Cholecystitis is an inflammation of the gallbladder. Your gallbladder is a small pear-shaped organ tucked away under your liver in the upper right section of your abdomen. The gallbladder’s job is to store bile – a fat-digesting fluid made by the liver – and to release it after you eat a meal. Cholecystitis usually develops when the bile gets trapped in your gallbladder, and becomes infected with bacteria. Bile gets trapped when gallstones block the flow of bile out of your gallbladder.
Gallstones are hardened deposits of the digestive fluids that form in your gallbladder, and can range in size from a tiny grain of sand (called sludge) to a golf ball. They are made up of either cholesterol or pigment stones. Gallstones made of cholesterol are yellow-greenish in color, and are more common. Pigment stones are mostly made of bilirubin, a substance that is created when the liver breaks down red blood cells.
Gallstones themselves are not necessarily a problem. It’s possible to have gallstones sitting in your gallbladder, never bothering you and, in that case, they don’t need to be treated. However, gallstones that leave the gallbladder can get stuck in your ducts (tubes). They block the flow of bile out of your gallbladder, which causes a buildup of bile. These events cause the walls of your gallbladder to become inflamed and swell, and that can lead to bacterial infection of the bile. Your life can even be in danger unless you seek prompt medical and surgical help.
The gallbladder connects to your liver by a duct system (tubes) that look like a tree trunk with branches. There are many ducts, or “branches” inside your liver. These tree branches connect to two main tree limbs in your liver, called the right and left hepatic ducts. These two ducts merge (like the trunk of a tree) to form your common hepatic duct. One main “tree limb” coming off the common hepatic duct is called the cystic duct. It connects directly into your gallbladder. The common hepatic duct, the “tree trunk,” continues but its name changes to the common bile duct. Your common bile duct empties into the duodenum section of the small intestine.
Bile, a fat-dissolving liquid substance that is made continuously by your liver, travels through the duct system and enters your digestive system at the duodenum. When you are not eating, a valve structure at the common bile duct and duodenum connection, called the major duodenal papilla, is usually closed. This allows the bile to reflux back through the cystic duct into your gallbladder to be stored. During mealtime, your gallbladder contracts, and the valve opens, pushing the stored bile out of your gallbladder, through the cystic duct and down the common bile duct into your intestine. Bile mixes with the partially digested food, further helping the breakdown of the fat in your diet.
Gallstones, or even sludge, in the gallbladder can obstruct this normal flow of bile, leading to cholecystitis.
Approximately 120,000 Americans are treated for acute cholecystitis every year. Women make up 60% of this number.
You are at greater risk of developing cholecystitis if you:
Cholecystitis is commonly caused by gallstones that have blocked your cystic duct, which prevents bile from exiting your gallbladder. Your gallbladder becomes swollen and may become infected with bacteria. Less common causes include blocked bile ducts due to scarring, reduced blood flow to your gallbladder, tumors that block the flow of bile from your gallbladder, or viral infections that inflame your gallbladder.
Structure of the digestive anatomy showcasing the liver, stomach, pancreas and gallbladder.
Symptoms can be acute or chronic.
Acute cholecystitis comes on suddenly and causes severe, ongoing pain. More than 95% of people with acute cholecystitis have gallstones. Pain begins in your mid to upper right abdomen and may spread to your right shoulder blade or back. Pain is strongest 15 to 20 minutes after eating and it continues. Pain that remains severe is considered a medical emergency.
Chronic cholecystitis means you’ve had repeated attacks of inflammation and pain. Pain tends to be less severe and doesn’t last as long as acute cholecystitis. The repeated attacks are usually caused by gallstones blocking the cystic duct intermittently.
Other signs and symptoms of cholecystitis may include:
Your healthcare professional will ask about your symptoms. They may order blood work to check your white blood cell count and how well your liver is working. A higher than normal white blood cell count is a sign of an infection, inflammation, or an abscess.
Imaging tests that could be ordered include:
Treatment of cholecystitis usually takes place in the hospital. Treatments may include:
Recovery from gallbladder surgery, when done laparoscopically, is usually uneventful. As with any surgery there can be minimal pain at the incision sites. Most patients are discharged from the hospital shortly after the surgery, and do not require additional testing or interventions. If the surgery is done through a larger wound (open surgery) then the recovery can be slower and require more days in the hospital.
Yes, you can live a normal life without a gallbladder. Since the gallbladder’s main role is the storage of the bile, and bile is made continuously by the liver, you don’t need your gallbladder for normal digestion. Bile can still flow directly from your liver, through the common bile duct and into the small intestine.
Complications can range from ongoing infection to possible death.
During early and later pregnancy cholecystitis can be treated by antibiotics. Surgery is usually a safe option during the second trimester, but can also be performed safely at any time if antibiotics fail to treat the infection
You can reduce your risk of developing cholecystitis by:
There is a higher rate of the symptoms recurring if cholecystitis is treated only with medications. There is a higher risk of death, as well, for patients who do not address the worsening conditions.
Surgery to remove the gallbladder (cholecystectomy) is usually the definitive treatment. The benefits of the surgery outweighs the risks in most cases, since the surgical treatment carries very low risk of complications in most cases. Your surgeon will assess your risks for the surgery and discuss all of your treatment options before the operation.
Cholelithiasis is the formation of gallstones. Cholecystitis is the inflammation of the gallbladder.
Educate yourself about the symptoms of cholecystitis so that you and your healthcare provider can identify it and treat it as early as possible.
Abdominal pain of any sort should always be an alarm. If you have sudden pain or bouts of pain in your upper right area of your abdomen or right shoulder or back, contact your healthcare provider.
Don’t hesitate to go to the emergency room if you have severe abdominal pain that does not spontaneously resolve or that continues to worsen.
A note from Cleveland Clinic
If you have pain in the upper right quadrant of your abdomen, seek immediate answers from a healthcare provider. Gallbladder inflammation, whether it’s chronic or acute, requires swift and vigilant care!
Last reviewed by a Cleveland Clinic medical professional on 07/10/2020.