Tag Archives: cholecystitis

Main Clinical Manifestations of Chronic Cholecystitis

Chronic cholecystitis denotes persistent, low-grade inflammation of the gall-bladder wall, usually in the setting of recurrent mechanical irritation by gallstones or, less commonly, chronic infection or metabolic deposition. Symptoms are episodic and less dramatic than those of acute cholecystitis, but they may culminate in fibrosis, loss of function, or acute exacerbation.

  1. Recurrent biliary colic
    Episodic, post-prandial right-upper-quadrant or epigastric pain lasting 15–60 min, often precipitated by fatty foods and radiating to the inter-scapular region or right shoulder. Pain is typically self-limiting but becomes more frequent over time.
  2. Dyspeptic syndrome
    Early satiety, eructation, bloating, and nausea reflect impaired gall-bladder emptying and coexist with colicky episodes.
  3. Fat intolerance
    Patients report loose stools or diarrhoea following meals rich in fat, attributable to inadequate bile acid delivery to the duodenum.
  4. Vague upper-abdominal discomfort
    A dull, non-colicky heaviness or fullness persists between attacks, especially when the gall-bladder is distended by viscous bile or sludge.
  5. Tender hepatomegaly
    The liver edge remains smooth and mildly tender; the gall-bladder fundus may be palpable as a soft, non-distended mass that moves with respiration.
  6. Laboratory changes
    Serum alkaline phosphatase and γ-glutamyl transferase may be intermittently elevated; total bilirubin is usually normal unless common bile-duct stones coexist. Repeated episodes can raise C-reactive protein minimally.
  7. Acute exacerbation
    Sudden intensification of pain, high fever, or guarding signals progression to acute cholecystitis, gangrene, or empyema and mandates urgent evaluation.
Symptom / SignTypical Presentation
Recurrent colicPost-prandial RUQ pain 15–60 min, fatty trigger
DyspepsiaEarly satiety, bloating, eructation
Fat intoleranceLoose stools after rich meals
Vague discomfortDull heaviness between attacks
Tender organSoft, mildly tender gall-bladder edge
LaboratoryIntermittent ↑ ALP/GGT, normal bilirubin
ExacerbationSudden severe pain, fever, guarding

Related articles：

  1. Main Clinical Manifestations of Acute Cholecystitis
  2. Main Clinical Manifestations of Hepatic Hydatid Disease
  3. Main Clinical Manifestations of Extrahepatic Bile-Duct Stones
  4. Main Clinical Manifestations of Cholangitis
  5. Main Clinical Manifestations of Bile-Duct Stones
  6. Main Clinical Manifestations of Biliary Tract Diseases

Main Clinical Manifestations of Acute Cholecystitis

Acute cholecystitis is acute inflammation of the gall-bladder wall, initiated most often by cystic-duct obstruction with secondary bacterial infection. The clinical picture evolves over hours, and recognition of its characteristic features guides early imaging, antibiotic therapy, and timely surgical intervention.

  1. Right-upper-quadrain pain
    Persistent, often severe pain begins beneath the costal margin, may radiate to the right scapula or inter-scapular region, and is exacerbated by deep inspiration or movement. Pain typically lasts > 6 h and is unrelenting.
  2. Murphy sign
    Inspiratory arrest elicited by palpation of the right upper quadrant during deep inspiration is a reliable physical finding; a positive Murphy sign has high diagnostic accuracy.
  3. Fever and systemic response
    Low-grade pyrexia (37.5–38.5 °C) with chills is usual; higher temperatures or rigors suggest suppurative complications such as empyema or gangrene.
  4. Nausea and vomiting
    Gastric stasis and vagal reflexes produce repeated retching that may transiently lessen pain but contributes to dehydration and electrolyte imbalance.
  5. Tender hepatomegaly and guarding
    The gall-bladder fundus is palpable as a smooth, exquisitely tender mass; voluntary guarding progresses to board-like rigidity if peritonism develops.
  6. Laboratory inflammation
    Leukocytosis with neutrophil left shift, elevated C-reactive protein, and modest rise in serum alkaline phosphatase and transaminases are characteristic; total bilirubin may be mildly elevated unless common bile-duct stones coexist.
  7. Local complications
    Persistent high fever, unrelenting pain, or palpable emphysematous crepitus indicates gangrene, perforation, or emphysematous cholecystitis and mandates urgent intervention.
Symptom / SignTypical Presentation
RUQ painPersistent > 6 h, radiates to scapula
Murphy signInspiratory arrest on palpation
FeverLow-grade, chills; high if suppurative
Nausea/vomitingRepeated, may relieve pain transiently
Tender massSmooth, exquisitely tender gall-bladder
LaboratoryLeukocytosis, ↑ CRP, ↑ ALP/ALT
Alarm signsHigh fever, crepitus, unrelenting pain

Related articles：

  1. Main Clinical Manifestations of Chronic Cholecystitis
  2. Main Clinical Manifestations of Extrahepatic Bile-Duct Stones
  3. Main Clinical Manifestations of Hepatic Hydatid Disease
  4. Main Clinical Manifestations of Hepatic Abscess
  5. Main Clinical Manifestations of Hepatic Ascites
  6. Main Clinical Manifestations of Lithiasis