Acute Cholecystitis: Causes, Symptoms, Diagnosis, and Treatment
Acute cholecystitis is a
sudden inflammation of the gallbladder, often triggered by a gallstone
obstructing the cystic duct—the channel through which bile exits the
gallbladder. This condition requires prompt medical attention due to the
potential for serious complications if left untreated.
What Is
the Gallbladder and Why Is It Important?
The gallbladder is a small, pear-shaped
organ situated beneath the liver. Its primary function is to store and
concentrate bile, a digestive fluid produced by the liver that helps in
breaking down dietary fats. When food, especially fatty meals, enters the
digestive tract, the gallbladder releases bile into the small intestine.
Although the gallbladder plays a role in digestion, it is not essential. People can live healthy lives without it, especially if gallbladder issues become recurrent or severe.
What Are
Gallstones?
Gallstones are small, hardened deposits that form in the
gallbladder, typically made up of cholesterol, bile salts, or calcium. These
stones are very common, affecting over 10% of adults in the UK
and many more globally. Most people with gallstones experience no symptoms.
However, when a stone blocks the cystic duct, it can lead to biliary colic
(intermittent pain) or, in more severe cases, acute cholecystitis.
Symptoms
of Acute Cholecystitis
The primary symptom of acute cholecystitis is intense,
persistent pain in the upper right side of the abdomen, which may
radiate to the right shoulder or back. Unlike transient abdominal
pain, this discomfort often lasts for several hours and worsens with deep
breaths or movement.
Additional
symptoms may include:
- High fever
- Nausea and vomiting
- Sweating and chills
- Loss of appetite
- Jaundice (yellowing of the skin and eyes)
- Bloating or abdominal distension
If you experience these symptoms—especially
persistent abdominal pain with fever or jaundice—seek medical help
immediately.
When to
Seek Medical Advice
It’s essential to consult a GP or healthcare
provider promptly if you experience sudden, severe abdominal pain that
lasts longer than a few hours or if it’s accompanied by other concerning
symptoms such as fever, vomiting, or yellowing of the skin.
If a GP is unavailable, contact NHS 111 or
your local urgent care service for immediate guidance.
What
Causes Acute Cholecystitis?
Acute cholecystitis is generally categorized into
two main types:
1. Calculous
Cholecystitis (95% of cases)
This more common form occurs when a gallstone or
biliary sludge (a thick mixture of bile and cholesterol crystals) blocks
the cystic duct. This blockage causes bile to accumulate, increasing pressure
and irritation in the gallbladder. Bacterial infections may develop in the
stagnant bile, intensifying the inflammation.
2. Acalculous
Cholecystitis
Less common but often more severe, this type occurs
without gallstones. It typically arises as a complication of critical
illness, trauma, surgery, or infections like sepsis. Risk factors
include:
- Major surgery
- Serious burns or injuries
- Severe malnutrition or dehydration
- Gallbladder trauma
How Is
Acute Cholecystitis Diagnosed?
Diagnosis starts with a clinical evaluation.
A common bedside test is Murphy’s sign, where pain upon deep breathing
while the doctor presses under the right ribcage suggests gallbladder
inflammation.
If acute cholecystitis is suspected, you’ll be
referred to a hospital for further evaluation, which may include:
- Blood tests to detect infection and inflammation
- Ultrasound imaging to confirm gallstones or
gallbladder swelling
- CT or MRI scans in some complex cases
Treatment
Options for Acute Cholecystitis
Hospital
Admission
Most cases require hospitalization for
stabilization and treatment.
Initial
Management Includes:
- Fasting to rest the digestive system
- IV fluids to prevent dehydration
- Pain relief medications
- Intravenous antibiotics to treat or prevent
infection
Depending on the severity, you may stay in hospital
for several days or return home to complete a course of antibiotics.
Gallbladder
Removal Surgery (Cholecystectomy)
To prevent future attacks and complications,
doctors often recommend surgical removal of the gallbladder after the
initial inflammation has subsided.
Types of
Surgery:
- Laparoscopic Cholecystectomy (keyhole surgery):
Minimally invasive, with quicker recovery time. Usually performed within
one week of diagnosis.
- Open Cholecystectomy: Required in some complex
or emergency cases.
Most people recover fully and adapt easily to life
without a gallbladder. However, some may experience temporary bloating or
changes in digestion.
Alternatives
When Surgery Isn’t an Option
If surgery is deemed unsafe due to other medical
conditions, doctors may:
- Drain the gallbladder using a catheter inserted
through the skin or
- Perform endoscopic drainage using a tube passed through the
digestive tract
These options relieve symptoms but may not prevent
future episodes.
Possible
Complications of Untreated Acute Cholecystitis
Without prompt treatment, acute cholecystitis can
lead to severe, life-threatening complications:
- Gangrenous cholecystitis: Tissue death due to lack
of blood flow
- Gallbladder rupture (perforation): May lead to peritonitis
(a widespread infection in the abdominal cavity) or abscess formation
Roughly 20–30% of cases may require emergency
surgery to manage such complications.
Preventing
Acute Cholecystitis and Gallstones
While not all cases are preventable, reducing your
risk of gallstones significantly lowers the chance of developing acute
cholecystitis.
Tips to
Prevent Gallstones:
- Maintain a healthy, balanced diet
- Limit saturated fats and cholesterol
- Avoid rapid weight loss or extremely low-calorie diets
- Exercise regularly
- Maintain a healthy weight
Gradual, steady weight loss is the most effective
and sustainable way to reduce your risk of gallstone formation.
Key
Takeaways
- Acute cholecystitis is a potentially serious
condition caused by gallbladder inflammation, often due to gallstones.
- Prompt diagnosis and treatment are crucial to avoid
life-threatening complications.
- Surgical removal of the gallbladder is the
most effective long-term treatment.
- You can live a healthy life without a gallbladder, and the liver
continues to produce bile for digestion.
- A healthy lifestyle is your best defence against gallstones
and gallbladder disease.