What are the symptoms of gallbladder pain? What causes gallstones and cholecystitis? How are gallbladder problems treated?.

Gallbladder Function and Gallstone Formation

The gallbladder is a small digestive organ located on the right side of the abdomen, under the liver. It stores and releases bile to aid in the digestion of fats. Bile is produced by the liver and consists of cholesterol and bilirubin. Normally, when a person eats fatty foods, the stomach digests some of the food and the gallbladder releases bile to further aid digestion.

However, the components of bile can sometimes build up and form small, pebble-like “stones” called gallstones. Worldwide, 5.3–25.0% of people experience gallstone disease, and roughly 20% of those with gallstones will experience pain and complications.

Gallbladder Pain Symptoms

When gallstones block the release of bile from the gallbladder, it can cause the bile to back up and the gallbladder to swell and become inflamed. This condition is known as cholecystitis and is the source of gallbladder pain. The pain typically:

• Affects the upper abdomen, usually on the right side
• May radiate to the back and right shoulder blade
• Comes on after a meal or in the evenings
• Worsens when taking a deep breath
• Is sudden and often intense

Other symptoms that may accompany gallbladder problems include bloating, chills, fever, nausea, shortness of breath due to discomfort when taking a deeper breath, and vomiting.

Causes of Gallbladder Pain

What causes the buildup of bile and gallstone formation in the first place? Factors that can contribute to gallstone development include:

1. High cholesterol levels
2. Rapid weight loss
3. Pregnancy
4. Diabetes
5. Certain medications

When gallstones block the release of bile, it can lead to the swelling and inflammation of the gallbladder, known as cholecystitis. This is the primary cause of gallbladder pain.

Gallbladder Pain Relief and Treatment

For mild gallbladder pain, dietary changes and over-the-counter medications may provide relief. Avoiding fatty, fried, and high-cholesterol foods can help manage symptoms. However, for severe or persistent pain, medical treatment may be necessary.

If the gallbladder pain does not subside within 6 hours or is accompanied by fever, nausea, severe bloating, vomiting, or malaise, it is important to seek emergency medical attention. A doctor can determine the underlying cause and recommend the appropriate treatment, which may include medication or surgery to remove the gallbladder (cholecystectomy).

Gallbladder Removal and Life Without a Gallbladder

Cholecystectomy, or the surgical removal of the gallbladder, is a common procedure and is often the recommended treatment for recurrent or severe gallbladder problems. After recovery, most people can lead a normal, healthy life without their gallbladder. The body can still digest fats, but may need to make adjustments to the diet.

Distinguishing Gallbladder Pain from Other Conditions

It is important to note that gallbladder pain can sometimes be mistaken for other conditions, such as gastroesophageal reflux disease (GERD). While GERD and gallbladder disease can both cause nausea and upper abdominal pain, the pain associated with gallbladder issues is typically on the right side and may radiate to the shoulder, whereas GERD pain is more of a burning sensation in the chest.

If a person experiences persistent upper abdominal pain, it is best to seek medical attention to determine the underlying cause and receive appropriate treatment.

Preventing Gallbladder Problems

While some risk factors for gallstone formation, such as genetics and age, cannot be controlled, there are steps people can take to reduce their risk:

• Maintain a healthy weight and avoid rapid weight loss
• Eat a diet low in saturated and trans fats
• Manage conditions like diabetes and high cholesterol
• Avoid certain medications that may contribute to gallstone formation

By understanding the symptoms, causes, and treatment options for gallbladder problems, individuals can take proactive steps to maintain their digestive health and prevent potentially serious complications.

Gallbladder pain: Treatments and home remedies

The gallbladder is a small digestive organ that sits on the right side of the abdomen, under the liver. It stores and releases bile to aid digestion. People are unlikely to pay much attention to their gallbladder unless they begin experiencing pain.

If a person experiences gallbladder-related pain, they may be able to manage some symptoms at home. However, severe gallbladder pain may require medical attention, including surgery to remove this organ.

This article explains how to recognize gallbladder-related symptoms and outlines potential home remedies and medical treatment options.

Share on PinterestAvoiding certain foods may help a person manage gallbladder pain.

The gallbladder’s function is to store and concentrate bile. Bile is a substance that the body uses to digest fats in a person’s diet. The liver produces bile, which the gallbladder stores until the body requires it for digestion.

Ideally, when a person eats foods that contain fats, the stomach digests some of the food, and the gallbladder releases bile to aid digestion.

However, the components of bile (specifically, cholesterol and bilirubin) can sometimes start to build up and become gallbladder sludge. This accumulation of substances may lead to the formation of small, pebble-like “stones” that doctors call gallstones.

Worldwide, 5.3–25.0% of people experience gallstone disease. In many people, gallstones do not cause any symptoms. However, roughly 20% of people with gallstones experience pain and complications.

Gallstones can block the release of bile from the gallbladder. When the stones block its release, the bile starts to back up in the gallbladder.

This buildup causes gallbladder swelling and inflammation, which can lead to infection and poor blood flow. Doctors call this condition cholecystitis, and it is where gallbladder pain comes in.

Cholecystitis pain has the following characteristics:

• affects the upper abdomen, usually on the right side
• may radiate to the back and the right shoulder blade
• comes on after a meal or in the evenings
• worsens when taking a deep breath
• is sudden and often intense

A person may describe the nature of the pain in a variety of ways. They may report a cramping, dull, or constant pain that can persist for up to 6 hours.

Other symptoms that may accompany gallbladder problems include:

• bloating
• chills
• fever
• nausea
• shortness of breath due to discomfort when taking a deeper breath
• vomiting

If a person experiences these symptoms, they should seek emergency medical treatment.

Learn about common gallbladder problems.

Learn more about gallbladder disease.

A person should seek emergency medical attention if their gallbladder pain does not subside 6 hours after it began. This persistent pain could indicate that the gallbladder is “clogged,” making the infection risk higher. A person should also seek emergency medical attention if they experience the following symptoms:

• fever
• nausea
• severe bloating
• vomiting
• malaise

Any time that a person has an upset stomach and right upper abdomen pain, a problem with the gallbladder could be responsible. A doctor can help guide a person as to the next best treatment steps.

People may experience pain in the right upper quadrant of their abdomen due to problems with their gallbladder. Typically, this pain is due to the formation of gallstones.

In some cases, dietary changes and medications may help manage the symptoms. However, if the symptoms persist, doctors can surgically remove the gallbladder to prevent further problems. Those without a gallbladder can lead a normal, healthy life after recovery.

GERD and gallbladder disease: Link and comparison

Gastroesophageal reflux disease (GERD) and gallbladder disease are common conditions that can cause nausea and pain in the upper abdomen. However, it is unclear whether the two conditions have a direct link.

Aside from a few shared symptoms, these conditions also feel different. The most common symptoms of GERD are heartburn and acid reflux, while in gallbladder disease, the pain is typically on the right side and may radiate to the shoulder.

This article looks at GERD and gallbladder disease, including their similarities and differences, whether the conditions are linked, and whether one can cause the other.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Gallbladder disease and GERD are two different medical conditions. In GERD, the contents of the stomach travel back up the esophagus, or food pipe, causing a burning sensation. This is known as heartburn or acid reflux.

The gallbladder is further down the digestive tract. It stores bile, which is similar to stomach acid in that it is a liquid that aids digestion. However, where stomach acid is strongly acidic, bile is alkaline.

Gallbladder disease occurs when the gallbladder becomes infected, inflamed, or develops gallstones, which are hardened deposits of bile. This results in pain and swelling.

Scientists are still learning whether there is a connection between GERD and gallbladder disease.

Can GERD cause gallbladder problems?

The association between GERD and gallbladder problems is unclear.

In an older 2015 study, researchers found that among 604 people with GERD, over 13% of them had gallstones, which is higher than the rates in the general population. Among people without GERD, approximately 6% of males and 9% of females have gallstones. This may suggest there is some link between these conditions.

However, gallstones are not uncommon, and scientists believe that rates are increasing due to obesity. Obesity is also a risk factor for GERD, as excess weight puts pressure on the esophagus, so both conditions may be more likely in those with higher body weights.

Another potential reason for the higher rates of gallstones in those with GERD is medication. A small study from 2006 suggests that proton pump inhibitors (PPIs), a common GERD medication, may reduce gallbladder function and increase gallstone formation.

However, this was a small study of only 19 people. A more recent literature review could not find enough high quality evidence to say if PPIs impact gallbladder function. The authors highlight a need for more rigorous scientific investigation.

Can gallbladder problems cause GERD?

There is not much evidence that gallbladder disease causes GERD. However, gallbladder removal is a risk factor for bile reflux, according to a 2021 study.

The gallbladder stores bile. Without it, bile may travel up into the stomach. This can cause symptoms that are very similar to GERD.

The table below compares symptoms of gallbladder disease and GERD.

	GERD	Gallbladder disease
Most common symptoms	heartburn acid reflux regurgitation of sour liquid	upper right abdominal pain that may radiate into the back and right shoulder
Other symptoms	difficulty swallowing pain in upper abdomen nausea	nausea or vomiting shortness of breath when inhaling due to pain
When the symptoms occur	usually occur after eating and worsen when lying down	often begin following a meal or at night
How long symptoms last	symptoms may last for several hours after eating or until food is digested	pain may last from 15 minutes to a few hours.

Doctors typically use a person’s symptoms and an ultrasound scan to diagnose gallstones and gallbladder disease. The doctor may also order blood tests that may show increased white blood cells and elevated inflammatory markers.

In addition, they may perform a test for Murphy’s sign, which involves applying pressure below the ribs on the right side and asking the person to inhale. The inhalation brings the gallbladder close to the doctor’s fingers. If the gallbladder is inflamed, this will cause pain and an inability to inhale further.

There are no gold standard tests to diagnose GERD. Instead, doctors use the individual’s symptoms and may trial GERD medications to see if they help.

However, if someone presents with alarming symptoms, including anemia, weight loss, swallowing difficulties, or vomiting blood, doctors evaluate them with an esophagogastroduodenoscopy (EGD). This procedure allows the doctor to examine the esophagus, stomach, and duodenum.

Doctors distinguish between gallbladder disease and GERD based on the individual’s symptoms, physical examination, and imaging tests.

There is little evidence to suggest that gallbladder removal helps with GERD symptoms.

Acid reflux happens when the lower esophageal sphincter does not close as it should, allowing digestive juices to rise into the esophagus.

Some health conditions can cause acid reflux. These include hiatal hernia, when the upper part of the stomach bulges through the diaphragm into the chest cavity. This means the lower esophageal sphincter cannot function as it should.

Hiatal hernia is a common condition affecting 55–60% of individuals over the age of 50 and is a leading cause of GERD.

Other factors that can contribute to GERD include things that put pressure on the esophagus or affect how it works. These include:

• lying down after meals
• obesity
• pregnancy
• high alcohol consumption
• connective tissue disorders
• numerous types of medication, including:
  • nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin
  • anticholinergics
  • calcium channel blockers
  • antidepressants
  • benzodiazepines
  • glucagon

If a person believes they have GERD or gallbladder disease, they should speak with their doctor as soon as possible. Only a doctor can make a firm diagnosis.

Anyone who has severe or worrying symptoms should dial 911 or the number of the nearest emergency department. Symptoms that require prompt attention include severe pain or vomiting blood.

Some questions to ask a doctor could include:

• Are my symptoms the result of gallbladder disease or GERD?
• What tests do I need to confirm the diagnosis?
• What is the best treatment for me?
• Are there any lifestyle changes I should make?
• How long will it take for my symptoms to improve?
• Are there any complications I should be aware of?
• What happens if I do not treat my condition?

If the symptoms may be due to medication side effects, or a person is concerned their PPIs may raise the risk of gallstones, they should discuss this with a doctor. Do not change the drug or dosage without consulting a medical professional.

Gallbladder disease and GERD are two different conditions that may cause similar symptoms. There may also be some links between the two.

For example, some studies suggest PPIs may play a role in gallstone formation. However, scientists highlight that there is a lack of high quality evidence to support this.

Additionally, people who undergo gallbladder removal may develop bile reflux, which can feel similar to GERD. If a person has any concerns they might have GERD, bile reflux, or gallbladder disease, they should speak with a doctor promptly.

Acute cholecystitis: causes, symptoms and recommendations for the treatment of the disease. Dr. Peter

The gallbladder is a small, pear-shaped organ that stores and concentrates bile used to digest fats. It is a biologically active compound composed primarily of cholesterol, bile salts and bilirubin, produced by the liver and stored in the gallbladder during fasting. When food enters the digestive tract, it is partially digested by the stomach and enters the small intestine, where bile is released to help break down fats.

If the components of bile, such as cholesterol and bilirubin, remain in the bladder and harden in the form of “sand”, stones (calculi) begin to grow. They can get stuck in the ducts and block the flow of bile, causing it to stagnate.

Up to 80% of all gallstones cause no symptoms, but duct obstruction can cause organ swelling, distension, and severe pain in the right side of the abdomen and/or back (biliary colic). If the obstruction persists, it leads to inflammation, infection, and even blockage of blood flow (ischemia). This is acute or acute calculous cholecystitis (ACC).

Recurrent mild episodes of illness can lead to a chronic process, causing the gallbladder wall to thicken and shrink, resulting in an inability to store bile.

Another form, acute acalculous cholecystitis, is an inflammatory disease of the gallbladder without evidence of stones or cystic duct obstruction. Approximately 2-15% of cases of cholecystitis are acalculous, and usually occur in severely ill hospitalized people. The exact causal mechanism is not clear. Acalculous cholecystitis is associated with a higher mortality rate (~45%) due in part to severe comorbidities and late diagnosis.

Causes of acute cholecystitis

The medical term for gallstones is cholelithiasis. Approximately 90% of cases of cholecystitis are associated with the presence of a stone blocking the cystic duct (calculous cholecystitis), which often leads to the accumulation of saturated bile in the gallbladder.

Cystic duct is a short tube that carries bile from the gallbladder to the common duct. The severity of cholecystitis depends on the duration of the blockage of the cystic duct. If the attack lasts longer than a couple of hours, gallstone disease leads to inflammation. The gallbladder becomes enlarged, tense, reddened, with thickened walls, necrosis, gangrene, or accumulation of gas in its wall may develop, which can lead to perforation (formation of a rupture of the wall). Perforation can cause inflammation of the lining of the abdomen (peritonitis) or the right upper quadrant of the liver.

Acute acalculous cholecystitis is not associated with the presence of gallstones, but with an underlying disease or clinical trauma such as extensive burns, end-stage renal disease, resuscitation from hemorrhagic shock, surgery, polytrauma, or leukemia, which can cause systemic inflammation. In addition, viral, bacterial and parasitic infectious diseases are associated with it. The exact cause of non-calculous cholecystitis is unknown, but it is thought to be caused by reduced blood flow to the gallbladder (ischemia), an infection, or lack of stimulation of the organ (refusal to eat) causing bile stasis.

Although stones do not block the bile ducts in this form of cholecystitis, other physical barriers may be present. They may be infectious or non-infectious. For example, blockage of the bile ducts can be caused by parasitic cysts, ascariasis (roundworms), hemophilia, congenital cysts and their narrowing (ampullar stenosis).

In addition, infections can lead to the death of gallbladder tissue (gangrene). Diabetes mellitus, inflammation of the blood vessels (vasculitis), opioid use, sickle cell anemia, dehydration, positive pressure ventilation, and blockage of oxygenated blood flow to the gallbladder (cystic artery obstruction) may be the cause.

Symptoms

Acute calculous cholecystitis

The specific symptoms associated with cholecystitis vary from patient to patient. The most common symptom is pain in the upper abdomen, often located in the right hypochondrium. In acute calculous cholecystitis, the pain is often sudden and intense and can be described as cramping, dull, or constant. The pain can become excruciating, lasting more than six hours, often starting hours after eating or at night. It may increase with deep inspiration and radiate to the back and right shoulder blade. Most likely, tenderness will be felt in the right hypochondrium, and in 25% of patients 24 hours after the onset of symptoms, a space-occupying mass will be palpated there.

In addition to pain, many victims experience nausea, vomiting and shortness of breath when inhaling (due to pain). Additional symptoms of cholecystitis include muscle stiffness on the right side of the abdomen, bloating, chills, and fever. A blood test may show an increase in the number of white blood cells and C-reactive protein (an increase indicates inflammation). If the serum amylase level is elevated, the patient may also have gallstone pancreatitis or gangrenous cholecystitis. Although bilirubin may be elevated, the development of severe jaundice in the absence of other complications is rare. When jaundice occurs, persistent yellowing of the skin, mucous membranes and whites of the eyes persists. Rarely, symptoms such as dark urine and clay-colored stools indicate an obstruction in the common bile duct.

Elderly people with cholecystitis may not have pain or fever. Their only symptoms may be tenderness in the upper right side of the abdomen, a change in mental state, or a decrease in food intake.

Affected individuals may develop a bacterial infection before or during biliary colic. In most patients, the attack lasts one to four days and then subsides. In rare patients with severe disease, the wall of the gallbladder may rupture (perforation) or pus may accumulate in the organ (empyema). In these patients, surgery may be required.

Acute acalculous cholecystitis

It differs from calculous cholecystitis because it usually occurs in association with other serious conditions requiring hospitalization. As in patients with calculous cholecystitis, acalculous often presents with pain in the right upper quadrant of the abdomen that radiates to the back. It is also characterized by fever, nausea and vomiting. An increased white blood cell count (leukocytosis), decreased contraction of the muscles in the intestines (paralytic ileus), gallbladder abscess, and/or gangrene are all signs of acalculous cholecystitis. Sometimes a palpable mass or Murphy’s sign is present. Nonspecific symptoms include diarrhea, indigestion, fatigue, altered mental status, and jaundice.

Possible complications and risks

Over the age of 65, 25% of women and 12% of men suffer from gallstone disease. Approximately 10% of all patients with symptomatic gallstones develop cholecystitis. If the gallbladder is not removed after acute cholecystitis, there is a 29% chance of a second attack within a year.

Although 60% of patients with acute cholecystitis are women, complications occur more frequently in men. They are also prone to more severe symptoms. Diabetes and older age increase the risk of developing cholecystitis.

Acalculous cholecystitis has an incidence rate of 0.12% in the general population. 80% of cases occur in male patients aged 50 years and older.

Diagnosis

Acute cholecystitis does not have any clinical or laboratory features with the level of diagnostic accuracy required for diagnosis. The recommended diagnostic minimum is clinical evidence with abdominal ultrasound. The Murphy sign test is a widely used diagnostic tool. The doctor presses just below the ribs on the right side and asks the patient to inhale. When inhaling, the gallbladder comes into contact with the doctor’s fingers, causing pain and stopping breathing if the organ is inflamed. Blood tests showing elevated levels of white blood cells (leukocytosis), elevated levels of C-reactive protein may be signs of infection and inflammation.

Imaging techniques are used to directly observe stones, gallbladder wall thickness, or cystic duct obstruction. The wall of the organ is pathologically thickened if it is >3 mm or wider on ultrasound.

Cholangiography and computed tomography (CT) can also be used to detect cholecystitis, although their diagnostic accuracy is lower. Additional imaging modalities include MRI.

How to treat acute cholecystitis

The main treatment for the disease is cholecystectomy, the surgical removal of the entire gallbladder. Surgical removal of stones alone has a high rate of pathological recurrence within 5 years.

Immediate laparoscopic cholecystectomy is recommended for patients with mild cholecystitis. In patients with moderate severity, emergency surgical removal of the gallbladder with preliminary preparation may be indicated. Patients will be placed on bowel rest and will receive intravenous fluids/electrolytes and pain medication, followed by surgery as soon as the patient’s condition improves.

Patients at high surgical risk, such as the elderly or patients with immunodeficiency or diabetes, may have a percutaneous transhepatic drainage tube, a cholecystostomy, permanently placed in the gallbladder under ultrasound guidance. Seriously ill patients undergo resuscitation and intravenous antibiotics in the intensive care unit, and after the patient’s condition improves, surgery is performed.

Treatment of non-calculous cholecystitis depends on the type of underlying disease or injury. All patients should be given antibiotics that target Gram-negative and anaerobic organisms. Treatment of any underlying diseases is also necessary. Some people are shown removal of the gallbladder due to the high risk of gangrene.

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Cholecystitis means inflammation of the gallbladder. In most cases, gallstones are the cause. Women get cholecystitis more often than men.

The gallbladder is a small, pear-shaped organ that stores bile used to digest fats. Bile is a compound made up primarily of cholesterol, bile salts, and bilirubin.

It is produced by the liver and stored in the gallbladder. When eating, bile is partially digested by the stomach and enters the small intestine, where it is involved in the process of splitting fats. Gallstones form when components of bile, such as cholesterol and bilirubin, remain in the gallbladder and harden into a pebble-like material. Gallstones can lodge in the bile ducts and block the flow of bile, causing bile stasis. Up to 80% of all gallstones cause no symptoms, but bile duct obstruction can cause the gallbladder to stretch and cause severe pain in the right side of the abdomen or back (biliary colic). If the obstruction persists, it leads to inflammation of the gallbladder walls, infection, and even lack of blood flow (ischemia). Thus arises acute cholecystitis . Recurrent episodes of acute cholecystitis can lead to chronic cholecystitis , causing the walls of the gallbladder to thicken and shrink, resulting in an inability to store bile.

Symptoms of cholecystitis

Symptoms of acute cholecystitis are usually very characteristic. They usually appear fairly quickly and the patient may feel very ill.

The most common symptom of cholecystitis is pain in the upper abdomen, often located in the right upper quadrant. In acute calculous cholecystitis, the pain is often sudden and intense, but may be described as crampy, dull, or constant. Pain in the upper abdomen usually lasts more than six hours, often starting several hours after eating or at night. It can intensify with a deep breath and give to the back and right shoulder blade.

In addition to pain, many patients experience nausea, vomiting, and shortness of breath when inhaling (due to pain). Additional symptoms of cholecystitis include muscle stiffness on the right side of the abdomen, bloating, chills, and fever.

A blood test may show an increase in white blood cells and C-reactive protein (an increase indicates inflammation). If the serum amylase level is elevated, the patient may also have gallstone pancreatitis or gangrenous cholecystitis. Although bilirubin may be elevated, frank jaundice rarely develops in the absence of other complications. If jaundice does occur, there is persistent yellowing of the skin, mucous membranes, and whites of the eyes. Rarely, symptoms such as dark urine and clay-colored stools indicate a blockage in the common bile duct.

In the elderly. those suffering from cholecystitis may not experience pain or fever. The only symptoms may be tenderness in the right upper abdomen, a change in mental state, and a decrease in appetite.

Patients may develop a bacterial infection before or during a gallbladder attack. In most patients, a gallbladder attack lasts one to four days and then goes away. In rare patients with severe disease, the wall of the gallbladder may rupture (perforation) or pus may accumulate inside the gallbladder (empyema). These patients require urgent surgical intervention.

Diagnosis of cholecystitis

The most reliable method for diagnosing cholecystitis is ultrasound – ultrasound of the abdominal cavity. This is a painless abdominal exam that uses sound waves to scan the abdomen (belly). The scan takes about 30 minutes. Ultrasound of the abdominal cavity can detect gallstones, as well as determine whether the wall of the gallbladder is thickened (as is the case with cholecystitis). If the diagnosis is in doubt, other, more detailed studies may be performed.

The doctor may also prescribe:

• Temperature, pulse and blood pressure monitoring.
• Estimation of the amount of urine produced.
• Blood tests showing elevated levels of white blood cells (leukocytosis), elevated C-reactive protein may be signs of infection and inflammation.
• Computed tomography (CT) of the abdomen (abdomen)

The

• Murphy sign test is a widely used diagnostic tool. The doctor applies pressure just below the ribs on the right side and asks the patient to inhale. When inhaled, the gallbladder comes into contact with the doctor’s fingers, causing pain and respiratory arrest if the gallbladder is inflamed.

Treatment of cholecystitis

The main treatment for the disease is usually cholecystectomy, the surgical removal of the entire gallbladder. Surgical removal of gallstones alone has a high rate of pathological recurrence within 5 years.

If the patient’s general condition is satisfactory, the National Institute for Health and Care Excellence (NICE) recommends surgery within a week of diagnosis. Depending on various factors, different methods of gallbladder removal may be used.

For patients with mild cholecystitis, immediate laparoscopic cholecystectomy is recommended. During this operation, a small, thin tube called a laparoscope is passed through a small incision in the abdominal wall to allow the surgeon to remove the diseased gallbladder.

Gallbladder removal surgery can be performed either openly (operative cholecystostomy) or laparoscopically.

Patients with moderate cholecystitis may have immediate surgical removal of the gallbladder. In some cases, intestinal rest and intravenous hydration with fluids/electrolytes and pain medications are given, followed by surgery after the patient improves.

Many patients with moderate to severe disease may not undergo cholecystectomy if it is complicated by infection and systemic disorders that increase the risk of surgery.

Patients at high surgical risk, such as the elderly or immunocompromised or diabetic patients, may consider percutaneous transhepatic cholecystostomy with ultrasound-guided permanent gallbladder drainage.