Cholecystitis is inflammation of the gallbladder and most commonly occurs when a Gallstone obstructs the cystic duct, producing acute calculous cholecystitis. Persistent obstruction causes gallbladder distension, impaired blood flow, inflammatory mediator release and sometimes secondary bacterial infection. Less commonly, Cholecystitis occurs without gallstones, a condition called acalculous cholecystitis, which is particularly associated with severe systemic illness, trauma, major surgery or prolonged critical care. Acute cholecystitis is distinct from simple biliary colic because inflammation persists rather than resolving rapidly after transient obstruction.
The typical presentation of acute Cholecystitis includes persistent right-upper-quadrant or upper abdominal pain, tenderness and often fever, nausea or vomiting. Pain may radiate towards the right shoulder or back because of referred sensory pathways. A positive Murphy-type finding, in which inspiration is interrupted by pain during palpation beneath the right costal margin, can support the diagnosis, although no single physical sign is perfectly sensitive or specific. Symptoms may begin after a meal but can persist for many hours. Jaundice is not a defining feature and, when prominent, can suggest common bile duct obstruction or another hepatobiliary problem.
The inflammatory process in Cholecystitis can range from uncomplicated mucosal inflammation to gangrene, perforation and abscess formation. Prolonged cystic-duct obstruction can compromise gallbladder perfusion and lead to tissue necrosis. Perforation allows infected or inflamed contents to enter the abdominal cavity and can cause peritonitis. Severe cases may produce sepsis, particularly in older or medically vulnerable patients. Acalculous cholecystitis can be particularly dangerous because it may develop in critically ill patients who cannot report typical abdominal symptoms clearly.
Diagnosis of Cholecystitis combines clinical findings, laboratory tests and imaging. Blood tests may show inflammatory changes and can reveal abnormalities in liver enzymes if there is associated biliary obstruction, although liver tests can be relatively normal in isolated cystic-duct obstruction. Ultrasound is usually the initial imaging modality because it can demonstrate gallstones, gallbladder-wall thickening, fluid around the gallbladder and other supportive findings. If ultrasound is inconclusive, hepatobiliary scintigraphy or cross-sectional imaging may sometimes be used. The imaging findings must be interpreted alongside symptoms and examination.
Treatment of acute Cholecystitis commonly involves hospital assessment, pain relief, appropriate fluid management and antibiotics when infection is suspected or according to clinical protocols. Early laparoscopic cholecystectomy is widely used for suitable patients with acute calculous cholecystitis because it treats the underlying source and reduces the risk of recurrent gallbladder problems. Patients who are not suitable for immediate surgery may sometimes undergo gallbladder drainage through a percutaneous or endoscopic approach, followed by reassessment. Management is influenced by disease severity, surgical risk, complications and local expertise.
Cholecystitis is closely related to Gallstones but the terms are not interchangeable. A person can have gallstones without inflammation, while Cholecystitis specifically denotes inflammation of the gallbladder. Biliary colic involves transient obstruction without established gallbladder inflammation, whereas acute cholecystitis involves sustained obstruction and an inflammatory response. Common bile duct obstruction can cause jaundice and cholangitis, a different infection of the biliary tree that can coexist with gallbladder disease. Pancreatitis can also occur when a gallstone obstructs the shared outflow region of the biliary and pancreatic ducts.
Chronic Cholecystitis can develop after repeated episodes of gallbladder inflammation and is often associated with gallstones. Repeated inflammation can produce fibrosis and a thickened, poorly functioning gallbladder. Some patients experience recurrent upper abdominal discomfort rather than the classic acute presentation. Gallbladder removal is commonly considered when symptoms are attributable to recurrent gallstone disease, although treatment decisions depend on the exact diagnosis and clinical circumstances. Simply identifying gallstones on an imaging study is insufficient to diagnose chronic cholecystitis because asymptomatic stones are common.
Cholecystitis has particular diagnostic importance because its symptoms can overlap with peptic ulcer disease, pancreatitis, hepatitis, gastroenteritis, appendicitis and other causes of Abdominal Pain. The persistence and localisation of pain, fever, tenderness and imaging findings help distinguish it from transient gastrointestinal illness. Older adults, people with diabetes and critically ill patients may have atypical presentations or fewer classic symptoms despite severe disease. Prompt recognition is important because progression to gangrene, perforation or systemic infection can occur. The condition therefore represents a specific inflammatory complication of gallbladder disease rather than simply another term for abdominal pain after eating.
