ACUTE CHOLECYSTI...

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Definition

Acute cholecystitis is a sudden inflammation of the gallbladder that causes severe abdominal pain.

See also: Chronic cholecystitis

Alternative Names

Cholecystitis - acute

Causes, incidence, and risk factors

In 90% of cases, acute cholecystitis is caused by gallstones in the gallbladder. Severe illness, alcohol abuse and, rarely, tumors of the gallbladder may also cause cholecystitis.

Acute cholecystitis causes bile to become trapped in the gallbladder. The build up of bile causes irritation and pressure in the gallbladder. This can lead to bacterial infection and perforation of the organ.

Gallstones occur more frequently in women than men. Gallstones become more common with age in both sexes. Native Americans have a higher rate of gallstones.

Symptoms

The main symptom is abdominal pain that is located on the upper right side or upper middle of the abdomen. The pain may:

• Be sharp, cramping, or dull
• Come and go
• Spread to the back or below the right shoulder blade
• Be worse after eating fatty or greasy foods
• Occur within minutes of a meal

Other symptoms that may occur include:

• Abdominal fullness
• Clay-colored stools
• Excess gas
• Fever
• Heartburn
• Indigestion
• Nausea and vomiting
• Yellowing of skin and whites of the eyes (jaundice)

Signs and tests

A physical exam will show that your abdomen is tender to the touch.

Your doctor may order the following blood tests:

• Amylase and lipase
• Bilirubin
• Complete blood count ( CBC) -- may show a higher-than-normal white blood cell count
• Liver function tests

Imaging tests that can show gallstones or inflammation include:

• Abdominal ultrasound
• Abdominal CT scan
• Abdominal x-ray
• Oral cholecystogram
• Gallbladder radionuclide scan

Treatment

Seek immediate medical attention for severe abdominal pain.

In the emergency room, patients with acute cholecystitis are given fluids through a vein and antibiotics to fight infection.

Although cholecystitis may clear up on its own, surgery to remove the gallbladder (cholecystectomy) is usually needed when inflammation continues or recurs. Surgery is usually done as soon as possible, however some patients will not need surgery right away.

Nonsurgical treatment includes pain medicines, antibiotics to fight infection, and a low-fat diet (when food can be tolerated).

Emergency surgery may be necessary if gangrene (tissue death), perforation, pancreatitis, or inflammation of the common bile duct occurs.

Occasionally, in very ill patients, a tube may be placed through the skin to drain the gallbladder until the patient gets better and can have surgery.

Reviewer Info: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. , 06/03/2008