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Acute cholecystitis

Last reviewed: 5 Nov 2023
Last updated: 10 Jan 2023



History and exam

Key diagnostic factors

  • previous episode of biliary pain
  • right upper quadrant pain
  • positive Murphy sign
  • abdominal mass
More key diagnostic factors

Other diagnostic factors

  • right shoulder pain
  • anorexia
  • nausea
  • fever
  • vomiting
  • jaundice
Other diagnostic factors

Risk factors

  • gallstones
  • physical inactivity
  • low fiber intake
  • severe illness
  • trauma
  • severe burns
  • total parenteral nutrition (TPN)
  • diabetes
  • ceftriaxone
  • cyclosporine
  • hepatic arterial embolization
  • infections
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC
  • C-reactive protein
  • LFTs
  • right upper quadrant ultrasound scan
More 1st investigations to order

Investigations to consider

  • cholescintigraphy (hepatobiliary iminodiacetic acid [HIDA] scan)
  • abdominal CT
  • abdominal MRI
  • abdominal x-ray
More investigations to consider

Treatment algorithm


mild (grade I): stable without signs of perforation/gangrene

moderate (grade II): stable with signs of perforation/gangrene

severe (grade III): suspected gangrene/perforation or evidence of organ dysfunction



Charles Bellows, MD

Professor of Surgery

University of New Mexico

School of Medicine




CB is an author of one study referenced in this topic. CB declares that he has no other competing interests.

Peer reviewers

Satyajit Bhattacharya, LVO, MB, MS, MPhil, FRCS

Consultant Surgeon

HPB Surgery Unit

The Royal London Hospital




SB declares that he has no competing interests.

Stefano Guandalini, MD

Professor of Pediatrics


Division of Gastroenterology, Hepatology, and Nutrition

University of Chicago Comer Children's Hospital




SG declares that he has no competing interests.

  • Acute cholecystitis images
  • Differentials

    • Acute cholangitis
    • Chronic cholecystitis
    • Peptic ulcer disease
    More Differentials
  • Guidelines

    • ACR Appropriateness Criteria: right upper quadrant pain
    • TG18 surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos)
    More Guidelines
  • Patient leaflets


    More Patient leaflets
  • Videos

    Venepuncture and phlebotomy: animated demonstration

    Central venous catheter insertion: animated demonstration

    More videos
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