What Is Acute Cholecystitis? How to Know if Your Gallbladder Is Inflamed—And What to Do About It

Chances are you don't give your gallbladder a passing thought until it acts up and you're in a world of hurt. An infected, inflamed gallbladder is a condition doctors call acute cholecystitis—and it's a serious condition.

When it's working properly, your gallbladder—a pouch-like organ situated in your upper right abdomen—stores and releases bile into the small intestine to aid digestion, according to the American Gastroenterological Association (AGA). But sometimes, gallstones can develop in the gallbladder, and they can block the flow of bile.

These hardened deposits (usually made of cholesterol or bilirubin) can prevent bile from being released from the gallbladder, and the resulting pressure and irritation can lead to swelling and infection, known as acute cholecystitis, the US National Library of Medicine (MedlinePlus) says.

Here, experts help explain what symptoms can signal acute cholecystitis, what can cause the condition, and how it's treated and diagnosed.

What is acute cholecystitis?

Cholecystitis is the medical term for an irritated or inflamed gallbladder, per MedlinePlus. Acute cholecystitis means the problem comes on suddenly, while chronic cholecystitis is a long-term condition due to repeated bouts of gallbladder swelling or irritation, usually through temporary blockages.

There are two main two types of cholecystitis:

• Calculous cholecystitis: This occurs a when a gallstone is blocking the duct through which bile travels. It's the most common type of inflammation of the gallbladder.
• Acalculous cholecystitis. This type of inflammation, which is not caused by a gallstone, is much less common. It can affect people who have autoimmune issues or systemic health problems like diabetes, Aurora D. Pryor, MD, division chief of Bariatric, Foregut and Advanced Gastrointestinal Surgery at Stony Brook Medicine, tells Health.

What causes cholecystitis, and who’s at risk?

Gallstones are usually what cause gallbladder irritation or inflammation. But as Johns Hopkins Medicine and Mayo Clinic point out, there are other causes, as well, including:

• A tumor
• Bile duct kinking or scarring
• Reduced blood flow to the gallbladder (this can be due to diabetes)
• Gallbladder sludge, a thick mixture of small particles and bile

Some people are more likely to develop gallstones (or "cholelithiasis," meaning the presence of hard deposits). The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and MedlinePlus list the following as factors:

• Being female
• Older age
• Family history of gallstones
• Use of hormone therapy
• Being Native American or Hispanic
• Rapidly gaining or losing weight
• Diabetes, insulin resistance, or metabolic syndrome
• Hemolytic disease, such as sickle cell anemia
• Cirrhosis
• Bile duct infections
• Intestinal disease, such as Crohn's
• High triglyceride levels or low HDL cholesterol

You can blame the hormone estrogen for the higher rate of acute cholecystitis in females. "You don't have to have estrogen around to form gallstones, but it can make it more likely," says Lindsay Hessler, MD, a board-certified surgeon with the Center for Minimally Invasive Surgery at Mercy Medical Center in Baltimore.

Of the 120,000 people treated for acute cholecystitis each year, 60% are women, per Cleveland Clinic.

What are the symptoms of acute cholecystitis?

Pain is a defining symptom of this condition. It's usually felt in the upper right or middle part of the abdomen, and it often travels to the right shoulder or back, says Cleveland Clinic. The pain can be a dull, sharp, or cramping, per MedlinePlus.

Sometimes people with chronic cholecystitis have a history of gallstone problems, where a stone occasionally blocks a duct but then pops out again, Dr. Pryor points out. They'll experience pain for up to four hours at a time, typically after a fatty meal, and then it subsides. That's called "symptomatic cholelithiasis." Acute cholecystitis, by contrast, isn't something you can wait out. When a stone becomes lodged in a duct, the gallbladder swells and can become infected and painful. "That is a big deal that doesn't resolve without help," she tells Health.

Other possible symptoms, per MedlinePlus, include:

• Nausea
• Vomiting
• Fever
• Clay-colored stools
• Yellowing of the skin and whites of the eyes

How is acute cholecystitis diagnosed?

After performing a physical exam and taking a medical history, your doctor will likely order blood work to look for signs of inflammation or infection, per the NIDDK.

Imaging tests can help doctors find gallstones and determine whether a blockage exists, says the AGA. These tests may include:

• Ultrasound
• CT scan
• MRI
• Cholescintigraphy—known as a HIDA (hydroxly iminodiacetic acid) scan—is a nuclear medicine test that involves injecting a radioactive tracer into a vein to assess gallbladder function and look for blockages
• ERCP (endoscopic retrograde cholangiopancreatography), a procedure combining endoscopy (use of a flexible, lighted tube passed through the mouth) and x-ray
• EUS (endoscopic ultrasound)

How is acute cholecystitis treated?

Untreated cholecystitis can lead to several different health problems. According to a 2021 StatPearls review, these include:

• Biloma (an accumulation of bile in the abdomen)
• Pus in the abdomen
• Bile duct injury
• Liver injury
• Small bowel injury
• Infection
• Retained stones in the bile duct
• Bleeding

Gallbladder removal surgery (aka "cholecystectomy") remains the gold standard for the treatment of acute cholecystitis, according to guidelines developed by the World Society of Emergency Surgery. Surgery may be performed using minimally invasive (laparoscopic) techniques unless the patient isn't a good candidate, and then open surgery may be necessary, says the AGA.

Though it may seem necessary, you don't actually need your gallbladder to live a full, healthy life. Though your gallbladder may come in handy after a particularly fatty meal to help break down the fat, if it's inflamed and infected, it's best for your overall health to get it out. After gallbladder removal surgery, some people may have diarrhea or bloating with fatty foods, says Dr. Hessler, but most people won't have any other ongoing effects.

In some cases, a person may be too ill to undergo surgery. In that case, a small tube may be inserted in the gallbladder to drain bile, relieving pressure in the organ, per the StatPearls review. "It's sort of a temporary fix for when people who are very sick and can't have their gallbladders out," says Dr. Hessler. But after that, surgery to fully remove the gallbladder may be recommended for a later date.