
• Rapid heartbeat

Sometimes, gallbladder inflammation persists for a long period of time. In such cases, the term ‘chronic cholecystitis’ is used. Chronic gallbladder inflammation is almost always caused by gallstones. With repeat episodes of acute cholecystitis, sometimes called gallbladder attacks, which occur in chronic cholecystitis, the gallbladder can become damaged, and its functioning may be impaired. Treatment typically involves surgery to remove the gallbladder (cholecystectomy). 26 27

Chronic gallbladder inflammation may increase the risk of gallbladder cancer. 1 If gallbladder inflammation is known or suspected, it is important to seek medical treatment to minimize the risk of complications occurring.

After having their gallbladder removed, an estimated 1 in 10 people develop what is known as postcholecystectomy syndrome (PCS). They may experience a number of symptoms associated with gallbladder disease, as well as symptoms related to removal of the gallbladder. 13

Read more about post-cholecystectomy syndrome »

While it may not be possible to prevent gallbladder inflammation, taking steps to reduce the risk of developing gallstones, the major cause of gallbladder inflammation, may be helpful. 2

Read more about preventing gallstones »

During pregnancy, a person’s risk of developing gallstones and, as a result, gallbladder inflammation, is increased. If cholecystitis occurs in pregnancy, surgery to remove the gallbladder may be necessary to avoid complications. This usually takes the form of a laparoscopic cholecystectomy and is generally considered to be safe at any stage of pregnancy. 28 29 30

Some doctors may prefer to treat a pregnant person with pain-relief measures, fluid replacement and antibiotics initially, recommending gallbladder surgery after the baby has been delivered. However, with delayed surgery, the risk of complications may be increased for both the mother and baby. 29 30

• Gallbladder inflammation
• Hot gallbladder (uncommon) 31

Q: Is cholecystitis an emergency?
A: In some cases, acute cholecystitis may be a medical emergency that requires immediate treatment at a hospital. In other cases, emergency treatment may not be required. However, because it is a serious condition that can result in potentially life-threatening complications, including sepsis, a doctor should be seen as soon as possible if inflammation of the gallbladder is suspected. If symptoms are severe, seek emergency assistance. 17 12

Q: Can cholecystitis be treated without surgery?
A: Surgery to remove the gallbladder, called cholecystectomy, is the standard treatment for cholecystitis. However, in cases where a person is unable to undergo surgery, non-surgical treatment may sometimes be recommended. 32

Q: Do I have cholecystitis?
A: If you are worried that you might have gallbladder inflammation, you can try using the Ada app for a free health assessment. Note that if symptoms of any kind are severe, it is always recommended that you see a doctor without delay.

Q: What is the difference between cholecystitis and cholangitis?
A: Cholecystitis refers to inflammation of the gallbladder, while cholangitis refers to inflammation of the bile ducts.

Q: What is the difference between cholecystitis and cholelithiasis?
A: Cholecystitis is the medical term for gallbladder inflammation. This is usually caused by gallstones, the medical name for which is cholelithiasis.

Q: What is the difference between cholecystitis and pancreatitis?
A: Cholecystitis is inflammation of the gallbladder, while pancreatitis is inflammation of the pancreas. In some cases, the two conditions may occur at the same time.