Symptoms of Cholecystitis

The most common symptoms of acute cholecystitis are:

• Constant pain in the right hypochondium that can irradiate into the right side of the chest, neck, and right arm;
• Nausea and vomiting that doesn’t bring relief to the patient;
• Bitter and metallic taste on the back of the tongue;
• Rise of the body’s temperature.

If we go into detail, the acute cholecystitis can be separated into three forms depending on the severity of the process:

Catarrhal cholecystitis

Catarrhal cholecystitis is the mildest form of acute cholecystitis. The prognosis for it is usually very good, and it very rarely results in complications.

• The main symptoms of catarrhal cholecystitis are intense pain in the right hypochondium and epigastric region, which can irradiate into lumbar region, right shoulder, scapula, and into the neck.
• In the beginning of the disease the patient may suffer from paroxysmal pain when the walls of the gallbladder become overstretched.
• Sometimes, the patient may experience vomiting that doesn’t bring relief.
• The body temperature is subfebrile (meaning that it doesn’t exceed 38°C).
• Heart rate increases to 80-90 beats/minute. Blood pressure might also slightly rise.
• The tongue is moist and can have a whitish coating.
• The abdominal wall takes part in the act of breathing, with a slight reduction in the upper-right part of the abdomen.
• Palpation of the abdomen causes acute pain in the right hypochondium.
• The abdominal muscles are relaxed or could be slightly tense.

Phlegmonous cholecystitis

Phlegmonous cholecystitis is a more severe form of cholecystitis when compared to catarrhal form. All the symptoms are more pronounced and the chances of complications are high.

• The pain, compared to catarrhal form, is much more intense, and is made worse by breathing, changing of the body’s position and coughing;
• The patient is more likely to experience repeated vomiting that brings no relief;
• The temperature is febrile (above 38°C);
• The heart beat increases to 100 beats/minute and more;
• The abdomen can be slightly swollen due to intestinal paresis;
• Upper right half of the abdomen is not involved in the act of breathing;
• Palpation and percussion of the abdominal wall causes a sharp pain in right hypochondriac and epigastric region. There are also signs of localized peritonitis in those regions.

Gangrenous cholecystitis

Gangrenous cholecystitis is usually a continuation of the phlegmonous cholecystitis, if the body is unable to contain the infection and it spreads throughout the tissues. The prognosis for this type of cholecystitis is poor and often leads to death. This type of cholecystitis is more often observed in elderly patients with atherosclerosis of the branches abdominal aorta and patients whose immune response is suppressed.

• Symptoms of severe intoxications associated with local or general peritonitis come to the forefront. These symptoms become especially acute if the wall of the gallbladder becomes perforated.
• The pain may slightly subside and the condition of the patient may appear to improve, but this is only because of the loss of the nerve endings within the gallbladder.
• Due to severe intoxication the patient becomes disoriented and confused.
• The body’s temperature is febrile.
• The heart beat increases to 120 beats/minute.
• The breathing is quick and shallow. The abdominal wall does not participate in the act of breathing.
• The abdominal wall becomes very tense as a result of the spreading peritonitis.