What is Acute Cholecystitis?
Acute cholecystitis refers to a sudden inflammation of the gallbladder, usually triggered by an infection. In most cases, this occurs when a gallstone blocks the duct that drains bile from the gallbladder, leading to a buildup of pressure, irritation, and eventually infection. In some instances, long-standing inflammation of the gallbladder can gradually worsen and develop into an acute infectious condition.
Symptoms of Acute Cholecystitis
Acute cholecystitis often occurs in patients with a history of biliary colic. Its pain typically starts in the upper abdomen and spreads to the right side under the ribs. Unlike the sharp, fluctuating pain of biliary colic, this pain is steadier and milder. A key diagnostic sign is Murphy's sign pain upon deep inhalation during palpation of the right upper abdomen.
Other common symptoms include nausea, vomiting, and a persistent fever that doesn’t respond well to medications like paracetamol. These symptoms tend to worsen after large or fatty meals. If left untreated, the fever can become more intense and continuous over time.
Acute Cholecystitis Causes
There are two possible causes for this potentially severe condition. We can group those causes into two categories.
Calculous cholecystitis is the most common category of acute cholecystitis, accounting for most cases. This condition occurs when a gallstone blocks the gallbladder opening (cystic duct). Biliary sludge can also contribute to duct blockage.
Biliary sludge combines bile and tiny crystals composed of salt and cholesterol. The duct blockage occurs when bile builds up inside the gallbladder. Too much bile increases the pressure inside the organ, leading to inflammation. For one out of five patients, the gallbladder becomes affected by a bacterial infection.
Acalculous Cholecystitis
Acalculous cholecystitis is a form of gallbladder inflammation that occurs without gallstones, often due to reduced bile flow. This condition is more common in patients who are seriously ill, recovering from major surgery or trauma, or who have weakened immune systems.
It typically causes pain in the upper right side of the abdomen and can progress quickly if not treated. Without timely care, it may lead to serious complications such as infection with pus in the gallbladder (empyema), tissue death (gangrene), or even rupture. Treatment usually involves IV antibiotics, and in many cases, surgical removal of the gallbladder (cholecystectomy) is necessary.
Risk Factors for Acute Gallbladder Inflammation
Recognized contributors to acute cholecystitis include:
- Preexisting Gallstones – Impactions inflame gallbladder mucosa initially.
- Obesity – Further hampers immobile stone expulsions.
- Infection - Local gallbladder or systemic spread to bile contents.
- High Estrogen – Impacts bile constituents and gallbladder dysmotility risks in females.
- Metabolic Syndrome – Type 2 diabetes and dyslipidemia correlate with increased prevalence.
- Family History – Over half cite other relatives with gallstones eventually requiring cholecystectomies.
While anyone can develop acute cholecystitis, prompt recognition, and management aim to prevent exacerbations or emergency complications among higher-risk groups.
Acute Cholecystitis Disease Progression Risks
Gallbladder inflammation often passes within a few days if the obstruction clears spontaneously, allowing bile drainage to resume. However, persistent blockages risk severe septic progression, tissue death, and structural compromises, mandating emergency surgery in up to 20% of hospitalized patients. Rare grave outcomes like gallbladder rupture spilling infected bile throughout the abdomen necessitate rapid open-operative interventions if necrosis and abscess formation develop unchecked by antibiotics.
General Approaches Treating Acute Inflammation and Infection
Most patients hospitalized with acute cholecystitis improve within 72 hours of supportive medical treatment aimed at:
- Pain Control: Patient-controlled intravenous narcotics or regional anesthesia blocks maximally treat discomfort until fever resolutions allow oral routes.
- Intravenous Fluids / Electrolyte Management: Vomiting and ongoing abdominal losses warrant repletion.
- Bowel Rest / Nutrition: Clear liquid diets advance as nausea abates, avoiding oral intake risks while severely inflamed.
- Antibiotics: Broad spectrum gram-negative/anaerobic antimicrobials treat infection effectively in over 85%. Culture-directed narrow-spectrum antibiotics continue if bacteremia is confirmed.
- Cholecystostomy Tubes: Placement using radiology guidance percutaneously into blocked gallbladders immediately decompresses shelf stones obstructing outlets in compromised patients too unstable for immediate surgery.
Today, acute cholecystitis is managed with urgency and precision using evidence-based medical protocols tailored to each patient’s condition. At Healthy Life Bariatrics, under the expert care of Dr. Babak Moeinolmolki, patients receive timely interventions that prioritise safety, comfort, and optimal recovery whether through advanced medical management or surgical treatment when necessary.
Acute Cholecystitis Treatment
Treatment for acute cholecystitis in Los Angeles has shifted from delayed open surgery to early laparoscopic removal within 1–5 days, which leads to fewer complications, shorter hospital stays, and lower overall costs.
Today, surgeons choose between two main strategies:
Early Laparoscopic Surgery: Preferred for stable patients, this minimally invasive procedure helps avoid future attacks and readmissions.
Delayed Surgery: Reserved for high-risk patients with complex medical conditions, allowing time for full stabilization before gallbladder removal.
Recovery After Acute Cholecystitis Surgery
Most patients who undergo early laparoscopic gallbladder removal recover quickly. Within the first week, they usually manage with oral pain medication, resume normal eating, and begin light activity. By two weeks, most swelling and soreness have resolved, and patients can return to driving, desk work, and light exercise.
In the following months, energy gradually returns, and long-term relief is achieved, with over 95% experiencing lasting symptom improvement. For those who required delayed surgery, recovery is spread out over a longer period, but the outcome remains effective.
Specialized Acute Cholecystitis Care by Dr. Babak Moein in Los Angeles, CA
Diagnosing an ailment like acute cholecystitis is essential as soon as possible. A consultation with world-class general surgeon Dr. Babak Moein can provide you with a diagnosis for the condition, and peace of mind. Get your questions answered and feel relieved that surgery for your acute gallbladder inflammation is only a short time away. Call Healthy Life Bariatrics to book your meeting with Dr. Moein from anywhere you are in Los Angeles, Encino, or Glendale, California. (310)861-4093.
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