Acute cholecystitis

Last reviewed: 3 Nov 2022
Last updated: 26 Oct 2021

Summary

Definition

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

ACUTE

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

Contributors

Authors

Charles Bellows, MD

Professor of Surgery

University of New Mexico

School of Medicine

Albuquerque

NM

Disclosures

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

London

UK

Disclosures

SB declares that he has no competing interests.

Stefano Guandalini, MD

Professor of Pediatrics

Chief

Division of Gastroenterology, Hepatology, and Nutrition

University of Chicago Comer Children's Hospital

Chicago

IL

Disclosures

SG declares that he has no competing interests.

  • Acute cholecystitis images
  • Differentials

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

    • TG18 antimicrobial therapy for acute cholangitis and cholecystitis
    • TG18 surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos)
    More Guidelines
  • Patient leaflets

    Gallstones

    More Patient leaflets
  • Videos

    Venepuncture and phlebotomy: animated demonstration

    Central venous catheter insertion: animated demonstration

    More videos
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer