For Patients & General Readers
Acute cholecystitis is a sudden inflammation of the gallbladder, often caused by gallstones blocking the bile duct. It typically causes severe upper right abdominal pain, fever, and nausea. Prompt medical attention is crucial to prevent complications.
Clinical Overview
Acute cholecystitis is a common surgical emergency characterized by inflammation of the gallbladder, most frequently precipitated by cystic duct obstruction from gallstones (cholelithiasis). This leads to a cascade of inflammatory mediators and potential ischemia, necessitating timely diagnosis and intervention.
Clinical Presentation
- Sudden onset of severe, constant, and sharp pain in the right upper quadrant (RUQ) of the abdomen.
- Pain often radiates to the right shoulder or scapula.
- Pain is typically exacerbated by deep inspiration (Murphy's sign).
- Associated symptoms include nausea, vomiting, anorexia, and fever.
- Patients may appear acutely ill and restless.
Signs & Symptoms
Symptoms (Patient-Reported)
- Severe pain in the upper right abdomen
- Pain that spreads to the right shoulder or back
- Nausea and vomiting
- Fever and chills
- Loss of appetite
- Indigestion or bloating
Signs (Clinician-Observed)
- Tenderness and guarding in the RUQ
- Positive Murphy's sign (inspiratory arrest on palpation of RUQ)
- Fever
- Jaundice (less common, suggests common bile duct involvement)
Differential Diagnoses
| Condition | Distinguishing Feature |
|---|
| Peptic Ulcer Disease | Epigastric pain, often relieved by food or antacids; typically no Murphy's sign. |
| Biliary Colic | Similar RUQ pain but typically episodic and self-limiting, without significant inflammation or fever. |
| Acute Pancreatitis | Epigastric pain radiating to the back, often associated with elevated amylase and lipase; can be caused by gallstones but has distinct pancreatic inflammation. |
| Right Lower Lobe Pneumonia | Pulmonary symptoms (cough, dyspnea), abnormal lung sounds; abdominal pain can be referred. |
| Hepatitis | Jaundice, fatigue, malaise; RUQ pain is usually dull and less acute; elevated liver enzymes. |
| Renal Colic | Flank pain radiating to the groin, often with hematuria; typically no RUQ tenderness or Murphy's sign. |
Red Flags — Seek Immediate Care
- Severe, unrelenting abdominal pain
- High fever (>102°F or 39°C)
- Signs of sepsis (hypotension, tachycardia, altered mental status)
- Jaundice with RUQ pain (suggests choledocholithiasis or cholangitis)
Key Investigations
- Abdominal Ultrasound: Gold standard for detecting gallstones and gallbladder wall thickening.
- Complete Blood Count (CBC): May show leukocytosis.
- Liver Function Tests (LFTs): May show elevated bilirubin and alkaline phosphatase if bile duct obstruction is present.
- Amylase and Lipase: To rule out concurrent pancreatitis.
- Hepatobiliary Iminodiacetic Acid (HIDA) Scan: Useful if ultrasound is equivocal or to assess cystic duct patency.
Management Overview
Management of acute cholecystitis involves prompt fluid resuscitation, analgesia, and broad-spectrum antibiotics. Definitive treatment is typically laparoscopic cholecystectomy, ideally performed within 24-72 hours of admission for uncomplicated cases.
Disclaimer: This article is for educational purposes only and does not constitute medical advice.
Always consult a qualified healthcare professional for diagnosis and treatment.
TruelyserMD does not replace clinical judgement.