Cholecystitis
If a gallstone becomes trapped in the opening (duct) in your gall bladder it can cause severe abdominal pain lasting from one to five hours; this is called cholecystitis
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Book an appointment onlineWhat is cholecystitis?
Cholecystitis is swelling and irritation of the gallbladder, a small organ under your liver that stores digestive fluid called bile. It's usually triggered by a gallstone blocking the tube that lets bile drain away and generally calls for hospital care to settle it safely.
What are the symptoms of cholecystitis?
The hallmark symptom is intense, unrelenting pain gripping the right flank of your upper belly, often radiating towards your shoulder or round to your back, and it doesn't ease off within a few hours the way ordinary indigestion might. Breathing in deeply, or pressing on the area, tends to make it worse.
Alongside this, you may notice:
- feeling or being sick
- a raised temperature
- going off your food
- yellowing of the skin or the whites of your eyes (jaundice)
- a swollen or tender tummy.
Older people, or those with other health conditions, sometimes have milder or vaguer symptoms, such as just feeling generally unwell, rather than the classic severe pain.
What are the causes of cholecystitis and who is at risk?
The vast majority of cases happen when a gallstone, or thickened bile known as sludge, blocks the tube leading out of the gallbladder. Trapped bile then builds up, raising the pressure inside the gallbladder until it becomes inflamed and, sometimes, infected.
A smaller number of cases develop without any gallstones at all. This type tends to affect people who are already seriously unwell, for instance following major surgery, a severe injury or burns, a serious infection, or a period of dehydration or poor nutrition.
Since gallstones are behind most cases, anything that raises your chances of developing them also raises your risk of cholecystitis. Being female, over 40, or pregnant all play a part, as does carrying excess weight, living with diabetes or high cholesterol, or losing weight very quickly. Gallstones running in the family, or taking the contraceptive pill, can add to the risk too.
Are there different types of cholecystitis?
Doctors mainly distinguish cholecystitis by cause:
- Calculous cholecystitis, caused by a blocked gallstone, makes up around 95% of cases and tends to be the less severe type.
- Acalculous cholecystitis, without any gallstone involved, is rarer but generally more serious, usually arising as a complication in someone who's already critically unwell.
It's also sometimes described as acute or chronic. An acute episode comes on suddenly and needs urgent attention. While chronic cholecystitis involves milder, recurring bouts of pain over a longer period, often following repeated smaller episodes.
How is cholecystitis diagnosed?
Where tummy pain is severe, a doctor may check for Murphy's sign: pressing gently below your right rib cage while you breathe in deeply. A sudden stab of pain as your gallbladder shifts down to meet their hand points towards cholecystitis.
If this suggests cholecystitis, you'll usually be referred to hospital straight away for further tests, which commonly include:
- blood tests, to look for signs of inflammation or infection
- an ultrasound scan, checking your gallbladder for gallstones and any other changes suggesting a problem
Occasionally, further imaging such as a CT scan may be used if the picture isn't clear or complications are suspected.
How is cholecystitis treated?
You'll usually be admitted to hospital, where initial treatment focuses on resting your digestive system and controlling symptoms: not eating or drinking for a while, fluids given directly into a vein, medicine for pain, and antibiotics if an infection is suspected or confirmed.
Once you've stabilised, removing the gallbladder (a cholecystectomy) is generally recommended to stop cholecystitis coming back and to lower the risk of further complications. This is usually done as keyhole surgery through a few small cuts, often within about a week of diagnosis, though a single larger incision is sometimes needed instead.
If surgery isn't a safe option for you right now, perhaps because of other health problems, a tube can be placed into the gallbladder to drain away the trapped fluid and relieve the pressure, either through the skin or via an endoscope passed down through your mouth.
When should I see a doctor?
Get medical advice promptly if you develop sudden, severe tummy pain that doesn't settle within a few hours, particularly alongside a fever or yellowing of your skin or eyes. If your GP can't be reached, try an urgent out-of-hours line or NHS 111.
If the discomfort is so intense that no position brings relief, or you feel seriously unwell, head straight to your nearest emergency department rather than waiting for an appointment.
FAQs
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Will I definitely need my gallbladder removed?
Not necessarily straight away, but surgery is usually recommended at some point, since the same problem is otherwise likely to recur. If you're not well enough for an operation immediately, doctors can drain the gallbladder instead as a temporary measure and revisit surgery once you've recovered further.
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Can I manage perfectly well without a gallbladder?
Yes. Your liver carries on producing all the bile you need, so digestion continues largely unaffected, though some people notice looser stools or bloating after fatty meals for a while as their body adjusts. Most people find this settles down over time.
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What's the difference between cholecystitis and ordinary gallstone pain?
Gallstone pain, sometimes called biliary colic, is usually a temporary episode that eases within a few hours once a stone shifts. Cholecystitis develops when the blockage doesn't clear: the pain becomes constant, is often joined by fever, and needs treatment in hospital rather than settling on its own.
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Can cholecystitis happen again if I don't have surgery?
Yes, this is common. As long as the gallbladder and its gallstones remain in place, further episodes are likely, which is the main reason doctors usually recommend having it removed once you've recovered from the initial episode.
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What happens if cholecystitis isn't treated?
Left untreated, the pressure and infection inside the gallbladder can cause its tissue to die (gangrene) or the organ itself to split open, spilling infection into the tummy and sometimes leading to a widespread, life-threatening infection. This is why prompt hospital treatment matters, even though most people recover very well once they receive it.