Cholecystitis Normal Abnormal This is when the gallbladder becomes infected. It is associated with gallstones more than 90% of the time. When gallstones become impacted in the bile ducts, infection occurs behind the impaction. Often starts after a large fatty meal Sudden, steady pain in the middle or right upper abdomen Vomiting Fever Gallstones Ischemia (blood supply decrease to gallbladder) Infections in persons with AIDS Examination: Tenderness in right upper abdomen Gallbladder can be felt in some cases Yellow skin or eyes may occur Laboratory Findings: Elevated white blood cell count Elevated total Bilirubin level Elevated Alkaline phosphatase Amylase may be moderately elevated Imaging X-Rays may who gall stones HIDA scan (special X-Ray test for obstructed gallstones) Ultrasound may show gallstones or thickened gallbladder wall Bowel rest (no food or drink) Intravenous fluid/feeding Intravenous broad-spectrum antibiotics Pain medications (Demerol usually best) Surgical removal of the gallbladder 2-3 days after cholecystitis for most patients Immediate surgical gallbladder removal if gangrene has occurred Untreated gangrene in the gallbladder may occur. This is a severe infection with destruction of tissue. Diabetics and the elderly are at highest risk. Cholangitis -- infection that occurs in common bile duct outside the gallbladder Seek immediate emergency medical treatment. Perforated ulcer Pancreatitis Appendicitis Liver Abscess Hepatitis Pneumonia (in right lung) Gallstones