Cholecystitis: symptoms, causes, treatment and when to get help

The main symptom of acute cholecystitis, according to the NHS, is a sudden, sharp pain in the upper right-hand side of your tummy (abdomen), spreading towards your right shoulder. The affected area is usually very tender and taking a deep breath can make the pain worse.

NHS inform separates this from biliary colic, the pain of a gallstone temporarily blocking a duct. Biliary colic usually lasts between 1 and 5 hours; with acute cholecystitis the pain typically lasts longer than 5 hours and is accompanied by a high temperature of 38C or above and a rapid heartbeat.

• A high temperature.

• Feeling sick or being sick.

• Sweating.

• Loss of appetite.

• Yellowing of the skin and the whites of the eyes (jaundice).

• A bulge in the tummy.

The gallbladder is a small pear-shaped organ beneath the liver. Its job is to store and concentrate bile, a liquid made by the liver that helps digest fats. The NHS says it is useful but not essential and can be safely removed without affecting your ability to digest food.

In cholecystitis the gallbladder becomes inflamed. The NHS says gallstones are very common, affecting more than 1 in 10 adults in the UK, and most do not cause symptoms. They can occasionally cause episodes of pain (biliary colic) or acute cholecystitis, and the inflamed gallbladder can sometimes become infected by bacteria.

The NHS groups the causes into two types. Calculous cholecystitis is the most common and usually the less serious form, accounting for around 95% of cases. It develops when the cystic duct is blocked by a gallstone or biliary sludge. The blockage makes bile build up, which raises the pressure inside the gallbladder and causes inflammation.

Acalculous cholecystitis is inflammation without gallstones. It is less common, but usually more serious. The NHS says its exact cause is not known and that it is usually a complication of a serious illness, infection or injury. Risk factors it lists include accidental damage to the gallbladder during major surgery, serious injuries or burns, sepsis, and severe malnutrition or dehydration.

For gallstones themselves, the NHS says you may be more likely to get them if you are over 40, are a woman, are living with obesity, eat a diet high in fat and low in fibre, have lost weight quickly, or have a condition such as diabetes or Crohn's disease.

With severe tummy pain, a GP will probably carry out a simple examination called Murphy's sign. You breathe in deeply with the GP's hand pressed just below the rib cage; the gallbladder moves down as you breathe in, and if you have cholecystitis the pain is sudden as it reaches the hand.

If symptoms suggest acute cholecystitis, the NHS says your GP will refer you to hospital immediately. Tests in hospital include blood tests to check for signs of inflammation and an ultrasound scan of the tummy to look for gallstones or other signs of a problem with the gallbladder.

If you are diagnosed with acute cholecystitis, you will probably be admitted to hospital. The NHS says initial treatment usually involves not eating or drinking to take strain off the gallbladder, fluids through a drip to prevent dehydration, and medicine to relieve pain. Antibiotics are given if infection is thought to be present and often need to continue for up to a week, either in hospital or at home.

Removing the gallbladder (cholecystectomy) may be recommended at some point after initial treatment, to prevent acute cholecystitis coming back and to reduce the risk of serious complications. If you are fit enough, your doctors decide the best timing, and the NHS says a laparoscopic (keyhole) cholecystectomy is often recommended within 1 week of confirming acute cholecystitis.

If surgery is not suitable, for example because of another health condition, the NHS says you may be offered a procedure to drain the fluid that has collected in the gallbladder using a narrow tube, placed either through the skin or endoscopically.

Without appropriate treatment, the NHS says acute cholecystitis can sometimes lead to potentially life-threatening complications. The main ones are death of gallbladder tissue (gangrenous cholecystitis), which can cause a serious infection that spreads through the body, and the gallbladder splitting open (perforation), which can spread infection within the tummy (peritonitis) or lead to an abscess.

The NHS says emergency surgery to remove the gallbladder is needed to treat these complications in about 2 or 3 in every 10 cases of acute cholecystitis. NHS inform adds that an emergency operation can be more difficult and has a higher chance of needing to be converted to open surgery.

The NHS says to see a GP as soon as possible if you develop sudden and severe abdominal pain, particularly if it lasts longer than a few hours or comes with other symptoms such as jaundice and a high temperature. If you cannot contact a GP immediately, phone your out-of-hours service or call NHS 111.

For gallstone symptoms, the NHS says to call 999 or go to A&E for sudden, severe tummy pain, pain that spreads from the tummy to the back with vomiting, a very high temperature or feeling hot, cold or shivery, or yellow skin or whites of the eyes. It says not to drive yourself to A&E.

It is not always possible to prevent acute cholecystitis, but you can lower your risk by reducing your chance of gallstones. The NHS recommends a healthy, balanced diet, reducing high-cholesterol foods and keeping to a healthy weight. It says to avoid low-calorie rapid weight loss diets, because they can disrupt bile chemistry and increase the risk of gallstones; gradual weight loss is better.

While waiting for surgery for gallstones, the NHS says you may want to avoid foods that cause symptoms and may be advised to eat a low-fat diet. After the gallbladder is removed, some people have bloating and diarrhoea after eating certain foods, but the NHS says you can lead a perfectly normal life without one. NHS inform says if certain foods trigger symptoms you may wish to avoid them in future.

Acute cholecystitis is an emergency presentation, so most people reach hospital through a GP referral, NHS 111 or A&E and are treated on the NHS. A gallbladder operation planned afterwards may be done soon after the acute episode or later once things have settled, as your surgical team decides.

Private hospitals also perform gallbladder removal for people with recurring gallstone symptoms who are well enough for planned surgery. Whichever route you take, ask who will be responsible for your care if the pain returns before surgery and what warning signs should send you to A&E.