Patients with acute cholecystitis usually present with the following symptoms:

• Pain: Patients with cholecystitis usually present with right upper quadrant pain which radiates to the tip of right shoulder. There may be tenderness in right hypochondrium.
• Symptoms typically start after eating.
  Fever: Patient may present with fever and possibly chills [5].
• Jaundice: Mild jaundice with dark urine and pale stools may also be present.
• Other symptoms: These include anorexia, nausea, vomiting, sweating and abdominal bloating.
• More severe symptoms such as high fever, shock and jaundice indicate the development of complications such as abscess formation, ascending cholangitis or perforation. Sepsis or pancreatitis may also develop [6].

• Inflammation

  Inflammation of the gallbladder. cholecystitis [kō′lisistī′tis] Etymology: Gk, chole + kystis, bag, itis, inflammation acute or chronic inflammation of the gallbladder. [medical-dictionary.thefreedictionary.com]

  Abstract We use open cholecystectomy (OC) to treat severe cholecystitis in cases in which we are worried that inflammation might cause anatomical changes in Calot's triangle. [ncbi.nlm.nih.gov]

  Definition: Acute inflammation of the gallbladder Variant Forms Acalculous cholecystitis (10% of cases): Inflammation of the gallbladder in the absence of gallstones or cystic duct obstruction that is more common in older patients and after non-biliary [coreem.net]

  Chemicals in the trapped bile or a bacterial infection can then lead to inflammation of the gallbladder. To continue reading this article, you must login. [health.harvard.edu]

  From Wikidata Jump to navigation Jump to search cholangitis that is characterized by an inflammation that is located in the gallbladder acute and chronic cholecystitis acute and chronic cholecystitis (disorder) gall bladderitis gall bladder inflammation [wikidata.org]

• Gangrene

  In patients with gangrenous cholecystitis, sonography may guide percutaneous cholecystostomy when clinically appropriate. [ultrasoundtraining.com]

  Convert to ICD-10-CM : 575.0 converts directly to: 2015/16 ICD-10-CM K81.0 Acute cholecystitis Approximate Synonyms Abscess, pericholecystic Acute cholecystitis (inflamed gallbladder) Acute gangrenous cholecystitis Acute gangrenous cholecystitis (inflamed [icd9data.com]

  Gangrene is the development of wall phlogosis, impaired blood supply, wall ischemia, gangrene; the final development of this complication can be the perforation. [intechopen.com]

  In the setting of acute cholecystitis, this finding has been shown to correlate pathologically with gangrenous changes in the wall. [sonoworld.com]

  Figure 1 Gangrenous cholecystitis. Figure 2 Gangrenous cholecystitis. Our patient was well post-operatively and kept on antibiotics for five days. He was discharged uneventfully on the sixth day after the operation. [jmedicalcasereports.biomedcentral.com]

• Weight Loss

  Risk factors: increased age female parity obesity diabetes mellitus profound weight loss fasting cystic fibrosis malabsorption syndromes familial various medication (oral contraceptive pill and clofibrate). [aci.health.nsw.gov.au]

  XGC patients with associated GBC were more likely to present with anorexia, weight loss, palpable lump and jaundice. Gall stones were present in majority of patients in both the groups. [ncbi.nlm.nih.gov]

  Talk to your doctor if you’re concerned about your weight. They’ll help you come up with an effective weight loss plan. [healthline.com]

  Rapid weight loss. As the body breaks down fat during prolonged fasting and rapid weight loss, the liver secretes extra cholesterol into bile. Rapid weight loss can also prevent the gallbladder from emptying properly. [web.archive.org]

• Chills

  — Felissa Allard, SELF, "These Are The Pregnancy Pains You Shouldn’t Ignore," 8 July 2019 If the gallstones cause infection in the gallbladder (cholecystitis) or block the flow of bile from the liver to the intestines through the bile duct,fever and chills [merriam-webster.com]

  You have a fever or chills. You have pain when you urinate. Your skin or eyes turn yellow. You have questions or concerns about your condition or care. Care Agreement You have the right to help plan your care. [drugs.com]

  Symptomatology: —Among the first symptoms are chill and fever. Usually the fever does not exceed 101.5° or 102° F., except in the suppurative forms, when it becomes remittent in character, and in the exacerbations may reach 104° or 104.5° F. [henriettes-herb.com]

  Chills. Bloating. Jaundice (yellowing of the skin and eyes). Cleveland Clinic News & More Cleveland Clinic News & More [my.clevelandclinic.org]

  The patient also experiences nausea, vomiting, and chills. In chronic cholecystitis the gallbladder often is contracted rather than swollen; its wall is grayish white, tough, and thickened. [britannica.com]

• Asymptomatic

  Clinical signs and symptoms of Cholelithiasis Usually asymptomatic, incidental finding. There are just a few stones in the gallbladder. [youtube.com]

  For asymptomatic gallstones, these are often simply picked up incidentally on scans, most commonly a trans-abdominal ultrasound scan (Fig. 2). [teachmesurgery.com]

  Asymptomatic patients can develop symptomatic disease in 20–30% of cases in the long term (20 years). [intechopen.com]

  TREATMENT: CHOLELITHIASIS In asymptomatic pts, risk of ... [accessmedicine.mhmedical.com]

  Gangrenous cholecystitis in an asymptomatic patient found during an elective laparoscopic cholecystectomy: a case report. [jmedicalcasereports.biomedcentral.com]

• Dyspnea

  Associated symptoms such as dyspnea. Associated with exertion. History of coronary artery disease. Pulmonary embolus: Dyspnea. Wells score can help. Signs/symptoms of deep vein thrombosis. Acute pancreatitis: Can co-exist with cholecystitis. [cancertherapyadvisor.com]

  […] katso alta), astma, infektiot (katso alta), sydämen vajaatoiminta, sydäninfarkti, sydänlihasiskemia, rintakipu, pyörtyily, aivoiskemia, hypertensio, hypotensio, kolekystiitti, pankreatiitti, ruoansulatuskanavaverenvuoto, bursiitti, sekavuus, depressio, dyspnea [mymemory.translated.net]

• Nausea

  Gastric decompression to reduce stimulation of the gallbladder may be indicated for control of severe nausea and vomiting. [medical-dictionary.thefreedictionary.com]

  Signs and symptoms of cholecystitis include upper GI pain (epigastric) that travels to the right shoulder blade (this pain tends to increase after a heavy greasy/fatty/spicy meal), positive Murphy's Sign, nausea, vomiting, steatorrhea, fever, and tachycardia [youtube.com]

  Biliary colic (colicky RUQ pain ) Especially postprandial May radiate to the epigastrium, right shoulder, and back ( referred pain ) Nausea, vomiting, feelings of satiety Bloating, dyspepsia Choledocholithiasis Colicky RUQ /epigastric pain Nausea, vomiting [amboss.com]

  This is usuallyaccompanied by diarrhea,vomiting and nausea. Thegallbladder may be tenderand distended. 9. [slideshare.net]

  […] duct (CBD) or common hepatic duct compression) Acute Hepatitis Hepatic abscess Right lower lobe pneumonia Cholangitis Pancreatitis Pyelonephritis Presentation History Right upper quadrant (RUQ) pain History of similar, self-limited pain (biliary colic) Nausea [coreem.net]

• Overeating

  It differs significantly from the clinical sign and refers to focal tenderness directly over the gallbladder when pressure is applied by the ultrasound transducer. [ultrasoundtraining.com]

  Patients with reasonably normal gall bladder function (over 40% GBEF) only need conservative management. There is still an option to progress to one of the other treatment options. [derangedphysiology.com]

  Focal tenderness over the gallbladder while scanning is very specific for acute cholecystitis, and should always be looked for. Wall thickening is not specific for cholecystitis, and has numerous causes. [sonoworld.com]

  MATERIALS AND METHODS: This was retrospective case-control study conducted over a period of 10 years from 2004 to 2014. [ncbi.nlm.nih.gov]

  In a systematic review, it was seen in 6-11% of patients with symptomatic gallstones over a median follow-up of 7 to 11 years. [aci.health.nsw.gov.au]

• Abdominal Pain

  A 61-year-old man presented with upper abdominal pain and jaundice. [ncbi.nlm.nih.gov]

  You need antibiotics given intravenously (into a vein) to treat infection, and medications to control symptoms of nausea and abdominal pain. [2minutemedicine.com]

  In the context of acute biliary pancreatitis may merge acute abdominal diseases different to each other; but they have in common hyperamylasemia and acute/severe upper abdominal pain and abdominal wall guarding. [intechopen.com]

• Right Upper Quadrant Pain

  All patients with acute right upper quadrant pain should be evaluated for sonographic signs of acute cholecystitis. Sonography of the gallbladder is best performed with a 5-MHz curved array transducer. [ultrasoundtraining.com]

  Acute cholecystitis refers to inflammation of the gallbladder and classically presents as a syndrome of right upper quadrant pain, fever, and leucocytosis. [aci.health.nsw.gov.au]

  It is the primary complication of cholelithiasis and the most common cause of acute pain in the right upper quadrant (RUQ). Constant right upper quadrant pain that can radiate to the right shoulder. [radiopaedia.org]

  Herein, we described a morbidly obese patient with poorly controlled diabetes presenting with non-specific right upper quadrant pain and was subsequently diagnosed with haemorrhagic cholecystitis. [ncbi.nlm.nih.gov]

• Upper Abdominal Pain

  A 61-year-old man presented with upper abdominal pain and jaundice. [ncbi.nlm.nih.gov]

  RUQ and epigastric radiation to left upper back persists beyond 6 hours often between 2100-0400 N+V Signs dull, poorly localised -> sharp, well localised mid-upper abdominal pain Risk factors increased age female parity obesity diabetes mellitus profound [lifeinthefastlane.com]

  Biliary colic is characterized by the sudden onset of intense right upper abdominal pain that may radiate to the shoulder. Sweating and vomiting are common. The pain tends to be steady and lasts up to three hours. [aafp.org]

  […] lang=us\u0026email="} The 5-F rule refers to risk factors for the development of cholelithiasis in the event of upper abdominal pain: fair: more prevalent in the Caucasian population 1 fat: BMI >30 female fertile: one or more children forty: age ≥40 cholelithiasis [radiopaedia.org]

• Tachycardia

  Signs and symptoms of cholecystitis include upper GI pain (epigastric) that travels to the right shoulder blade (this pain tends to increase after a heavy greasy/fatty/spicy meal), positive Murphy's Sign, nausea, vomiting, steatorrhea, fever, and tachycardia [youtube.com]

  Bulletin of the New York Academy of Medicine, 18, 83-92. [ 14 ] Vacca, G., Battaglia, A. and Mary, D.A. (1994) Tachycardia and Pressure Response to Distension of the Gallbladder in the Anaesthetized Pig. [dx.doi.org]

  The physical examination may reveal fever, tachycardia, and tenderness in the RUQ or epigastric region, often with guarding or rebound. However, the absence of physical findings does not rule out the diagnosis of cholecystitis. (See Presentation .) [emedicine.com]

• Hypotension

  CLINICAL Charcot's Triad - Right Upper Quadrant Pain, Fever and Jaundice Reynold's Pentad - Hypotension, Altered Mental status INVESTIGATIONS Ultrasound shows dilated bile ducts ERCP - see the stones and remove them Laboratory - leukocytosis, bile duct [youtube.com]

  → infection ascends the biliary tract and can even track into the hepatic ducts Clinical features [32][29] Charcot cholangitis triad Abdominal pain (most commonly RUQ) High fever Jaundice (less common) Reynolds pentad: Charcot cholangitis triad PLUS hypotension [amboss.com]

  […] active-controlled, and open-label trials of enbrel, serious adverse events reported included malignancies (see below), asthma, infections (see below), heart failure, myocardial infarction, myocardial ischaemia, chest pain, syncope, cerebral ischaemia, hypertension, hypotension [mymemory.translated.net]

  Ascending cholangitis (or simply cholangitis or infection of the biliary system) causes symptoms and signs that include fever, abdominal pain, jaundice and even hypotension (low blood pressure), and confusion; it is a medical emergency. [medicinenet.com]

  Patients with cholangitis are more likely to have fever, tachycardia, and/or hypotension. Patients with gallbladder colic have relatively normal vital signs. In a retrospective study, only 32% of patients with cholecystitis had fever. [regenerativenutrition.com]

• Jaundice

  A 61-year-old man presented with upper abdominal pain and jaundice. [ncbi.nlm.nih.gov]

  Because bilirubin contains a yellowish color, it causes a yellowish cast to the skin and eyes that is called jaundice. Gallstone formation is seen in twice as many women as men, particularly those between the ages of 20 and 60. [medical-dictionary.thefreedictionary.com]

  The classicalsign of cholangitis is Charcots triad, which is rightupper quadrant pain, fever and jaundice. [slideshare.net]

  Courvoisier’s Law: The presence of jaundice, palpable gallbladder means that the jaundice is unlikely to be due to stones. It is tumour of the head of the pancreas until proven otherwise. [armandoh.org]

• Hepatomegaly

  When examining any patient with suspected gallbladder pathology, it is important to check for signs of inflammation (e.g. tachycardia, pyrexia), signs of peritonitis or perforation, and signs of jaundice or hepatomegaly. [teachmesurgery.com]

  […] fever, adrenal crisis Epigastric Heart: myocardial infarction, pericarditis Stomach: gastritis, stomach ulcer, stomach cancer Pancreas: pancreatitis, pancreatic cancer Intestinal: duodenal ulcer, diverticulitis, appendicitis Right upper quadrant Liver: hepatomegaly [en.wikipedia.org]

  Tender hepatomegaly can be seen in viral hepatitis, congestive heart failure, and alcoholic hepatitis. In choledocholithiasis and cholecystitis, right upper quadrant (RUQ) tenderness is appreciated. [ncbi.nlm.nih.gov]

• Yellow Discoloration of the Skin

  discoloration of the skin and whites of the eyes (jaundice), poor appetite, vomiting, tiredness, abdominal pain, and diarrhea.[1][2] Hepatitis is acute if it resolves within six months, and chronic if it lasts longer than six months.[1][5] Acute hepatitis [en.wikipedia.org]

• Shoulder Pain

  It is the primary complication of cholelithiasis and the most common cause of acute pain in the right upper quadrant (RUQ). Constant right upper quadrant pain that can radiate to the right shoulder. [radiopaedia.org]

  For example, sometimes a patient may not realize that their stomach pain may be related to their recent onset of shoulder pain. [physio-pedia.com]

  The pain may be crampy and episodic, or it may be constant. The pain is often described as pushing through to the right upper back and shoulder. Because deep breathing increases the pain, breathing becomes shallow. [medical-dictionary.thefreedictionary.com]

• Anger

  Tasab, Jaln, Hasad : Gall : a feeling of deep and bitter anger and ill-will. [urdu.wordinn.com]

• Hunger

  This pain can be misinterpreted as hunger, indigestion, or heartburn. Pain is usually caused by the ulcer, but it may be aggravated by the stomach acid when it comes into contact with the ulcerated area. [en.wikipedia.org]

• Renal Insufficiency

  insufficiency, kidney calculus, deep vein thrombosis, pulmonary embolism, membranous glomerulonephropathy, polymyositis, thrombophlebitis, liver damage, leucopenia, paresis, paresthesia, vertigo, allergic alveolitis, angioedema, scleritis, bone fracture [mymemory.translated.net]

  Avoid aminoglycosides in the elderly or those with renal insufficiency if possible. 1 or 2 doses can be given empirically pending microbiologic results in patients without serious risk (2). [unboundmedicine.com]

  Renal Insufficiency. No change in standard management. B. Liver Insufficiency. In severe liver disease, HIDA scan can be falsely positive if biliary excretion is not normal. C. Systolic and Diastolic Heart Failure. No change in standard management. [cancertherapyadvisor.com]

• Irritability

  When a stone blocks this duct, bile builds up, causing irritation and pressure in the gallbladder. This can lead to swelling and infection. [nlm.nih.gov]

  Sometimes the gall bladder is also inflamed resulting in necrosis and irritation of bowel and diaphragm. [anandlab.com]

  Boas sign — Increasedsensitivity below the rightscapula (also due to phrenicnerve irritation). 21. Subsequent laboratory andimaging tests are used toconfirm the diagnosis andexclude other possible causes.Ultrasound can assist in thedifferential 22. [slideshare.net]

  This results in an irritated and swollen gallbladder. Infection or trauma, such as an injury from a car accident, can also cause cholecystitis. [uofmhealth.org]

• Headache

  Therapy - Australasian Menopause Society Women generally undergo menopause between the ages of 45 and 55 years.Around the time of menopause, women may experience symptoms such as hotflushes, sweats, anxiety, dry vagina, loss of libido, irritability, headaches [healthdirect.gov.au]

  Gallbladder Is There a Link Between Headaches and Gallbladder Problems? Practitioners of Eastern medicine see a clear connection between headaches and gallbladder problems. One study indicates that idea may be correct. [everydayhealth.com]

  These include fatigue, nausea, vomiting, poor appetite, joint pain, and headaches.[15][16] Fever, when present, is most common in cases of hepatitis A and E.[15] Late in this phase, people can experience liver-specific symptoms, including choluria (dark [en.wikipedia.org]

• Lethargy

  Patients with lethargy or mental confusion and shock, along with the triad, were classified as having acute obstructive suppurative cholangitis (AOSC). [doi.org]

Cholecystitis is diagnosed clinically by history and physical examination. The following signs are specific for cholecystitis.

Murphy’s sign

It is inspiratory arrest during deep palpation of right upper quadrant. It occurs due to touching of the inflammed gallbladder with parietal peritoneum. When parietal peritoneum touches the gallbladder, severe pain is felt and patient immediately withholds the breath by reflex mechanism.

Boas sign

It is hyperesthesia of the skin below the scapula.

Laboratory investigations

• Leukocytosis: Leukocytosis with a left shift may be observed in cholecystitis .
• Ultrasonography: Ultrasonography is the most useful investigation [7]. Acute cholecystitis is indicated by features such as thick walled (>3mm) gallbladder, pericholecystic fluid and sonographic Murphy's sign.
• CT scan: It might not be helpful for detecting gallstones, but usually provides an excellent view of the gallbladder, plus the surrounding structures such as liver, bile duct and pancreas.
• Radionuclide Scan: A hepatobiliary iminodiacetic acid scan will show non filling of gallbladder even after 24 hours of injection. It involves injecting a radioactive chemical in body. The chemical binds to the bile producing-cells, so it can be clearly seen as it travels with the bile through the bile ducts.

The treatment of choice for acute cholecystitis is cholecystectomy; however, patient should be resuscitated and prepared before this operation can be performed. Cholecystectomy can be performed laparoscopically or by open surgery. Laparoscopic cholecystectomy is the better option of the two [8]. Cholecystectomy can be performed within 2-3 days of illness or after 6-10 weeks of initial attack.

More than 90% of uncomplicated cases of acute cholecystitis resolve spontaneously with conservative measures. Conservative measures in this group of patients include the following:

• Nil per oral (i.e. oral intake of food is ceased).
• Antibiotics: Antibiotic regimen in cholecystitis usually consist of broad spectrum antibiotics such as cephalosporins, clindamycin and metronidazole [9] [10].
• Analgesics: Parenteral narcotics can be used to control pain until the inflammation in gall bladder is relieved.
• Intravenous fluids.
• Patient is monitored with blood pressure, pulse and temperature.

Emergency cholecystectomy should be performed in these conditions.

• Worsening of symptoms despite of conservative management.
• Detection of gas in biliary tract.
• Empyema of gallbladder.
• Established generalized peritonitis.
• Gangrene or perforation of gallbladder.

In patients who are severly ill and cannot tolerate general anesthesia, a percutaneous cholecystectomy can be performed under ultrasound guidance.

Patients with chronic cholecystitis require the removal of gallbladder surgically. Moreover, removal of gallstones in common bile duct can be done with newer techniques such as endoscopic retrograde cholangiopancreatography.

Uncomplicated cholecystitis has an excellent prognosis. Most cases of acute cholecystitis recover within a few days to a few weeks. However, 25-30% of patients either require surgery or develop some serious complications such as gangrene, perforation, empyema or rupture of gallbladder. In patients with acalculous cholecystitis, mortality rate can be as high as 50-60%.

The following factors increase the risk of cholecystitis [2] [3].

• Gallstones: As much as 90% of the cases of acute cholecystitis are caused by gallstones obstructing the flow of bile in the biliary tree. Gallstone impaction (called cholelithiasis) mostly occurs at the neck of the gallbladder.
• Female gender: Women have a greater risk of gallstones as compared to men. This makes women more likely to develop cholecystitis.
• Increasing age: The risk of gallstones increases with age.
• Obesity: The incidence of cholecystitis is higher in obese women.
• Drugs: Drugs especially hormonal therapy in women increases the risk of develoing gallstones.
• Bile duct obstruction: This can lead to obstruction of bile flow, thus causing cholecystitis.
• Tumor: A tumor may also prevent bile draining out of gallbladder properly, causing bile buildup that can lead to cholecystitis.

Cholecystectomy performed due to cholecystitis is one of the most common major surgical procedures worldwide. The incidence of cholecystitis increases with age. Gallstones are 2-3 times more common in females than in males. In the United States, the prevalence of gallstones is higher in white people than black people.

In acute calculous cholecystitis, blockage of cystic duct with gallstones causes accumulation of bile in the gallbladder. This can lead to bacterial infection, causing inflammation and distention of the gallbladder. As a result, blood flow and lymphatic drainage are compromised leading to mucosal ischemia, necrosis and cell death.

In acute acalculous cholecystitis, concentrated bile remains stagnant in the lumen causing inflammation of gallbladder and bile duct [4].

Since most of the cases of cholecystitis are caused by gallstones, the risk of cholecystitis can be reduced by controlling the risk factors that lead to the formation of gallstones. These include reduction of weight by regular exercise and avoiding a high fat diet.

Cholecystitis is inflammation of the gallbladder which most commonly occurs due to impaction of gallstones at its neck causing obstruction of the cystic duct. This is known as acute calculous cholecystitis. It results in a buildup of bile in the gallbladder causing it to become inflamed, hyperemic, edematous, tense and distended.

Cholecystitis may also occur in the absence of gallstones in around 10% of the cases [1]. In this case, it is known as acalculous cholecystitis. It critically develops in the patients who are admitted in intensive care units and also in those with extensive burns, sepsis, multiple traumas and hemolytic anemias.
If left untreated, cholecystitis can lead to serious complications, such as gangrene and rupture of gallbladder.

Cholecystitis is the pain and swelling of the gallbladder which occurs most commonly due to stones. The patients usually present with pain in the upper abdomen, fever, vomiting and yellowing of the skin or eyes. The disease is more common in women as compared to men. With proper treatment, the disease has an excellent prognosis.

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9. Kittisupamongkol W. Role of antibiotics in the severity of cholecystitis. American journal of surgery. May 2010;199(5):723; author reply 722-723.
10. Lishchenko AN. [Is it necessary to use antibiotics in acute cholecystitis?]. Khirurgiia. Jul 1986(7):51-53.