Synopsis
Diagnose inflamed gallbladder disease early, identify gangrene, perforation and sepsis, provide safe initial hospital care and secure definitive or temporising source control.
- Acute cholecystitis usually follows persistent cystic-duct obstruction and presents with sustained right-upper-quadrant pain, fever, focal tenderness and inflammatory-marker elevation rather than a completely resolving attack.
- A Murphy sign supports the diagnosis but is less reliable after analgesia, in older or immunosuppressed people, and in severe disease with gallbladder necrosis.
- Ultrasound is first-line: seek stones, gallbladder distension, wall thickening, pericholecystic fluid and a sonographic Murphy sign while remembering that no single feature is diagnostic alone.
Key red flags
Peritonism, a palpable mass, escalating pain, ileus, worsening acidosis or gas in the gallbladder wall suggests empyema, gangrene, emphysematous infection or perforation.
Investigation priorities
Grade physiological disturbance immediately and identify a patient who needs resuscitation before diagnostic refinement.
Management branches
Sustained focal pain, inflammation and imaging or examination support acute cholecystitis.
- Assess ABCDE, establish venous access, prescribe analgesia and antiemetic therapy, and replace fluid according to perfusion and comorbidity.
- Send blood tests, cultures when indicated and urgent ultrasound, while involving the on-call surgical team at the start of care.
Key medicines
Local biliary-infection antibiotic regimenSelect intravenous agents, dose interval and duration from the current trust guideline and BNF after allergy and renal review.
Parenteral opioid analgesiaGive small intravenous or subcutaneous increments under the local acute-pain protocol, reassessing pain, consciousness and respiratory rate after each dose.