Acute cholecystitis

Symptoms of cholecystitis

Gallstones are small stones that form in the gallbladder.

They are formed from bile. This is a substance stored in the gallbladder and released into the gut. It helps to digest the fats you eat in food.

Bile contains a mixture of salts, cholesterol and bilirubin. Bilirubin is formed by the breakdown of red blood cells in the body.

Gallstones usually (but not always) develop when cholesterol levels in the bile are too high, and excess cholesterol turns into stones.

Gallstones are very common. They don't usually cause symptoms, but they can occasionally cause episodes of pain (biliary colic) or acute cholecystitis.

The main symptom of acute cholecystitis is a sudden sharp pain in the upper right-hand side of your tummy (abdomen). This pain spreads towards your right shoulder.

Unlike other types of abdominal pain, the pain of acute cholecystitis is usually persistent. The pain doesn't usually go away within a few hours.

Some people may have other symptoms, such as:

• a high temperature (fever)
• nausea and vomiting
• sweating
• loss of appetite
• yellowing of the skin and the whites of the eyes (jaundice)
• a bulge in the abdomen

When to seek medical advice

See your GP as soon as possible if you develop sudden and severe abdominal pain. This is particularly if it lasts longer than a few hours or is accompanied by other symptoms such as jaundice and a fever.

If you're unable to contact your GP immediately, contact your GP out-of-hours service.

It's important for acute cholecystitis to be diagnosed as soon as possible. This is because  there's a risk serious complications could develop if it isn't treated without delay.  

Causes of cholecystitis

The causes of acute cholecystitis can be grouped into two main types:

• calculous cholecystitis (caused by a stone)
• acalculous cholecystitis (not caused by a stone)

Calculous cholecystitis

Calculous cholecystitis is the most common, and usually less serious, type of acute cholecystitis.

It develops when the main opening to the gallbladder, called the cystic duct, gets blocked by a gallstone or a substance known as biliary sludge (thickened bile).

The blockage in the duct causes bile to build up in the gallbladder. This increases the pressure inside it, causing it to become inflamed. The inflamed gallbladder can also become infected by bacteria.

Acalculous cholecystitis

Acalculous cholecystitis is a less common. But it is usually a more serious, type of acute cholecystitis. It usually develops as a complication of a serious illness, infection or injury that damages the gallbladder.

Diagnosing acute cholecystitis

If you have severe abdominal pain, your GP will probably carry out a simple test. You'll be asked to breathe in deeply with your GP's hand pressed on your tummy, just below your rib cage.

Your gallbladder will move downwards as you breathe in. If you have cholecystitis, you'll experience sudden pain as your doctor reaches the area of the gallbladder.

If your symptoms suggest you have the condition, your GP will refer you to hospital immediately for further tests and treatment.

Treating acute cholecystitis

If you're diagnosed with acute cholecystitis, you'll probably need to be admitted to hospital for treatment.

After initial treatment, any gallstones that may have caused acute cholecystitis usually fall back into the gallbladder. The inflammation will often calm down.

Surgery

Removing your gallbladder may be recommended at some point after initial treatment. This is to prevent acute cholecystitis recurring. This is also to reduce your risk of developing potentially serious complications. 

The consultant surgeon at the hospital will discuss with you whether surgery is the best option.

Although some people who've had their gallbladder removed have reported symptoms of bloating and diarrhoea after eating certain foods, it's possible to lead a perfectly normal life without a gallbladder.

The organ is useful, but it's not essential.

Possible complications

Without treatment, acute cholecystitis can sometimes lead to potentially life-threatening complications.

Emergency surgery to remove the gallbladder is needed to treat these complications in about one in every five cases of acute cholecystitis.

Preventing acute cholecystitis

It isn't always possible to prevent acute cholecystitis. You can lower your risk of developing it by reducing your risk of getting gallstones.

One of the main things you can do to lower your chances of getting gallstones is to adopt a healthy, balanced diet.  Also reducing the number of high-cholesterol foods you eat, as cholesterol is thought to contribute to the formation of gallstones.

Being overweight, particularly being obese, also increases your risk of developing gallstones. Having a healthy diet and exercise regularly is important to help maintain good health.

Low-calorie rapid weight loss diets should be avoided. A more gradual weight loss plan is best. 

• Acute cholecystitis

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