Acute cholecystitis

What is acute cholecystitis?

Acute cholecystitis is inflammation of the gallbladder. It usually happens when a gallstone, which is a small stone made from cholesterol, blocks the tube coming out of the gallbladder. This results in a build-up of digestive fluid called bile, which results in painful inflammation.

What causes acute cholecystitis?

Acute cholecystitis is most often caused by a gallstone blocking the gallbladder's main opening called the cystic duct. It leads to a build-up of bile, which causes inflammation of the gallbladder. Other causes of acute cholecystitis include bile duct problems, tumours, severe illness, and certain infections.

Symptoms of acute cholecystitis

The main symptom of acute cholecystitis is sudden, sharp pain in the upper right-hand side of the abdomen (tummy). The pain sometimes moves to the centre of the stomach.

Other acute cholecystitis symptoms are:

• Pain the spreads to your right shoulder or back

• A tender abdomen that gets worse when breathing deeply

• High temperature

• Feeling sick

• Vomiting

• Loss of appetite

• Sweating

• Jaundice (yellowing of the skin and whites of eyes)

• A bulge in the tummy

How is acute cholecystitis diagnosed?

It's vital to see a doctor if you get a sudden, intense pain in your abdomen that doesn't go away after a few hours. This is particularly important if you have other symptoms, like a fever or jaundice (yellowing of the skin and the whites of the eyes).

The doctor will probably do a simple test called Murphy's sign. This involves being asked to breathe in deeply with the doctor's hand pressed on your abdomen. If you have acute cholecystitis, you'll get a sudden, sharp pain as you inhale, and your gallbladder moves downwards towards the doctor's hand.

If the doctor thinks you have acute cholecystitis symptoms, they'll refer you to the hospital immediately for more tests and treatment.

Tests at the hospital may include:

• Blood tests to check for signs of inflammation

• Ultrasound scan of your abdomen to see if you have gallstones or any other problems with your gallbladder

• Other scans, like an X-ray, CT scan or MRI scan, may also be carried out to check your gallbladder in more detail and exclude other problems if doctors aren't sure what's wrong

Treatment for acute cholecystitis

Acute cholecystitis treatment usually involves a stay in the hospital to control the inflammation in your gallbladder.

Hospital treatment may include:

• Fasting (not eating or drinking) to give your gallbladder a rest

• Fluids through a vein in your arm to prevent dehydration

• Antibiotics to fight any infection

• Pain medication to relieve your pain and make you feel more comfortable

• A procedure to remove the gallstones called endoscopic retrograde cholangiopancreatography (ERCP)

You may need treatment in the hospital for up to a week or you may be able to go home and continue your treatment there.

Acute cholecystitis treatment usually results in the gallstones falling back into the gallbladder and the inflammation and pain settling down.

But most people with acute cholecystitis will eventually need an operation to remove their gallbladder because the inflammation comes back.

Surgery for acute cholecystitis

The doctor may recommend removing your gallbladder to prevent acute cholecystitis from returning. It will also reduce the risk of potentially serious complications. Surgery to remove your gallbladder is called a cholecystectomy.

There are three types of cholecystectomy to remove the gallbladder:

1. Laparoscopic cholecystectomy – keyhole surgery to remove the gallbladder through minor cuts in your abdomen

2. Single-incision laparoscopic cholecystectomy – removal of the gallbladder through a single cut, usually made near the belly button

3. Open cholecystectomy – the gallbladder is removed through a single, larger cut in the abdomen.

Complications of acute cholecystitis

You don't get quick treatment for acute cholecystitis, there's a risk of serious complications, including:

• Infection in the gallbladder – if bile builds up within your gallbladder, it may get infected

• Acute gangrenous cholecystitis – this happens when tissue in the gallbladder dies (gangrene). It's the most common complication in older people and those with diabetes. It can cause infection to spread in the body

• Torn gallbladder – if your gallbladder gets swollen, infected, or some of the tissue dies, it may result in a tear (perforation)

If you get any of these complications, you'll probably need emergency surgery to remove your gallbladder (cholecystectomy).

Preventing acute cholecystitis

It's not always possible to prevent acute cholecystitis, but there are some steps you can take to prevent gallstones:

• Eat a healthy, balanced diet that's low in fat and high in fibre with plenty of fruit, vegetables and whole grains

• Maintain a healthy weight as being overweight makes you more likely to get gallstones

• If you need to lose weight, do it gradually. Rapid weight loss can increase the risk of gallstones