Cholecystitis - Diagnosis and treatment (2023)



To diagnose cholecystis, your health care provider will likely do a physical exam and discuss your symptoms and medical history. Tests and procedures used to diagnose cholecystitis include:

  • Blood tests. Your health care provider may order blood tests to look for signs of an infection or signs of gallbladder problems.
  • Imaging tests that show your gallbladder. Abdominal ultrasound, endoscopic ultrasound, computerized tomography (CT) scan or magnetic resonance cholangiopancreatography (MRCP) can be used to create pictures of your gallbladder and bile ducts. These pictures may show signs of cholecystitis or stones in the bile ducts and gallbladder.
  • A scan that shows the movement of bile through your body. A hepatobiliary iminodiacetic acid (HIDA) scan tracks the production and flow of bile from your liver to your small intestine. A HIDA scan involves injecting a radioactive dye into your body, which attaches to bile-producing cells. During the scan, the dye can be seen as it travels with the bile through the bile ducts. This can show any blockages.

More Information

  • Abdominal ultrasound
  • CT scan
  • HIDA scan


Endoscopic retrograde cholangiopancreatography

Cholecystitis - Diagnosis and treatment (1)

Endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) uses a dye to highlight the bile ducts and pancreatic duct on X-ray images. A thin, flexible tube (endoscope) with a camera on the end is passed down your throat and into your small intestine. The dye enters the ducts through a small hollow tube (catheter) passed through the endoscope.

(Video) CHOLECYSTITIS, Causes, Signs and Symptoms, Diagnosis and Treatment.

Laparoscopic cholecystectomy

Cholecystitis - Diagnosis and treatment (2)

Laparoscopic cholecystectomy

Special surgical tools and a tiny video camera are inserted through incisions in your abdomen during laparoscopic cholecystectomy. Your abdomen is inflated with carbon dioxide gas to allow room for the surgeon to work with surgical tools.

Treatment for cholecystitis usually involves a hospital stay to control the inflammation in your gallbladder. Sometimes, surgery is needed.

At the hospital, your health care provider will work to control your symptoms. Treatments may include:

  • Fasting. You may not be allowed to eat or drink at first in order to take stress off your inflamed gallbladder.
  • Fluids through a vein in your arm. This treatment helps prevent dehydration.
  • Antibiotics to fight infection. If your gallbladder is infected, your provider likely will recommend antibiotics.
  • Pain medications. These can help control pain until the inflammation in your gallbladder is relieved.
  • Procedure to remove stones. You may have a procedure called an endoscopic retrograde cholangiopancreatography (ERCP). During this procedure that uses dye to highlight the bile ducts, instruments can be used to remove stones blocking the bile ducts or cystic duct.
  • Gallbladder drainage. In some cases, such as when surgery to remove the gallbladder is not an option, gallbladder drainage (cholecystostomy) may be done to remove infection. Drainage is done through the skin on the abdomen (percutaneous) or by passing a scope through the mouth (endoscopic).

Your symptoms are likely to decrease in 2 to 3 days. However, gallbladder inflammation often returns. Most people with cholecystitis eventually need surgery to remove the gallbladder.

Gallbladder removal surgery

The procedure to remove the gallbladder is called a cholecystectomy. Usually, this is a minimally invasive procedure, involving a few tiny cuts (incisions) in your abdomen (laparoscopic cholecystectomy). An open procedure, in which a long incision is made in your abdomen, is rarely required.

The timing of surgery depends on the severity of your symptoms and your overall risk of problems during and after surgery. If you're at low surgical risk, surgery may be performed during your hospital stay.

Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder. Even without your gallbladder you can still digest food.

(Video) Acute Cholecystitis - Overview (signs and symptoms, pathophysiology, treatment)

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Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

(Video) Acute Cholecystitis - Causes, Symptoms, Physical Signs, Diagnosis & Treatment

Preparing for your appointment

Make an appointment with your health care provider if you have symptoms that worry you. If your provider suspects that you have cholecystitis, you may be referred either to a specialist in the digestive system (gastroenterologist) or you may be sent to a hospital.

What you can do

Before your appointment:

  • Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
  • Make a list of your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Make a list of key personal information, including major stresses or recent life changes.
  • Make a list of all medications, vitamins, herbs and other supplements that you're taking.
  • Take a family member or friend along, if possible. Someone who accompanies you can help you remember the information you get.
  • Make a list of questions to ask your health care provider.

For cholecystitis, some basic questions to ask include:

  • Is cholecystitis the likely cause of my abdominal pain?
  • What are other possible causes for my symptoms?
  • What tests do I need?
  • Do I need gallbladder removal surgery?
  • How soon do I need surgery?
  • What are the risks of surgery?
  • How long does it take to recover from gallbladder surgery?
  • Are there other treatment options for cholecystitis?
  • Should I see a specialist?
  • Are there brochures or other printed material that I can take with me? What websites do you recommend?

Don't hesitate to ask other questions, as well.

What to expect from your doctor

Your health care provider is likely to ask you a number of questions, including:

  • When did your symptoms begin?
  • Have you had pain like this before?
  • Are your symptoms constant or do they come and go?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

By Mayo Clinic Staff

Request an appointment

Sept. 09, 2022


(Video) Gallstones and Cholecystitis - Signs, Symptoms And Treatment

  1. Ferri FF. Cholecystitis. In: Ferri's Clinical Advisor 2023. Elsevier; 2023. Accessed July 11, 2022.
  2. Sanford DE. An update on technical aspects of cholecystectomy. Surgical Clinic of North America. 2019; doi:10.1016/j.suc.2018.11.005.
  3. Acute cholecystitis. Merck Manual Professional Version. Accessed June 16, 2022.
  4. Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed June 16, 2022.
  5. Afdhal NH. Acalculous cholecystitis: Clinical manifestations, diagnosis, and management. Accessed June 17, 2022.
  6. Zakko SF, et al. Acute calculous cholecystitis: Clinical features and diagnosis. Accessed June 17, 2022.
  7. Vollmer CM, et al. Treatment of acute calculous cholecystitis. Accessed June 17, 2022.
  8. AskMayoExpert. Biliary stone disease. Mayo Clinic; 2021.
  9. Miura F, et al. Tokyo Guidelines 2018: Initial management of acute biliary infection and flowchart for acute cholangitis. Journal of Hepato-Biliary-Pancreatic Science. 2018; doi:10.1002/jhbp.509.
  10. Rajan E (expert opinion). Mayo Clinic. July 10, 2022.


Associated Procedures

  • Abdominal ultrasound
  • CT scan
  • HIDA scan



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  • Cholecystitis
(Video) Cholecystitis in 5 minutes! - Nursing Risk Factors, Symptoms, Complications, Diagnostics, Treatment


What is the best diagnosis for cholecystitis? ›

Ultrasonography is the preferred initial imaging test for the diagnosis of acute cholecystitis; scintigraphy is the preferred alternative. CT scanning is a secondary imaging test that can identify complications of acute cholecystitis and extrabiliary disorders when ultrasonography has not yielded a clear diagnosis.

What is the standard treatment for cholecystitis? ›

In acute cholecystitis, the initial treatment includes bowel rest, intravenous hydration, correction of electrolyte abnormalities, analgesia, and intravenous antibiotics. For mild cases of acute cholecystitis, antibiotic therapy with a single broad-spectrum antibiotic is adequate.

What is the most common treatment for cholecystitis? ›

Initial treatment will usually involve: fasting (not eating or drinking) to take the strain off your gallbladder. receiving fluids through a drip directly into a vein (intravenously) to prevent dehydration. taking medication to relieve your pain.

What is the gold standard for diagnosing cholecystitis? ›

Ultrasonography is preferred as the initial diagnostic test and hepatobiliary scintigraphy is reserved for the 20% of patients with equivocal ultrasonography test results. Hepatobiliary scintigraphy is the most reliable imaging study for patients with suspected acalculous acute cholecystitis.

Can cholecystitis be treated without surgery? ›

Some critical ill patients are unfit for cholecystectomy, and percutaneous cholecystostomy (PC) is performed as a minimally invasive alternative to surgery. In PC procedure, a drainage catheter is placed within the gallbladder lumen to decompress the gallbladder and relieve inflammation.

Is cholecystitis an emergency? ›

If you have cholecystitis, you'll experience sudden pain as your gallbladder reaches your doctor's hand. If your symptoms suggest you have acute cholecystitis, your GP will refer you to hospital immediately for further tests and treatment.

How long does it take to treat cholecystitis? ›

For moderate-severe cholecystitis, antibiotics should generally be limited to 4-7 days once the source of infection is controlled. Consider 14 days of antibiotics in cases of bacteremia with gram-positive bacteria known to cause infective endocarditis (eg, Enterococcus spp and Streptococcus spp)

What are 3 risk factors for cholecystitis? ›

It is known that cholecystitis is often caused by obstruction of the cystic duct. Known risk factors for gallbladder stones include old age, female gender, obesity, multiparity, family history, rapid weight loss, physical inactivity, dietary habit, oral contraceptives and others.

What is the gold standard in the treatment of symptomatic cholecystitis? ›

Laparoscopic cholecystectomy is considered the "gold standard" for the surgical treatment of gallstone disease. This procedure results in less postoperative pain, better cosmesis, and shorter hospital stays and disability from work than open cholecystectomy [2-8].

What are the red flags of cholecystitis? ›

Cases of chronic cholecystitis present with progressing right upper quadrant abdominal pain with bloating, food intolerances (especially greasy and spicy foods), increased gas, nausea, and vomiting. Pain in the midback or shoulder may also occur.

What should you avoid with cholecystitis? ›

Avoid high-fat foods, such as: Chocolate, whole milk, ice cream, processed cheese, and egg yolks. Fried, deep fried, or buttered foods. Sausage, salami, and bacon.

What happens if cholecystitis is not treated? ›

Untreated cholecystitis can cause tissue in the gallbladder to die (gangrene). It's the most common complication, especially among older people, those who wait to get treatment and those with diabetes. This can lead to a tear in the gallbladder, or it may cause your gallbladder to burst.

What lab value confirms cholecystitis? ›

Diagnosis of acute cholecystitis by elevation of CRP level (3 mg/dl or more), with ultrasonographic findings suggesting acute cholecystitis, has a sensitivity of 97%, specificity of 76%, and positive predictive value of 95% (level 1b).

What is the treatment for Grade 1 cholecystitis? ›

Mild (grade I) acute cholecystitis: early laparoscopic cholecystectomy is the preferred procedure. Moderate (grade II) acute cholecystitis: early cholecystectomy is performed. However, if patients have severe local inflammation, early gallbladder drainage (percutaneous or surgical) is indicated.

What are the stages of cholecystitis? ›

  • Stage 1 (edematous) 2-4 days. Gallbladder tissue intact with edema in subserosal layer. ...
  • Stage 2 (necrotizing) 3-5 days. ...
  • Stage 3 (suppurative) 7-10 days. ...
  • Stage 4 (chronic) After repeated episodes of cholecystitis.

Do you have to get your gallbladder removed if you have cholecystitis? ›

Most people with cholecystitis eventually need surgery to remove the gallbladder.

Can cholecystitis be managed at home? ›

The management of gallstones, biliary colic and cholecystitis. Many patients can be managed initially at home. Factors to be taken into account include the age of the patient, social support and the severity of symptoms.

How long is the hospital stay for cholecystitis? ›

After open surgery, you'll usually have to stay in hospital for 3 to 5 days, and your recovery time will be longer.

What will the ER do for gallbladder pain? ›

When a gallbladder attack occurs, it can land you in the emergency room. Because there is no medication to treat gallstones, surgical removal of the gallbladder may be your only treatment option. Laparoscopic surgery is the most common surgery used to remove a gallbladder.

What is the survival rate of cholecystitis? ›

Abstract. Acute cholecystitis is a common serious complication of gallstones. The reported mortality of acute cholecystitis is approximately 3%, but the rate increases with age or comorbidity of the patient.

When should I go to the hospital for cholecystitis? ›

See your doctor if you have abdominal pain, fever, nausea and vomiting. If the pain is so bad that you can't sit still or get comfortable, go straight to your nearest hospital emergency department.

Is cholecystitis a critical illness? ›

Acalculous cholecystitis should be considered in any critically ill patient with right upper quadrant abdominal pain, persistent fever, sepsis, or jaundice which is otherwise unexplained.

What are the 4 F's of cholecystitis? ›

It seemed appropriate to answer the question whether 4 x F canon (forty--the age over 40 years of age; female--sex; fertile--fertility; fat--obesity) still remains the basic canon among risk factors that determine the development of cholecystolithiasis.

What is the leading cause of cholecystitis? ›

What causes cholecystitis? Cholecystitis happens when a digestive juice called bile gets trapped in your gallbladder. In most cases, this happens because lumps of solid material (gallstones) are blocking a tube that drains bile from the gallbladder. When gallstones block this tube, bile builds up in your gallbladder.

What quality of pain is cholecystitis? ›

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.

Is ultrasound or CT better for cholecystitis? ›

Abstract. Background: Ultrasound (US) is the first-line diagnostic study for evaluating gallstone disease and is considered the test of choice for diagnosing acute cholecystitis (AC).

What is the most specific ultrasound finding for cholecystitis? ›

Ultrasound. The most sensitive US finding in acute cholecystitis is the presence of cholelithiasis in combination with the sonographic Murphy sign. Both gallbladder wall thickening (>3 mm) and pericholecystic fluid are secondary findings. Other less specific findings include gallbladder distension and sludge.

What lab tests to order for cholecystitis? ›

How is cholecystitis diagnosed?
  • Complete blood count (CBC). This test measures your white blood cell count. You may have a high white blood cell count if you have an infection.
  • Liver function tests. This group of special blood tests can tell if your liver is working properly.

Is a negative CT good enough to rule out acute cholecystitis? ›

CT may miss cases of acute cholecystitis subsequently found on cholescintigraphy. Since a negative CT does not fully rule out acute cholecystitis, further testing should be obtained following a negative CT in patients with continued suspicion based on history, physical exam, and laboratory findings.

How accurate is ultrasound for acute cholecystitis? ›

APPENDIX 1: Results for the Third Year of This Study

The sensitivity of US for acute cholecystitis (AC) improved from 68% to 74%. Interestingly, the sensitivity of CT for AC also improved from 85% to 89%.

Do you need contrast for cholecystitis? ›

CT with intravenous (IV) contrast is useful in diagnosing acute cholecystitis in patients with nonspecific abdominal pain. MRI, often with IV gadolinium-based contrast medium, is also a possible secondary choice for confirming a diagnosis of acute cholecystitis.

What are 5 signs of cholecystitis on ultrasound? ›

Ultrasonic imaging signs of acute cholecystitis include gallbladder wall thickening (> 3 mm), wall edema, gallbladder distention (> 40 mm), positive sonographic Murphy sign, and pericholecystic and perihepatic (C sign) fluid [2, 17] (Figs. 4A and 4B).

Can an ultrasound miss cholecystitis? ›

Background. Acute cholecystitis is one of the most common diseases requiring emergency surgery. Ultrasonography is an accurate test for cholelithiasis but has a high false-negative rate for acute cholecystitis. The Murphy sign and laboratory tests performed independently are also not particularly accurate.

Can you see cholecystitis on ultrasound? ›

Ultrasound: The sensitivity of ultrasound in the detection of acute cholecystitis is 95% and the specificity is 78-80%. The combination of gallstones and a positive sonographic Murphy's sign has a positive predictive value for acute cholecystitis of as high as 90-96%.

What pain relief is good for cholecystitis? ›

Meperidine is the drug of choice for pain control. It is an analgesic with multiple actions similar to those of morphine. It may produce less constipation, smooth muscle spasm, and depression of cough reflex than similar analgesic doses of morphine.


1. Acute cholecystitis causes, symptoms, diagnosis, treatment & pathology
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3. Gallbladder Stones Symptoms | Cholelithiasis | Gallstones Symptoms | Gallstones Warning Signs
4. Chronic cholecystitis causes, symptoms, diagnosis, treatment, & pathology
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