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Acute cholecystitis

Cholecystitis - acute; Gallstones - acute cholecystitis; Acalculous cholecystitis

Acute cholecystitis is sudden swelling and irritation of the gallbladder. It causes severe belly pain.

Causes

The gallbladder is an organ that sits below the liver. It stores bile, which is produced in the liver. Your body uses bile to digest fats in the small intestine.

Acute cholecystitis occurs when bile becomes trapped in the gallbladder. This often happens because a gallstone blocks the cystic duct, the tube through which bile travels into and out of the gallbladder. When a stone blocks this duct, bile builds up, causing irritation and pressure in the gallbladder. This can lead to swelling and infection.

Other causes include:

  • Serious illnesses, such as HIV or diabetes
  • Tumors of the gallbladder (rare)

Some people are more at risk for gallstones. Risk factors include:

  • Being female
  • Pregnancy
  • Hormone therapy
  • Older age
  • Being Native American or Hispanic
  • Obesity
  • Losing or gaining weight rapidly
  • Diabetes

Sometimes, the bile duct becomes blocked temporarily. When this occurs repeatedly, it can lead to long-term (chronic) cholecystitis. This is swelling and irritation that continues over time. Eventually, the gallbladder becomes thick and hard. It does not store and release bile as well as it did.

Symptoms

The main symptom of acute cholecystitis is pain in the upper right side or upper middle of your belly that usually lasts at least 30 minutes. You may feel:

  • Sharp, cramping, or dull pain
  • Steady pain
  • Pain that spreads to your back or below your right shoulder blade
  • Pain that occurs after a meal, more commonly after a fatty meal

Other symptoms that may occur include:

  • Clay-colored stools
  • Fever
  • Nausea and vomiting
  • Yellowing of the skin and whites of the eyes (jaundice)

Exams and Tests

Your health care provider will perform a physical exam and ask about your symptoms. During the physical exam, you will likely have pain when the provider pushes on your belly.

Your provider may order the following blood tests:

Imaging tests can show gallstones or inflammation. You may have one or more of these tests:

Treatment

If you have severe belly pain, seek medical attention right away.

In the emergency room, you'll be given fluids through a vein. You may also be given antibiotics to fight infection.

Cholecystitis may clear up on its own. However, if you have gallstones, you will probably need surgery to remove your gallbladder.

Nonsurgical treatment includes:

  • Antibiotics you take at home to fight infection
  • Low-fat diet (if you are able to eat)
  • Pain medicines

You may need emergency surgery if you have complications such as:

  • Tissue death (gangrene) of the gallbladder
  • A hole that forms in the wall of the gallbladder (perforation)
  • Inflamed pancreas (pancreatitis)
  • Persistent bile duct blockage
  • Infection due to a stone in the common bile duct -- also known as cholangitis

If you are very ill, a tube may be placed through your belly into your gallbladder to drain it. Once you feel better, your provider may recommend that you have surgery.

Outlook (Prognosis)

Most people who have surgery to remove their gallbladder recover completely.

Possible Complications

Untreated, cholecystitis may lead to any of the following health problems:

  • Empyema (pus in the gallbladder)
  • Gangrene
  • Injury to the bile ducts draining the liver (may occur after gallbladder surgery)
  • Pancreatitis
  • Perforation
  • Peritonitis (inflammation of the lining of the abdomen)

When to Contact a Medical Professional

Contact your provider if you have:

  • Severe belly pain that does not go away
  • Symptoms of cholecystitis return

Prevention

Removing the gallbladder and gallstones will prevent further attacks.

Open References

References

Clary B, Broderick R, Schaeffer AB, Moffett J, White R. Biliary system. In: Tyler DS, Hayes-Dixon A, Hines J, et al, eds. Sabiston Textbook of Surgery. 22nd ed. Philadelphia, PA: Elsevier; 2026:chap 88.

Fogel EL, Sherman S. Diseases of the gallbladder and bile ducts. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 141.

Glasgow RE. Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 66.

Wang DQ-H, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 65.

  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Cholecystitis, CT scan

    Cholecystitis, CT scan - illustration

    This is a CT scan of the upper abdomen showing cholecystitis (gall stones).

    Cholecystitis, CT scan

    illustration

  • Cholecystitis - cholangiogram

    Cholecystitis - cholangiogram - illustration

    Cholelithiasis can be seen on a cholangiogram. Radio-opaque dye is used to enhance the x-ray. Multiple stones are present in the gallbladder (PTCA).

    Cholecystitis - cholangiogram

    illustration

  • Cholecystolithiasis

    Cholecystolithiasis - illustration

    Cholecystolithiasis. CT scan of the upper abdomen showing multiple gallstones.

    Cholecystolithiasis

    illustration

  • Gallstones, cholangiogram

    Gallstones, cholangiogram - illustration

    A cholecystogram in a patient with gallstones.

    Gallstones, cholangiogram

    illustration

  • Gallbladder removal - Series

    Gallbladder removal - Series

    Presentation

    •  
  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Cholecystitis, CT scan

    Cholecystitis, CT scan - illustration

    This is a CT scan of the upper abdomen showing cholecystitis (gall stones).

    Cholecystitis, CT scan

    illustration

  • Cholecystitis - cholangiogram

    Cholecystitis - cholangiogram - illustration

    Cholelithiasis can be seen on a cholangiogram. Radio-opaque dye is used to enhance the x-ray. Multiple stones are present in the gallbladder (PTCA).

    Cholecystitis - cholangiogram

    illustration

  • Cholecystolithiasis

    Cholecystolithiasis - illustration

    Cholecystolithiasis. CT scan of the upper abdomen showing multiple gallstones.

    Cholecystolithiasis

    illustration

  • Gallstones, cholangiogram

    Gallstones, cholangiogram - illustration

    A cholecystogram in a patient with gallstones.

    Gallstones, cholangiogram

    illustration

  •   Gallbladder removal - Series

    Gallbladder removal - Series

    Presentation

    •  

A Closer Look

 
 

Review Date: 7/22/2025

Reviewed By: Todd Eisner, MD, Private practice specializing in Gastroenterology in Boca Raton and Delray Beach, Florida at Gastroenterology Consultants of Boca Raton. Affiliate Assistant Professor, Florida Atlantic University School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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