Acute cholecystitis

Acute cholecystitis is a major complication of cholelithiasis (i.e., gallstones); symptomatic gallstones are common before developing cholecystitis.

Right upper quadrant (RUQ) pain lasting more than 3 to 6 hours and fever are common.

RUQ tenderness, a distended RUQ mass, and positive Murphy sign are key examination findings.

Ultrasound is the initial test of choice; hepatobiliary iminodiacetic acid (HIDA) scanning and magnetic resonance imaging may be helpful in cases where diagnosis is unclear.

Optimal treatment is early cholecystectomy.

Acute cholecystitis is acute inflammation of the gallbladder, and is one of the major complications of cholelithiasis (the presence of gallstones). In most cases (90%), acute cholecystitis is caused by obstruction of the cystic duct due to a stone in the gallbladder neck or cystic duct, which leads to inflammation within the gallbladder wall.[1]Ziessman HA. Acute cholecystitis, biliary obstruction and biliary leakage. Semin Nucl Med. 2003 Oct;33(4):279-96. http://www.ncbi.nlm.nih.gov/pubmed/14625840?tool=bestpractice.com In 5% of cases, bile inspissation (due to dehydration) or bile stasis (due to trauma or severe systemic illness) can block the cystic duct, causing acalculous cholecystitis.[1]Ziessman HA. Acute cholecystitis, biliary obstruction and biliary leakage. Semin Nucl Med. 2003 Oct;33(4):279-96. http://www.ncbi.nlm.nih.gov/pubmed/14625840?tool=bestpractice.com [Figure caption and citation for the preceding image starts]: The biliary treeCreated by BMJ Publishing Group [Citation ends].

Bacterial infection can develop as a secondary feature; it is not an initiating event. Infection may be community- or healthcare-acquired. This topic covers community-acquired infection only.