What Are the Symptoms and Treatment of Acute Cholecystitis?
Dec 21, 2020
Source: Cainiu Health
Dr. Gao Jun
Introduction
In general, symptoms of acute cholecystitis include abdominal pain, vomiting, high fever, jaundice, and a positive Murphy’s sign. Treatment primarily involves dietary modification, rest, pharmacotherapy, percutaneous transhepatic gallbladder drainage, and cholecystectomy. Patients with cholecystitis should also maintain a light diet in daily life and avoid high-fat, high-oil foods—such as fried foods and animal offal—to prevent excessive gallbladder contraction.
Generally, acute cholecystitis presents with symptoms including abdominal pain, vomiting, high fever, jaundice, and a positive Murphy’s sign. Treatment options primarily include dietary modification, rest, pharmacotherapy, percutaneous transhepatic gallbladder drainage, and cholecystectomy.
I. Symptoms
1. Abdominal Pain
Abdominal pain is typically the initial symptom of acute cholecystitis. This pain usually manifests as paroxysmal colicky pain in the right upper quadrant and may radiate to the right scapular region.
2. Vomiting
In addition to abdominal pain, nausea and vomiting are common in patients with acute cholecystitis. Without timely and appropriate intervention, vomiting frequency may increase, potentially leading to dehydration.
3. High Fever
Patients with acute cholecystitis often do not exhibit fever early in the disease course; however, a small number may present with mild fever. High fever generally develops as the condition progresses and becomes more severe.
4. Jaundice
Jaundice may occur in cases of severe acute cholecystitis. Its appearance suggests bacterial involvement of the liver and impaired bile flow due to obstruction or inflammation.
5. Positive Murphy’s Sign
A positive Murphy’s sign is elicited when, during deep inspiration, the inflamed gallbladder descends with the liver and contacts the examiner’s palpating finger, causing sharp pain.
II. Treatment
1. Dietary Modification
During an acute episode, patients should observe strict fasting (no food or fluids) to allow the gallbladder to rest and reduce bile secretion, thereby alleviating its workload.
2. Rest
Patients should remain on bed rest in a quiet, comfortable environment. A semi-Fowler’s position helps relax abdominal musculature, improves respiratory function, and reduces pain.
3. Pharmacotherapy
Medications—including anti-inflammatory and cholagogue agents such as Xiaoyan Lidan tablets, clindamycin hydrochloride tablets, and ursodeoxycholic acid tablets—should be administered under physician guidance.
4. Percutaneous Transhepatic Gallbladder Drainage
In cases of severe cholecystitis with marked gallbladder distension or fluid accumulation, a needle can be inserted percutaneously through the liver into the gallbladder to drain its contents. This procedure rapidly relieves intragallbladder pressure and alleviates pain and inflammation.
5. Cholecystectomy
Cholecystectomy is indicated for recurrent cholecystitis, gangrenous or perforated gallbladder, or cholecystitis complicated by gallstones—typically performed under medical supervision.
Additionally, patients with cholecystitis should maintain a light, low-fat diet in daily life and avoid high-oil, high-fat foods—such as fried items and organ meats—to prevent excessive gallbladder contraction.
