Inflammation of the gallbladder occurring acutely or chronically, often secondary to previously asymptomatic gallstones.

• System(s) affected: Gastrointestinal
• Genetics: Increased prevalence in Native Americans and Caucasians, less prevalent in African Americans
• Incidence/Prevalence in USA:
  • Increases with age, body mass index. Prevalence by ultrasound surveys:
    • By age 30, 30% of Native Americans
    • By age 60, 80% of Native Americans
    • By age 60, 30% of Caucasians
    • By age 60, 20% of African Americans
• Predominant age: 5th and 6th decade
• Predominant sex: Female > Male (2:1)

• Asymptomatic. 5-10% become symptomatic each year.
• Acute cholecystitis
  • Abdominal pain - sudden onset, intense, in epigastrium or right upper quadrant, radiates to shoulder or back. Pathognomonic feature is "biliary colic" a pain rising over 2-3 minutes to a plateau of intensity that is maintained for > 20 minutes.
  • Nausea and vomiting
  • Recurrent attacks following meals by 1-6 hours, lasting > 12 hours until recovered, usually < 3 days
  • Elevated temperature - mild to moderate
  • Local tenderness, rarely diffuse
  • Murphy's sign - inspiratory arrest elicited when palpating right upper quadrant while asking the patient for deep inhalation
  • Palpable gall bladder - 5% of cases
• Common duct stone
  • Jaundice in 50%
  • Biliary colic 60%
  • Fever and chills 30%
  • Pruritus 10%
  • Loose bowel movements, light color
  • Mild to marked hepatomegaly > 80%
  • Tenderness infrequent
  • Palpable gall bladder 10%
  • Gallstone ileus (rare)
  • Gallstone > 3 cm fistulizes into bowel and obstructs at ileocecal area
  • Antecedent pain, often over weeks with non-biliary colic
  • Abdominal distension, mild tenderness
  • Air in biliary passages on plain x-ray
  • Intestinal obstruction at level of terminal ileum
• Pancreatitis
  • Pain over upper abdomen
  • Nausea and vomiting
• Empyema
  • Phlegmon of obstructed gall bladder
  • Insidious weight loss, mild wasting
  • Gradual onset of occult infection signs, fever, anorexia
  • Mass usually present
  • Tenderness usually absent
• Chronic cholecystitis
  • Associated with gallstones, often asymptomatic; 20% become symptomatic over 15-20 years
  • Mild dyspepsia following fatty meals

• Gallstones in 90-95% of cases. May obstruct the cystic duct, leading to acute cholecystitis; obstruction of the common bile duct, causing jaundice, or obstruction of the pancreatic duct, causing pancreatitis.
• Gallbladder sludge, a viscous material, insoluble in bile, that layers on sonogram, and occasionally produces cholecystitis, common duct obstruction or pancreatitis. Occurs in most pregnant women, most total parenteral nutrition, and most patients with rapid weight loss
• Acalculous cholecystitis in 5% of cases. Associated with severe stressful situations including cardiac surgery, multiple trauma. May be associated with ischemic damage to the gallbladder wall.
• Bacteria. Usually do not initiate the inflammation but important in the complications of empyema and ascending cholangitis. In emphysematous cholecystitis, Clostridia are probably responsible for both initiation and complications.
• Neoplasms and strictures of common bile duct. Usually associated with cholangitis and pancreatitis.

• Cardiac surgery
• Trauma
• Biliary parasites
• Gallstones (see topic Cholelithiasis)
• Rapid weight loss
• Prolonged parenteral alimentation
• Pregnancy