Symptoms of Cholecystitis: Signs of Gallbladder Inflammation

Pain in the right upper abdomen makes you consider various possibilities: liver, stomach, back. Cholecystitis — inflammation of the gallbladder — is one of them, and it has recognizable signs. Below is what the pain feels like, what accompanies it, and at what point waiting for it to "go away on its own" becomes dangerous.

What is cholecystitis

The gallbladder lies under the liver and stores bile for digesting fats. Cholecystitis is inflammation of its wall. Most often it is a complication of gallstone disease: a stone or bile clot (biliary sludge) blocks the cystic duct, bile accumulates, pressure rises, the wall becomes inflamed, and sometimes infection sets in. This calculous form accounts for about 95% of acute cholecystitis cases. The acalculous variant — without stones — is less common but usually more severe: it develops against the background of severe illness, infection, trauma, burns, sepsis, malnutrition, or dehydration. One in ten adults has gallstones, and most often they cause no symptoms.

Where it hurts in cholecystitis and what the pain is like

The main sign is pain in the upper abdomen on the right, under the ribs. It may shift toward the center, to the epigastric region. The character varies: sharp, cramping, or dull but constant. Such pain does not subside within a couple of hours. In the acute form, it lasts at least 30 minutes, in practice — for hours. The abdomen under the ribs is tender on pressure, and deep breathing intensifies the sensations. The doctor checks this with Murphy's sign: pressing under the costal arch and asking the patient to take a deep breath. In inflammation, the breath is interrupted by sharp pain. Another pattern is pain after eating, more often after fatty food.

Back pain and other referred pains

Cholecystitis can refer pain. The pain radiates to the back, under the right shoulder blade, to the right shoulder, lower back, supraclavicular area, and the right side of the neck. In the phlegmonous form, pain intensifies with breathing, coughing, and changing body position.

Accompanying signs: nausea, vomiting, fever

Nausea and vomiting, sweating, and loss of appetite accompany the pain. Temperature rises, in the phlegmonous form — to febrile levels. At the same time, vomiting may be repeated, the pulse quickens to 110–120 per minute, the abdomen is distended, and the right half of the anterior abdominal wall lags during breathing. The skin and sclera turn yellow, stool becomes light up to white, and urine darkens. This is jaundice, and it changes the urgency of the situation.

• pain in the right upper abdomen that does not subside for several hours;
• tenderness on pressure and sharp pain on deep inspiration;
• nausea, vomiting, sweating, loss of appetite;
• elevated body temperature;
• jaundice, light stool, dark urine.

Differences between acute and chronic cholecystitis

Acute cholecystitis starts suddenly and is pronounced. Chronic is a recurring inflammation: the gallbladder wall thickens and becomes rough, the organ stores and releases bile less effectively. It manifests as nausea and dull pain in the right upper abdomen after eating, without acute intensity. The chronic form may be a consequence of the acute one or may be independent. Hepatic colic is distinguished separately: a stone smaller than 1 cm gets stuck in the ducts, the pain is stronger than at the onset of acute cholecystitis, more often at night or early morning, and jaundice appears later.

Warning signs and when to see a doctor

Do not postpone a conversation with a doctor if severe abdominal pain persists for more than several hours or is accompanied by jaundice and high fever. In acute cholecystitis, a diagnosis is needed quickly: without treatment, tissue necrosis of the gallbladder, perforation with peritonitis, abscess, pancreatitis, empyema, and cholangitis are possible. Emergency surgery is required in about 2–3 out of 10 cases. In the hospital, blood tests and abdominal ultrasound are performed, and if necessary, CT, MRI, or radionuclide scanning are added.

Inflammation of the gallbladder by itself is not a reason to call an ambulance. 103 or 112 — if severe abdominal pain does not subside for several hours, especially together with jaundice and high fever.

This material is for reference: it helps to navigate the signs but does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer