Cholecystitis

Cholecystitis is inflammation of the gallbladder, the small organ under the liver that stores bile. In the great majority of cases it happens when a gallstone becomes stuck in the neck or duct of the gallbladder, blocking bile from draining; the trapped bile builds up, irritates and inflames the gallbladder wall, and it often becomes infected. This is different from simple biliary colic (a gallstone attack), which is severe pain that comes and goes over hours and then settles: in cholecystitis the pain is more constant and prolonged (typically lasting more than six hours), usually with fever, nausea and a tender upper-right abdomen, and it does not resolve on its own. A characteristic sign a doctor may find is that pressing under the right ribs during a breath in causes the person to catch their breath from pain (Murphy's sign). It is diagnosed with the clinical picture, raised inflammatory markers, and an ultrasound. Treatment is usually pain relief, fluids and antibiotics, followed by removal of the gallbladder, often during the same admission.

• White cell count (WBC) and CRP — raised, reflecting inflammation and infection.
• Liver enzymes (ALT, AST) and bilirubin — may rise, especially if a stone also blocks the main bile duct.
• Alkaline phosphatase and GGT — a cholestatic (bile-obstruction) pattern.
• Lipase/amylase — checked to exclude gallstone pancreatitis.
• Ultrasound of the abdomen — the main imaging test; shows gallstones and an inflamed, thickened gallbladder.

• Severe, constant pain in the upper-right abdomen, often for more than a few hours
• Pain that may spread to the right shoulder or back
• Fever and chills
• Nausea and vomiting
• Tenderness over the upper-right abdomen; catching the breath on pressing there (Murphy's sign)
• Pain often following a fatty meal
• Jaundice, if a stone also blocks the main bile duct