CLINICIAN REVIEWEDEVIDENCE-BASED

Acute cholecystitis

Acute cholecystitis is sudden inflammation of the gallbladder, most often caused by a gallstone blocking the cystic duct. It can progress to infection, tissue damage or perforation and usually requires hospital treatment.

At a glance

Quick facts

Condition snapshot
Category
Acute gallbladder inflammation
Most common cause
Gallstone blocking cystic duct
Typical symptom
Persistent right-upper abdominal pain
Initial imaging
Ultrasound
Usual setting
Hospital treatment
Definitive treatment
Early laparoscopic cholecystectomy when suitable
Medically reviewed

Dr. Francis Chibueze Nwokpoku

Medical Officer · 9th Division Hospital, Nigerian Army

Reviewed for clinical accuracy, important omissions and patient-facing safety wording.

7 Oct 2026Reviewer profile →

Names & terminology

How this entity may be named or searched

Acute cholecystitis
Acute inflammation of the gallbladder.
Calculous cholecystitis
Cholecystitis caused by gallstones; the most common form.
Acalculous cholecystitis
Gallbladder inflammation without stones, often in seriously ill patients.
Murphy sign
Pain and interrupted inspiration when the gallbladder area is palpated during a deep breath.

Structured entity profile

Clinical profile

Condition data
NatureAcute inflammatory conditionUsually follows persistent blockage of the cystic duct.
SymptomsPersistent right-upper abdominal painPain may radiate to the right shoulder and is often accompanied by tenderness, nausea or fever.
DiagnosisClinical + blood tests + imagingUltrasound is the principal first imaging test.
TreatmentHospital-basedFluids, analgesia and antibiotics may be needed while definitive treatment is arranged.
SurgeryUsually early laparoscopic cholecystectomyNICE recommends surgery within 1 week of diagnosis when appropriate.
ComplicationsCan be seriousGangrene, perforation, abscess, sepsis or bile-duct complications can occur.

Overview

Acute cholecystitis occurs when the gallbladder becomes inflamed. The usual mechanism is a gallstone blocking the cystic duct, trapping bile and increasing pressure inside the gallbladder. [1]

Calculous cholecystitis accounts for most cases. Acalculous cholecystitis is less common and tends to occur in people who are critically ill, after major injury or surgery, or in other high-risk settings. [1]

Symptoms and warning signs

The main symptom is sudden, persistent pain in the upper right abdomen, often with marked tenderness and sometimes radiation to the right shoulder. Fever, nausea, vomiting or jaundice can occur. Unlike brief biliary colic, pain usually persists for several hours. [1]

SYMPTOM MATRIX

Persistent gallbladder pain plus inflammation needs hospital assessment

Acute cholecystitis can worsen quickly and is not the same as an uncomplicated short gallbladder attack.

Gallbladder emergency
Typical features
  • Persistent right-upper abdominal pain
  • Marked tenderness
  • Pain with deep breathing
  • Nausea or vomiting
  • Fever
Can also occur
  • Pain radiating to right shoulder
  • Loss of appetite
  • Sweating
  • Jaundice
  • Abdominal guarding
Severe complication pattern
  • Very severe or spreading abdominal pain
  • High fever or shaking chills
  • Confusion or low blood pressure
  • Persistent vomiting / dehydration
  • Jaundice with systemic illness

These features can indicate sepsis, gallbladder perforation or bile-duct infection and require urgent care.

Diagnosis

Assessment includes abdominal examination, blood tests for inflammation and liver abnormalities, and imaging. Ultrasound is the usual first imaging test to identify gallstones and gallbladder inflammation. [1] [2]

CT, MRI/MRCP or other imaging may be used if the diagnosis is uncertain or a complication is suspected. Clinicians also assess for common-bile-duct stones and pancreatitis because these change management. [1] [2]

Diagnostic pathway

Confirm gallbladder inflammation and look for complications

Diagnosis combines a compatible clinical picture with inflammatory findings and imaging.

Acute biliary assessment
1Clinical assessmentIdentify persistent right-upper abdominal pain, tenderness, fever and systemic illness.
2Laboratory testsCheck inflammatory markers, liver tests and other labs according to presentation.
3UltrasoundLook for gallstones and sonographic features of acute gallbladder inflammation.
4Escalate imagingUse CT or MRCP when complications or bile-duct stones are uncertain.
UltrasoundFirst linegallstones + inflammatory signs
Blood testsInflammation / liversupport diagnosis and complications
CT / MRCPSelecteduncertain or complicated cases

Ultrasound findings are interpreted together with symptoms, examination and laboratory results rather than as a stand-alone diagnosis. Source [1] Source [2]

Calculous and acalculous cholecystitis

Gallstones cause the great majority of acute cholecystitis. Acalculous disease occurs without gallstones and is often associated with severe systemic illness, major surgery, trauma or sepsis. It can be especially serious because diagnosis may be difficult in an already unwell patient. [1]

Treatment and management

Acute cholecystitis usually requires hospital care. Initial management commonly includes fasting or adjusted intake, intravenous fluids, pain relief and antibiotics when bacterial infection is suspected or part of the local treatment pathway. [1]

NICE recommends early laparoscopic cholecystectomy, carried out within 1 week of diagnosis, for acute cholecystitis when the patient is suitable for surgery. If surgery is temporarily unsafe, gallbladder drainage can be considered with later reassessment for definitive surgery. [3]

Treatment & care hub

Stabilize first, then control the source

The treatment goal is to relieve acute inflammation and prevent recurrence or perforation.

Hospital management
Supportive careImmediate

Fluids and pain control

Hospital treatment addresses dehydration, pain, nausea and physiologic instability.

AntibioticsWhen indicated

Treat infection risk

Antibiotic choice depends on severity, local protocols and whether infection or sepsis is suspected.

CholecystectomyDefinitive

Remove the inflamed gallbladder

Early laparoscopic surgery is recommended for suitable patients with acute cholecystitis.

DrainageSelected high-risk patients

Decompress the gallbladder

Percutaneous or endoscopic drainage may be used when immediate surgery is not appropriate.

Recognize inflammation→Confirm with ultrasound→Stabilize→Treat definitively

Complications and recurrence

Without effective treatment, acute cholecystitis can progress to gangrene, perforation, abscess, peritonitis or sepsis. Removing the gallbladder also reduces the risk of future gallstone-related attacks. [1] [3]

Gallstone context

Gallstones affect more than 1 in 10 adults in the UK

Acute cholecystitis is a relatively common complication of gallstones.

NHS Acute cholecystitis ↗
Gallstones>1 in 10adults
Most gallstonesAsymptomatic
Acute cholecystitisComplication
Main mechanismCystic-duct blockage
Source: NHS acute cholecystitis overview. The statistic refers to gallstones, not the incidence of acute cholecystitis itself.

Common questions

Frequently asked questions

Reference content

Sources

  1. NHS — Acute cholecystitis
  2. NICE — Diagnosing gallstones — CG188 information for the public
  3. NICE — Gallstone disease: diagnosis and management (CG188)

This article is based on trusted medical sources and has undergone clinician review. It is not a substitute for personalized medical advice.