Cholecystitis is inflammation of the gallbladder that occurs most commonly because of an obstruction of the cystic duct by gallstones arising from the gallbladder (cholelithiasis). Uncomplicated cholecystitis has an excellent prognosis; the development of complications such as perforation or gangrene renders the prognosis less favorable.
Signs and symptoms
The most common presenting symptom of acute cholecystitis is upper abdominal pain. The following characteristics may be reported:
Signs of peritoneal irritation may be present, and the pain may radiate to the right shoulder or scapula
Pain frequently begins in the epigastric region and then localizes to the right upper quadrant (RUQ)
Pain may initially be colicky but almost always becomes constant
Nausea and vomiting are generally present, and fever may be noted
Laboratory tests are not always reliable, but the following findings may be diagnostically useful:
- Leukocytosis with a left shift may be observed
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels may be elevated in cholecystitis or with common bile duct (CBD) obstruction
- Bilirubin and alkaline phosphatase assays may reveal evidence of CBD obstruction
- Amylase/lipase assays are used to assess for pancreatitis; amylase may also be mildly elevated in cholecystitis
- Alkaline phosphatase level may be elevated (25% of patients with cholecystitis)
- Urinalysis is used to rule out pyelonephritis and renal calculi
- All females of childbearing age should undergo pregnancy testing
Diagnostic imaging modalities that may be considered include the following:
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
Treatment of cholecystitis depends on the severity of the condition and the presence or absence of complications.
In acute cholecystitis, the initial treatment includes bowel rest, IV hydration, correction of electrolyte abnormalities, analgesia, and IV antibiotics.
Surgical and interventional procedures used to treat cholecystitis include the following:
Laparoscopic cholecystectomy (standard of care for surgical treatment of cholecystitis)
Endoscopic ultrasound-guided transmural cholecystostomy
Endoscopic gallbladder drainage