Acute Cholecystitis

Overview

Acute cholecystitis is a sudden inflammation of the gallbladder, a small organ under the liver that helps digest food. It most often happens when a gallstone blocks the tube that lets bile out of the gallbladder. This blockage can cause swelling, pain, and sometimes infection.

Yes, acute cholecystitis is one of the most common complications of gallstones. Many people who have gallstones never have symptoms, but when a stone gets stuck, it can cause this condition.

It can affect anyone, but it is more common in adults, especially women, people over 40, and those who are overweight. People who have had previous gallbladder attacks are also at higher risk.

Symptoms

Common symptoms

• Sudden, severe pain in the upper right side of the belly
• Pain that spreads to the right shoulder or between the shoulder blades
• Tenderness when the belly is touched, especially the right side
• Fever and chills
• Nausea and vomiting
• Feeling bloated or full

Causes

Main causes

• Gallstones blocking the cystic duct, the tube that drains bile from the gallbladder
• A tumor or other mass pressing on the bile ducts
• Reduced blood flow to the gallbladder due to serious illness or injury
• Infection, such as from bacteria that travel up the bile duct

Risk factors

• Being overweight or obese
• Losing weight too quickly
• Being female, especially during pregnancy or after multiple pregnancies
• Being older than 40
• Having a family history of gallstones
• Eating a diet high in fat and cholesterol and low in fiber
• Having certain medical conditions like diabetes or liver disease

When to see a doctor

See a doctor urgently if:

• See a doctor the same day if you have steady belly pain that lasts more than a few hours, especially on the upper right side.
• Go to urgent care or an emergency department if you have fever, vomiting, or if the pain is getting worse.

Book a routine appointment if:

• If you have had a gallbladder attack before that went away on its own, make an appointment to discuss it with your doctor.
• If you have been told you have gallstones but have not had symptoms, talk to your doctor about whether you need any regular checks.

Diagnosis

A doctor will usually start by asking about your symptoms and doing a physical exam. They will press on your belly to check for tenderness. If they suspect acute cholecystitis, they will order imaging tests to look at your gallbladder and check for blockages.

Tests that may be done

• Blood tests to look for signs of infection, inflammation, or liver problems
• An ultrasound of the belly, which is the most common imaging test for this condition
• A HIDA scan, which checks how well the gallbladder is emptying
• A CT scan or MRI in some cases, if the diagnosis is unclear or complications are suspected

What to expect at your appointment

If acute cholecystitis is suspected, you will likely be admitted to the hospital. Doctors will monitor your condition, manage your pain and hydration, and may run more tests to confirm the diagnosis and rule out other causes of severe belly pain.

Treatment

Acute cholecystitis is usually treated in the hospital. The main goals are to calm the inflammation, treat any infection, and relieve the blockage. Most people need intravenous fluids, pain relief, and antibiotics. For many, the gallbladder is eventually removed to prevent future attacks.

Self-care at home

• Do not eat or drink until a doctor says it is safe, especially if you are having severe symptoms.
• Rest and avoid heavy activity while you are recovering.
• If you have been diagnosed with a mild attack and are home, use a warm compress on your belly to help with pain, if your doctor agrees.
• Always follow the specific advice your doctor gives you about eating, drinking, and medications.

Medical treatments

Treatment usually begins in the hospital with fluids given through a vein, pain relievers, and antibiotics to treat or prevent infection. Doctors may also give medication to help with nausea. In many cases, a procedure called an ERCP may be done to remove a stone blocking the bile duct. The most common long-term treatment is surgery to remove the gallbladder. This is called a cholecystectomy and is often done using small incisions, leading to a faster recovery. In some situations, a tube may be placed through the belly to drain the gallbladder if surgery has to be delayed.

When is surgery considered?

Surgery to remove the gallbladder is usually recommended, either during the hospital stay or within a few weeks after the inflammation improves. It is the most reliable way to prevent the condition from coming back. Your doctor will decide the timing based on your overall health and the severity of the attack.

Living with this condition

After recovering from acute cholecystitis, you can usually return to normal activities within a few weeks, depending on whether you had surgery. If your gallbladder is removed, you can still digest food well—your liver makes bile, which is released directly into the intestine after the gallbladder is gone. Some people have loose stools for a while, but this often settles over time.

Lifestyle tips

• Try to keep a healthy weight, but avoid very rapid weight loss, which can make gallstones worse.
• Eat regular meals and avoid long periods without eating, because fasting can make bile collect in the gallbladder.
• If you drink alcohol, keep it moderate—ask your doctor for specific advice.
• Stay active with daily walks and build up slowly after surgery.

Diet and exercise

A balanced, low-fat diet is often recommended. Focus on fruits, vegetables, whole grains, and lean protein. Limit fried foods, fatty meats, and creamy sauces. If you still have your gallbladder, a high-fat meal can trigger an attack. After surgery, you can gradually add fiber and variety, but small, regular meals may help your digestion. Gentle exercise like walking is encouraged, but check with your healthcare team before lifting heavy things after an operation.

Mental health and emotional wellbeing

Dealing with sudden severe belly pain and a hospital stay can be stressful and frightening. It is normal to feel anxious or low afterward, especially if you worry about another attack. Give yourself time to recover and talk to your healthcare team about how you are feeling. If anxiety or sadness lasts, consider speaking to a counselor or your GP.

Prevention

You cannot always prevent acute cholecystitis, especially if you already have gallstones. But there are steps that reduce your risk: keep a healthy weight, avoid crash diets, eat regular balanced meals, and include fiber in your diet. If you already have gallstones, following these steps may reduce the chance of them getting stuck.

Vaccines

There is no vaccine for acute cholecystitis.

Screening programmes

Screening is not routinely done for gallstones in healthy people. If you have symptoms or risk factors, your doctor may order an ultrasound to check for gallstones, but regular scans are not usually recommended unless you have a reason.

Complications

If left untreated

• If the bile duct stays blocked, infection can spread from the gallbladder to the bloodstream, causing sepsis.
• The gallbladder may rupture, leaking bile into the belly, which is a life-threatening emergency.
• A collection of pus, called an abscess, may form around the gallbladder.
• Gallstones can also pass into the pancreas and cause pancreatitis, a painful inflammation of the pancreas.

Long-term outlook

With prompt care, most people with acute cholecystitis get better completely. Removing the gallbladder is a very common operation with excellent results. Most people return to a full, active life and have no long-term problems from the surgery. Following your doctor's advice and taking recovery slowly will give you the best outcome.

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