Cholecystitis

Overview

Cholecystitis is inflammation of the gallbladder, a small organ located under the liver. The gallbladder stores bile, a fluid that helps the body digest fats. In many cases, cholecystitis happens when a gallstone blocks the tube that allows bile to leave the gallbladder. This blockage can cause swelling, irritation, infection, and pain.

Cholecystitis may be acute, meaning it develops suddenly and can require urgent medical care, or chronic, meaning repeated episodes of inflammation occur over time. Because untreated inflammation can sometimes lead to serious complications, timely medical assessment is important. General surgeons commonly evaluate and treat this condition, often working with gastroenterology, radiology, and emergency medicine teams when needed.

Symptoms

The most common symptom of cholecystitis is pain in the upper right part of the abdomen. The pain may be steady, may become severe, and may spread to the right shoulder or back. It often starts after eating, especially after a fatty meal, but it can occur at any time.

Other possible symptoms include:

• Nausea or vomiting
• Fever or chills
• Tenderness when the upper right abdomen is touched
• Bloating or a feeling of fullness
• Loss of appetite
• Yellowing of the skin or eyes if bile flow is affected
• Dark urine or pale stools in some cases

Symptoms can vary from person to person. Older adults, people with diabetes, or people with weakened immune systems may have less typical symptoms, such as general weakness, confusion, or mild discomfort rather than strong abdominal pain.

Causes and Risk Factors

Gallstones are the most common cause of cholecystitis. They can block the cystic duct, which is the passageway from the gallbladder. When bile becomes trapped, the gallbladder can become inflamed and sometimes infected.

Less commonly, cholecystitis can occur without gallstones. This may happen in people who are severely ill, have had major surgery or trauma, or have certain conditions affecting blood flow or bile drainage.

Factors that may increase the risk of gallstones and cholecystitis include:

• Being female
• Increasing age
• Pregnancy or hormonal changes
• Family history of gallstones
• Being overweight or experiencing rapid weight loss
• Certain metabolic conditions, including diabetes
• A diet high in fat or refined carbohydrates
• Previous episodes of gallbladder pain

Having one or more risk factors does not mean a person will develop cholecystitis, and some people develop the condition without obvious risk factors.

Diagnosis

Diagnosis begins with a medical history and physical examination. A doctor will ask about the location, timing, and nature of the pain, associated symptoms, previous attacks, medical conditions, and any past surgeries. During the examination, the doctor may check for tenderness in the upper right abdomen and signs of fever or jaundice.

Blood tests may be used to look for signs of inflammation, infection, or problems with liver and bile duct function. Imaging tests are also important. Ultrasound is commonly used because it can show gallstones, gallbladder swelling, and signs of inflammation. In some cases, additional imaging such as computed tomography, magnetic resonance imaging, or a specialized scan of gallbladder function may be recommended.

If there is concern that a stone has moved into the main bile duct, further evaluation of the bile ducts may be needed. The choice of tests depends on the patient’s symptoms, examination findings, and overall health.

Treatment Options

Treatment depends on the severity of inflammation, the presence of complications, and the patient’s general condition. Acute cholecystitis often requires care in a hospital. Initial management may include fasting, fluids given through a vein, pain control, and medicines to treat infection when appropriate. The medical team monitors the patient closely and decides the safest next steps.

For many patients with gallstone-related cholecystitis, removal of the gallbladder is recommended to prevent repeated attacks and complications. This operation is called cholecystectomy. It is often performed using a minimally invasive approach with small incisions, although open surgery may be needed in some situations. People can live without a gallbladder because bile can still flow from the liver to the intestine, although some patients may notice temporary digestive changes.

If a patient is not fit for immediate surgery, a drainage procedure may be considered to relieve pressure and inflammation in the gallbladder. If stones are present in the main bile duct, an endoscopic procedure may be used to remove them before or around the time of gallbladder surgery. The treatment plan is individualized according to the patient’s condition and test results.

When to See a Doctor

Medical attention should be sought promptly for persistent or severe pain in the upper right abdomen, especially if it is accompanied by fever, vomiting, chills, or yellowing of the skin or eyes. These symptoms may indicate acute cholecystitis or another condition that needs urgent evaluation.

Emergency care is especially important if abdominal pain is severe, lasts for several hours, or is associated with confusion, fainting, shortness of breath, or a high fever. People with diabetes, older adults, pregnant patients, and those with weakened immune systems should seek medical advice early, even if symptoms seem mild.

Recurrent episodes of upper abdominal pain after meals should also be discussed with a doctor. Early assessment can help identify gallbladder disease and reduce the risk of complications. This information is general and does not replace evaluation by a qualified healthcare professional.