Last updated: February 21, 2017

Acute cholecystitis

Acute cholecystitis: Introduction

Acute cholecystitis literally means the inflammation of the gall bladder. The symptoms of acute cholecystitis are a result of the inflammation. As gall bladder in located in the right upper part of the belly, the inflammation of acute acute cholecystitis causes pain and tenderness in that area. The actual symptoms of acute cholecystitis depend on several factors. I hope to illustrate the symptoms of acute cholecystitis clearly and practically by describing my actual patients with acute cholecystitis.

Acute cholecystitis: A twenty five year old female with “stomach flu”

Miss B is twenty five year old female who works at the local grocery store. She is also taking evening classes at the local community college to become a home inspector. She is also a single mom of two kids ages 2 and 4. She has a very busy life but she has always been a hard worker and is well adjust to a life which others might consider too hectic or too hard. On the flip side, she does not normally have time to take care of herself and does not have a regular doctor.

After dropping her kids in the preschool, she went to the local Chinese drive-through before heading to work. As she gulped down the chicken-lo-mien, she felt something was not quite right. She did not know what it was until she reached work. she had her own office in the back of the grocery store. She sat there on her chair going through the computer screen checking the store inventory and all of a sudden she had a pain in her chest. Well, she thought it was a chest pain. It was on the right lower side of her chest which is also the right upper part of the abdomen. Slowly, the started to build up and steadily got worse over the next 2 hours. She drank some water but that did not help her at all. She became very weak and then she started to throw up. Her co-worker noticed something was not right. Luckily, they had one urgent care center inside the grocery store and they got her in there right away. By that time she had thrown up a few time and was weak. She still had the pain but she was more concerned about the vomiting. Based on the history of Chinese food and throwing up, the doctor thought she had a gastroenteritis or a stomach flu or some kind of food poisoning. He might have thought about acute cholecystitis but she did not appear sick enough to have it. Her blood pressure was normal and she only had a mild fever. They gave her some medications for nausea and send her home and told her to drink plenty of Gatorade. She took some Gatorade from the store and went home.

At first, she felt a little better after she took the medications and kept some Gatorade down but later started feeling worse. Her pain worsened and became very sweaty and weak. She called her mother and told her to pick up the kids and drove herself to the hospital. She was evaluated in the ER and was found to have a high fever. She did have significant tenderness in her right upper abdomen at this time and the doctor was immediately suspecting acute cholecystitis. She had some blood work and it showed a very high white cell count which is a marker of inflammation. It is usually elevated in patients with acute cholecystitis. With this information the ER doctor ordered an ultrasound of the abdomen which showed that her gall bladder was inflamed. It confirmed the diagnosis of acute cholecystitis.

As the on-call admitting doctor, I admitted the patient to the medical floor and started her on iv fluids and antibiotics with the working diagnosis of acute cholecystitis. She was very dehydrated and required significant amounts of fluids to correct her dehydration. I explained her about the treatment options for acute cholecystitis. After her dehydration was corrected and her blood pressure stabilized, I called the surgeon on-call and he agreed with the diagnosis of acute cholecystitis and planned to do surgery on her the next day. We held all food and drinks from her in anticipation of the surgery.

Next day, patient had a laparoscopic cholecystectomy. They removed her her gall bladder with a device with camera inserted into her abdoment by drilling a few holes in it. With the infected gall bladder gone, patient quickly recovered from her acute cholecystitis and went home after two days.

This how most young and healthy patients with acute cholecystitis present. The first doctor who diagnosed a possible stomach flu in this patient was not wrong or incompetent. At that early stage of the disease, she had not developed the specific signs of acute cholecystitis and treated her appropriately and told her that she she should go to ER if her symptoms worsen. That is what she did and the ER doctor got the diagnosis of acute cholecystitis.

Not all patients with acute cholecystitis have this kind of happy ending. Some patients with acute cholecystitis do develop complications requiring prolonged hospitalization and even severe long term consequences. But, in young and otherwise healthy patients with acute cholecystitis, complications are just considered exceptions rather than rules.

I hope the story of Miss B helped you understand more about acute cholecystitis. Please check back soon as I will be uploading more stories about different aspects of patients with acute cholecystitis.

Thank you

Nabin Sapkota, MD