Acute cholecystitis

It is an acute inflammation of the gallbladder.  Infection may be mild to moderate.  The condition usually resolves with conservative management, but may lead to gangrene, perforation or abscess formation.


Unremitting & presenting with more severe pain than biliary colic.  Pain in right upper quadrant or epigastrium associated with anorexia, nausea, vomiting, or chills.


  • Fever is usually present.
  • A tender mass is usually palpable in the right hypochondrium.
  • Mild jaundice may be present.  Moderate to severe jaundice suggests presence of inflammation or obstruction of common bile duct.


  • TLC is markedly raised.  (12000 to 15000 cmm/L).  A TLC more than 20,000 suggests gangrene, perforation, or cholangitis.
  • LFTs are usually slightly raised.
  • Ultrasonography confirms the diagnosis.


  • Hospital admission.
  • Nothing orally till nausea and vomiting settles.
  • I/V fluids.
  • I/V antibiotics (2nd 0r 3rd generation cephalosporins).


Inj. Diclofenac sodium 75 mg deep intragluteal  BD for  48 hours

Inj. Nalbufin 0.3mg/kg I/V x  6 hourly

Tab. Paracetamol 2 x TDS

Tab. Naproxen sodium 2 x TDS

Cap. Campax 50mg  1 x BD

Conservative management is reassessed frequently. If the patient is improving clinically, she may undergo early cholecystectomy on next available elective list if patient does not improve or deteriorates then consider:

1-   Change of antibiotic or

2-   Emergency cholecystectomy.