Symptoms of Cholecystitis
The cardinal symptoms of acute cholecystitis are right upper quadrant abdominal pain, Murphy's sign, and fever, often accompanied by nausea and vomiting. 1
Core Clinical Presentation
The classic symptom triad consists of:
- Right upper quadrant abdominal pain that is severe, steady in intensity, and may radiate to the upper back or right shoulder 1, 2
- Murphy's sign (focal tenderness over the gallbladder that can be elicited on physical examination or ultrasound) 1
- Fever indicating inflammatory response 1, 3
Additional Common Symptoms
Beyond the classic triad, patients frequently experience:
- Nausea and vomiting that typically begin soon after pain onset 1, 2, 3
- Anorexia (loss of appetite) 1
- Abdominal tenderness on palpation 1
- Palpable gallbladder mass in the right upper quadrant, which specifically indicates complicated acute cholecystitis 1
Pain Characteristics
The pain pattern has distinctive features:
- Onset is relatively abrupt, often awakening patients from sleep 2
- Duration lasts hours to up to a day, distinguishing it from brief spasms 2
- Location is primarily epigastric and/or right upper quadrant 2, 4
- May be associated with eating, though this is not universal 3
Relationship to Prior Biliary Colic
Approximately 58% of patients with acute cholecystitis experience "warning" episodes of biliary colic before developing acute inflammation 4. However, this means that 42% of patients develop cholecystitis without any prior warning symptoms 4. The absence of previous biliary colic does not exclude the diagnosis.
Critical Pitfall to Recognize
Dyspeptic symptoms alone (indigestion, belching, bloating, heartburn, food intolerance) are common in persons with gallstones but are probably unrelated to the stones themselves and frequently persist after surgery 2. Do not rely on these nonspecific symptoms to make the diagnosis—focus on the classic triad described above.
When Symptoms Suggest Complicated Disease
Certain findings indicate progression beyond uncomplicated cholecystitis:
- Palpable gallbladder lump suggests gangrenous cholecystitis, perforation, or abscess formation 1
- Persistent symptoms beyond 7-10 days warrant investigation for complications 1
- Jaundice suggests common bile duct involvement rather than simple cholecystitis 1
Diagnostic Confirmation
While symptoms guide clinical suspicion, ultrasound is the investigation of choice and should demonstrate gallbladder wall thickening, pericholecystic fluid, gallstones (often impacted in the cystic duct), distended gallbladder, and ultrasonographic Murphy's sign 1. Ultrasound has approximately 81% sensitivity and 83% specificity for acute cholecystitis 3.