Cholecystitis - Diagnosis and treatment (2024)



To diagnose cholecystis, your health care provider will likely do a physical exam and discuss your symptoms and medical history. Tests and procedures used to diagnose cholecystitis include:

  • Blood tests. Your health care provider may order blood tests to look for signs of an infection or signs of gallbladder problems.
  • Imaging tests that show your gallbladder. Abdominal ultrasound, endoscopic ultrasound, computerized tomography (CT) scan or magnetic resonance cholangiopancreatography (MRCP) can be used to create pictures of your gallbladder and bile ducts. These pictures may show signs of cholecystitis or stones in the bile ducts and gallbladder.
  • A scan that shows the movement of bile through your body. A hepatobiliary iminodiacetic acid (HIDA) scan tracks the production and flow of bile from your liver to your small intestine. A HIDA scan involves injecting a radioactive dye into your body, which attaches to bile-producing cells. During the scan, the dye can be seen as it travels with the bile through the bile ducts. This can show any blockages.

More Information

  • Abdominal ultrasound
  • CT scan
  • HIDA scan


Endoscopic retrograde cholangiopancreatography

Cholecystitis - Diagnosis and treatment (1)

Endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) uses a dye to highlight the bile ducts and pancreatic duct on X-ray images. A thin, flexible tube with a camera on the end, called an endoscope, is passed down your throat and into your small intestine. The dye enters the ducts through a small hollow tube, called a catheter, passed through the endoscope. Tiny tools passed through the catheter also can be used to remove gallstones.

Laparoscopic cholecystectomy

Cholecystitis - Diagnosis and treatment (2)

Laparoscopic cholecystectomy

Special surgical tools and a tiny video camera are inserted through incisions in your abdomen during laparoscopic cholecystectomy. Your abdomen is inflated with carbon dioxide gas to allow room for the surgeon to work with surgical tools.

Treatment for cholecystitis usually involves a hospital stay to control the inflammation in your gallbladder. Sometimes, surgery is needed.

At the hospital, your health care provider will work to control your symptoms. Treatments may include:

  • Fasting. You may not be allowed to eat or drink at first in order to take stress off your inflamed gallbladder.
  • Fluids through a vein in your arm. This treatment helps prevent dehydration.
  • Antibiotics to fight infection. If your gallbladder is infected, your provider likely will recommend antibiotics.
  • Pain medications. These can help control pain until the inflammation in your gallbladder is relieved.
  • Procedure to remove stones. You may have a procedure called an endoscopic retrograde cholangiopancreatography (ERCP). During this procedure that uses dye to highlight the bile ducts, instruments can be used to remove stones blocking the bile ducts or cystic duct.
  • Gallbladder drainage. In some cases, such as when surgery to remove the gallbladder is not an option, gallbladder drainage (cholecystostomy) may be done to remove infection. Drainage is done through the skin on the abdomen (percutaneous) or by passing a scope through the mouth (endoscopic).

Your symptoms are likely to decrease in 2 to 3 days. However, gallbladder inflammation often returns. Most people with cholecystitis eventually need surgery to remove the gallbladder.

Gallbladder removal surgery

The procedure to remove the gallbladder is called a cholecystectomy. Usually, this is a minimally invasive procedure, involving a few tiny cuts (incisions) in your abdomen (laparoscopic cholecystectomy). An open procedure, in which a long incision is made in your abdomen, is rarely required.

The timing of surgery depends on the severity of your symptoms and your overall risk of problems during and after surgery. If you're at low surgical risk, surgery may be performed during your hospital stay.

Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder. Even without your gallbladder you can still digest food.

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Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Preparing for your appointment

Make an appointment with your health care provider if you have symptoms that worry you. If your provider suspects that you have cholecystitis, you may be referred either to a specialist in the digestive system (gastroenterologist) or you may be sent to a hospital.

What you can do

Before your appointment:

  • Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
  • Make a list of your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Make a list of key personal information, including major stresses or recent life changes.
  • Make a list of all medications, vitamins, herbs and other supplements that you're taking.
  • Take a family member or friend along, if possible. Someone who accompanies you can help you remember the information you get.
  • Make a list of questions to ask your health care provider.

For cholecystitis, some basic questions to ask include:

  • Is cholecystitis the likely cause of my abdominal pain?
  • What are other possible causes for my symptoms?
  • What tests do I need?
  • Do I need gallbladder removal surgery?
  • How soon do I need surgery?
  • What are the risks of surgery?
  • How long does it take to recover from gallbladder surgery?
  • Are there other treatment options for cholecystitis?
  • Should I see a specialist?
  • Are there brochures or other printed material that I can take with me? What websites do you recommend?

Don't hesitate to ask other questions, as well.

What to expect from your doctor

Your health care provider is likely to ask you a number of questions, including:

  • When did your symptoms begin?
  • Have you had pain like this before?
  • Are your symptoms constant or do they come and go?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

By Mayo Clinic Staff

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Sept. 09, 2022


  1. Ferri FF. Cholecystitis. In: Ferri's Clinical Advisor 2023. Elsevier; 2023. Accessed July 11, 2022.
  2. Sanford DE. An update on technical aspects of cholecystectomy. Surgical Clinic of North America. 2019; doi:10.1016/j.suc.2018.11.005.
  3. Acute cholecystitis. Merck Manual Professional Version. Accessed June 16, 2022.
  4. Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed June 16, 2022.
  5. Afdhal NH. Acalculous cholecystitis: Clinical manifestations, diagnosis, and management. Accessed June 17, 2022.
  6. Zakko SF, et al. Acute calculous cholecystitis: Clinical features and diagnosis. Accessed June 17, 2022.
  7. Vollmer CM, et al. Treatment of acute calculous cholecystitis. Accessed June 17, 2022.
  8. AskMayoExpert. Biliary stone disease. Mayo Clinic; 2021.
  9. Miura F, et al. Tokyo Guidelines 2018: Initial management of acute biliary infection and flowchart for acute cholangitis. Journal of Hepato-Biliary-Pancreatic Science. 2018; doi:10.1002/jhbp.509.
  10. Rajan E (expert opinion). Mayo Clinic. July 10, 2022.


Associated Procedures

  • Abdominal ultrasound
  • CT scan
  • HIDA scan



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  • Cholecystitis
Cholecystitis - Diagnosis and treatment (2024)


How do you diagnose cholecystitis? ›

Abdominal ultrasound, endoscopic ultrasound, computerized tomography (CT) scan or magnetic resonance cholangiopancreatography (MRCP) can be used to create pictures of your gallbladder and bile ducts. These pictures may show signs of cholecystitis or stones in the bile ducts and gallbladder.

What is the most common cause of cholecystitis? ›

Gallstones. Most often, cholecystitis is the result of hard particles that develop in your gallbladder (gallstones). Gallstones can block the tube (cystic duct) through which bile flows when it leaves the gallbladder. Bile builds up in the gallbladder, causing inflammation.

What is the best medicine for cholecystitis? ›

Sanford Guide recommendations for the treatment of cholecystitis include ampicillin/sulbactam or piperacillin/tazobactam for non–life-threatening cases of cholecystitis. In life-threatening cases, Sanford recommends imipenem/cilastatin or meropenem.

How do hospitals manage cholecystitis? ›

In acute cholecystitis, the initial treatment includes bowel rest, intravenous hydration, correction of electrolyte abnormalities, analgesia, and intravenous antibiotics. For mild cases of acute cholecystitis, antibiotic therapy with a single broad-spectrum antibiotic is adequate.

What is the gold standard for cholecystitis diagnosis? ›

Ultrasonography is the preferred initial imaging test for the diagnosis of acute cholecystitis; scintigraphy is the preferred alternative. CT scanning is a secondary imaging test that can identify complications of acute cholecystitis and extrabiliary disorders when ultrasonography has not yielded a clear diagnosis.

What are three signs of cholecystitis? ›

Acute cholecystitis
  • a high temperature (fever)
  • nausea and vomiting.
  • sweating.
  • loss of appetite.
  • yellowing of the skin and the whites of the eyes (jaundice)
  • a bulge in the abdomen.
May 29, 2023

What is a classic symptom of cholecystitis? ›

Cases of chronic cholecystitis present with progressing right upper quadrant abdominal pain with bloating, food intolerances (especially greasy and spicy foods), increased gas, nausea, and vomiting. Pain in the midback or shoulder may also occur. This pain could be present for years until diagnosis.

Does cholecystitis go away? ›

Cholecystitis may clear up on its own. However, if you have gallstones, you will probably need surgery to remove your gallbladder. Nonsurgical treatment includes: Antibiotics you take at home to fight infection.

How do doctors tell if your gallbladder is inflamed? ›

ERCP (endoscopic retrograde cholangiopancreatography.

This is used to find and treat problems in your liver, gallbladder, bile ducts, and pancreas. It uses X-ray and a long, flexible tube (endoscope) with a light and camera at one end. The tube is put into your mouth and throat.

What does an inflamed gallbladder feel like? ›

Gallbladder pain builds quickly to a peak, which may be severe. It may feel sharp, dull or crampy and may be worse when you breathe deeply. Some people mistake it for chest pain or even a heart attack.

Can cholecystitis resolve without surgery? ›

However, the definitive treatment of acalculous cholecystitis is cholecystectomy for patients who are able to tolerate surgery. In selected patients with acute acalculous cholecystitis (AAC), nonsurgical treatment (such as antibiotics or percutaneous cholecystostomy) may be an effective alternative to surgery.

What should a patient with cholecystitis avoid? ›

Avoid high-fat foods, such as: Chocolate, whole milk, ice cream, processed cheese, and egg yolks. Fried, deep fried, or buttered foods. Sausage, salami, and bacon.

What happens if cholecystitis is not treated? ›

Without appropriate treatment, acute cholecystitis can sometimes lead to potentially life-threatening complications. The main complications of acute cholecystitis are: the death of gallbladder tissue (gangrenous cholecystitis) – which can cause a serious infection that could spread throughout the body.

What is the first line treatment for cholecystitis? ›

20,21 Therefore, according to the clinical trials available so far, piperacillin, ampicillin and an aminoglycoside, as well as several cephalosporins, are recommended for the treatment of acute cholecystitis (recommendation A).

What lab value confirms cholecystitis? ›

Diagnosis of acute cholecystitis by elevation of CRP level (3 mg/dl or more), with ultrasonographic findings suggesting acute cholecystitis, has a sensitivity of 97%, specificity of 76%, and positive predictive value of 95% (level 1b).

What is the best imaging to diagnose cholecystitis? ›

The best diagnostic test to confirm gallbladder disease is the abdominal ultrasound. It is noninvasive and is 90% to 95% accurate in detecting gallstones. Pericholic fluid and thickened gallbladder walls can also be identified as in acute cholecystitis.

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