Cholecystitis (Gallbladder Inflammation)
Acute cholecystitis often develops after a gallstone blocks the cystic duct and presents with persistent right upper abdominal pain, fever, nausea and vomiting. Symptoms may worsen within hours and clearly affect daily life. Diagnosis is based on clinical findings, ultrasound and blood tests. Management is planned according to the severity of inflammation (using classifications such as the Tokyo Guidelines), comorbidities and surgical risk. This page covers symptoms, diagnosis, treatment options and the warning signs that warrant urgent evaluation.
Cholecystitis is inflammation of the gallbladder, most often caused by obstruction of the cystic duct by a gallstone. It can present with prolonged right upper abdominal pain, nausea, vomiting and fever. Diagnosis is based on examination, ultrasound and blood tests. Management — urgent or planned surgery — depends on severity, the patient's general condition and comorbidities.
Symptoms
- Persistent right upper abdominal pain (>6 hours)
- Fever, chills
- Nausea, vomiting
- Pain radiating to the right shoulder
- Jaundice in some patients
Why does it occur?
In most cases, a gallstone obstructs the cystic duct leading to bile stasis and inflammation. It can also occur without stones (acalculous cholecystitis), particularly in critically ill patients, those who fast for long periods and in certain chronic illnesses.
How is it diagnosed?
On examination, right upper abdominal tenderness and a positive Murphy's sign are typical. Ultrasound may show wall thickening, pericholecystic fluid and stones. Elevated WBC and CRP support inflammation. CT or MRCP can be added when needed.
Required tests
- Complete blood count, CRP
- Liver function tests, bilirubin
- Amylase, lipase
- Abdominal ultrasound
- CT or MRCP when indicated
Comparison table
| Condition | Symptom | Required test | Possible approach | Urgency |
|---|---|---|---|---|
| Gallstones | Pain after fatty meals, bloating | USG, blood tests | Follow-up or surgery | Depends on symptoms |
| Cholecystitis | Prolonged right upper abdominal pain, fever | USG, CRP, WBC | Urgent evaluation / surgery | High |
| CBD stones | Jaundice, dark urine | MRCP, bilirubin | ERCP ± surgery | High |
| Liver cyst | Usually asymptomatic | USG, CT/MRI | Follow-up or surgery | Low–Moderate |
| Hydatid cyst | Right upper abdominal fullness, pain | USG, CT/MRI, serology | Medication ± surgery | Moderate |
Treatment options
Treatment is based on the severity of inflammation and the patient's status: antibiotics, intravenous fluids and surgery at the appropriate time. In selected cases early laparoscopic cholecystectomy is preferred; for patients who are not surgical candidates, percutaneous drainage may be considered.
When is surgery needed?
A large proportion of patients diagnosed with acute cholecystitis are treated surgically at an appropriate time. Whether to perform early surgery or planned surgery after the acute episode settles depends on the severity, comorbidities and the team's assessment.
When to go to the emergency department
- Severe abdominal pain lasting longer than 6 hours
- Fever and chills
- Jaundice, dark urine
- Persistent vomiting
- Confusion
Frequently Asked Questions
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Share your existing ultrasound, MRCP, CT/MRI, blood tests or discharge summary to receive preliminary information about the process. A definitive evaluation is only possible after physical examination and the necessary investigations.
The information on this page is provided for general patient education only and does not replace diagnosis, treatment or any surgical decision. An assessment appropriate for you can only be made after a clinical examination and the necessary investigations.