The cardinal symptom of acute cholecystitis is an abrupt-onset sudden sharp pain in the upper right side of the abdomen that spreads towards your right shoulder; the area is also extremely tender to palpation, and breathing deeply can aggravate the pain.
Unlike other types of abdominal pain, the pain associated with acute cholecystitis is usually persistent, and doesn't abate within a few hours.
• Other associated symptoms include fever, chills, nausea, and vomiting, sweating
• loss of appetite
• yellowing of the skin and the whites of the eyes (jaundice)
• a bulge in the abdomen
Acute cholecystitis is the most common complication of gall bladder stones (cholelithiasis). More than 95% of patients with acute cholecystitis have cholelithiasis. When a persistently obstructs the ducts, acute inflammation results. Bile, the greenish thick digestive fluid secreted by the gall bladder, stagnates, with subsequent of inflammatory compounds leading to damage of the mucosa, which in turn secretes more fluid into the gallbladder lumen than it absorbs. The resulting distention further releases inflammatory mediators, worsening mucosal damage and inflammation. Bacterial infection can also develop on top of inflammation.
• Most patients have had prior attacks of biliary colic or acute cholecystitis. The pain of cholecystitis is similar in quality and location to biliary colic but lasts longer (ie, > 6 h) and is more severe. Vomiting is common, as is right-sided tenderness below the rib cage. Within a few hours, deep inspiration exacerbates the pain during palpation of the right upper quadrant and halts inspiration, and involuntary guarding of upper abdominal muscles on the right side develop. Fever, usually low grade, is common.
• In the elderly, the first or only symptoms may be systemic and nonspecific (eg, anorexia, vomiting, malaise, weakness, fever). Sometimes fever does not develop.
• Acute cholecystitis begins to subside in 2 to 3 days and resolves within 1 week in 85% of patients even without treatment.