Chronic cholecystitis is long-term inflammation of the gallbladder, nearly always from gallstones that block its outlet again and again. The gallbladder wall thickens and scars, and removing it is the usual cure.
Key symptoms
- Repeated attacks of right upper or upper middle belly pain
- Pain after fatty or large meals, lasting from 30 minutes to a few hours
- Pain that may spread to the right shoulder or back
- Nausea, bloating and belching
What you find on exam
- Mild right upper quadrant tenderness or a normal exam between attacks
- No fever in uncomplicated cases
- Murphy sign may be mild or absent
- Check the eyes and skin for jaundice
Tests
- Right upper quadrant ultrasound: gallstones and a thick, contracted wall
- Liver tests and lipase to look for duct stones or pancreatitis
- Blood count, usually normal
- HIDA scan with ejection fraction if ultrasound is unclear
Treatment basics
- Elective laparoscopic cholecystectomy
- Pain control during attacks with an NSAID such as ketorolac
- Smaller, lower-fat meals while waiting for surgery
- Ursodiol only for selected patients who cannot have surgery
Red flags
- Pain lasting more than 6 hours with fever, suggesting acute cholecystitis
- Jaundice or dark urine from a stone in the bile duct
- Severe pain going to the back with vomiting, suggesting pancreatitis
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.