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Are Nausea, Fever And Loss Of Appetite Normal In Someone With Cholecystitis?
Question: Generally, would someone with cholecystitis look and feel unwell, with symptoms such as nausea, fever, loss of appetite etc.?
Brief Answer:
Your symptoms corroborate with Cholecystitis.
Detailed Answer:
Hello,
The symptoms you mention are definitely a part of Cholecystitis.
You should get your blood tested for CBC to know whether there is any infection.
There could also be an element of Gastritis.
I therefore usually advice a course of Tab Pantoprazole or Cap Omeprazole twice a day before meals for 15 days.
If infection is evident on blood test then it would be prudent to add on an antibiotic for a week.
Do let me know if I can help you with any further queries.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
Your symptoms corroborate with Cholecystitis.
Detailed Answer:
Hello,
The symptoms you mention are definitely a part of Cholecystitis.
You should get your blood tested for CBC to know whether there is any infection.
There could also be an element of Gastritis.
I therefore usually advice a course of Tab Pantoprazole or Cap Omeprazole twice a day before meals for 15 days.
If infection is evident on blood test then it would be prudent to add on an antibiotic for a week.
Do let me know if I can help you with any further queries.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by :
Dr. Sonia Raina
Thank you, but just to clarify, I don't have those symptoms. I feel fine except for some tenderness in abdominal area around gall bladder. I have history of gallstones. Recently had cramps there. It doesn't feel painful under rib cage, but rather on top, when I puff abdoekn out. Does this surges abdominal wall? As indicated, I feel fine. Still have appetite and no nausea or fever. Just a mild tender area as described in abdomen.
I am debating whether to go to emergency to get ultrasound, but does not feel like emergency situation at all. My only concern is history of gallstones combined with es in that area. But no waves if pain unlike past biliary colic episodes I have experienced. Could it be indicative of abdominal wall, if I can press under rib cage without feeling tremendous pain? And, wouldn't unwell feeling accompany most cases of inflamed gallbladder?
I am debating whether to go to emergency to get ultrasound, but does not feel like emergency situation at all. My only concern is history of gallstones combined with es in that area. But no waves if pain unlike past biliary colic episodes I have experienced. Could it be indicative of abdominal wall, if I can press under rib cage without feeling tremendous pain? And, wouldn't unwell feeling accompany most cases of inflamed gallbladder?
Brief Answer:
You dont have an acutely inflamed bladder. Emergency visit not required.
Detailed Answer:
Hi,
If you do not have the symptoms you mentioned then you do not have Cholecystitis at least not acute cholecystitis.
You do not need to go to the Emergency.
Tenderness on moving the abdominal wall can be due to movements of a large pendulous and full gall bladder.
But if you have gallstones and feel pain or colic off and on then Surgery in the form of Laparoscopic Cholecystectomy would be the right choice of treatment. Especially if the stones are larger than 1 to 2cm in size.
Most cases of Gallstone disease do not have any symptoms or mild nausea/ fullness at the most.
Surgery is fairly safe and this operation is the commonest operation performed around the world.
You should decide as to whether you want to get it treated or want to live with it. That would be completely your call.
Presently with your symptoms you need not worry. You are fine and do not need any medication presently.
Feeling unwell accompanies almost all cases of Acutely inflamed Gall bladders not those with chronic inflammation. You must be having a long standing problem and there are no signs suggestive of acute inflammation in your case. So do not worry.
Do let me know if there are other questions in your mind.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
You dont have an acutely inflamed bladder. Emergency visit not required.
Detailed Answer:
Hi,
If you do not have the symptoms you mentioned then you do not have Cholecystitis at least not acute cholecystitis.
You do not need to go to the Emergency.
Tenderness on moving the abdominal wall can be due to movements of a large pendulous and full gall bladder.
But if you have gallstones and feel pain or colic off and on then Surgery in the form of Laparoscopic Cholecystectomy would be the right choice of treatment. Especially if the stones are larger than 1 to 2cm in size.
Most cases of Gallstone disease do not have any symptoms or mild nausea/ fullness at the most.
Surgery is fairly safe and this operation is the commonest operation performed around the world.
You should decide as to whether you want to get it treated or want to live with it. That would be completely your call.
Presently with your symptoms you need not worry. You are fine and do not need any medication presently.
Feeling unwell accompanies almost all cases of Acutely inflamed Gall bladders not those with chronic inflammation. You must be having a long standing problem and there are no signs suggestive of acute inflammation in your case. So do not worry.
Do let me know if there are other questions in your mind.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you for the detailed Nswer. A few follower-up questions:
What if it is chronic inflammation? Would not thumus still be an inflamed, thickened gall bladder requiring immediate attention in case it ruptured or gets infected? I don't understand difference between acute inflammation and chronic inflammation. why one is emergency situation but not the other?
I have never had an acute hall bladder inflammation, could I still get chronic inflammation without ever having had acute attacks?
Do you think this sorenrss I Am feeling could be related to gall bladder irritation or recent attack? It is only in that area near gall bladder, like dull burning sensation and tenderness when I touch, radiating a little to back This is why I am still a little concerned.
What is pendulous?
I am still having apoetiite. stomach grumbling do I guess that us goid sign !?
Yes, I XXXXXXX waiting to book elective surgery. Gallstones are about 1.5 cm. two of them.
So you clearly advise not going to ER to get immediate attention based o m my symptoms and felling find except fir sureness? I would rather not go and weaut for hours. Just some nagging doubt. But your thoughts are reassuring. I do feel perfectly fine other than the soreness.
What if it is chronic inflammation? Would not thumus still be an inflamed, thickened gall bladder requiring immediate attention in case it ruptured or gets infected? I don't understand difference between acute inflammation and chronic inflammation. why one is emergency situation but not the other?
I have never had an acute hall bladder inflammation, could I still get chronic inflammation without ever having had acute attacks?
Do you think this sorenrss I Am feeling could be related to gall bladder irritation or recent attack? It is only in that area near gall bladder, like dull burning sensation and tenderness when I touch, radiating a little to back This is why I am still a little concerned.
What is pendulous?
I am still having apoetiite. stomach grumbling do I guess that us goid sign !?
Yes, I XXXXXXX waiting to book elective surgery. Gallstones are about 1.5 cm. two of them.
So you clearly advise not going to ER to get immediate attention based o m my symptoms and felling find except fir sureness? I would rather not go and weaut for hours. Just some nagging doubt. But your thoughts are reassuring. I do feel perfectly fine other than the soreness.
Brief Answer:
You should undergo the Surgery but it is not an Emergency.
Detailed Answer:
Hi,
Chronic inflammation usually follows acute inflammation. Specially when the offending factor remains and the organ accommodates or gets accustomed to the insult and changes itself accordingly. Therefore, acute inflammation has all the signs requiring immediate attention and has the complications of rupture, infection, etc. However, in chronic inflammation the organ has already compensated by becoming thickened and there are almost no chances of rupture or infection and therefore not an emergency.
The pain and tenderness you are feeling is characteristic of Chronic calculous cholecystitis.
You do not need to go to the ER as of now. If you feel nausea, vomiting, severe pain and tenderness, fever, jaundice, constipation then you would need to go to the ER.
Your stones at 1.5cm and two of them are a definite indication for Surgery. I feel you should have no doubt and go for surgery. There is no emergency, however for the surgery. But it should be done whenever earliest you can get it done.
Take care and if there are any more questions surfacing in your mind I would be happy to attempt to answer them to the best of my ability.
Dr Rishi, New XXXXXXX XXXXXXX
You should undergo the Surgery but it is not an Emergency.
Detailed Answer:
Hi,
Chronic inflammation usually follows acute inflammation. Specially when the offending factor remains and the organ accommodates or gets accustomed to the insult and changes itself accordingly. Therefore, acute inflammation has all the signs requiring immediate attention and has the complications of rupture, infection, etc. However, in chronic inflammation the organ has already compensated by becoming thickened and there are almost no chances of rupture or infection and therefore not an emergency.
The pain and tenderness you are feeling is characteristic of Chronic calculous cholecystitis.
You do not need to go to the ER as of now. If you feel nausea, vomiting, severe pain and tenderness, fever, jaundice, constipation then you would need to go to the ER.
Your stones at 1.5cm and two of them are a definite indication for Surgery. I feel you should have no doubt and go for surgery. There is no emergency, however for the surgery. But it should be done whenever earliest you can get it done.
Take care and if there are any more questions surfacing in your mind I would be happy to attempt to answer them to the best of my ability.
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
One more question;
I did an ultrasound about 1 month ago. Did not show any thickening or anything else abnormal other than presence of gallstones, Cholecystitis was ruled out,
So how could I have chronic inflammation now? It wouldn't follow to have cholecystitis all of a sudden unless it was acute
Could my soreness just be lingering effects of a recent biliary colic attack rather than true gall bladder inflammation?
I did an ultrasound about 1 month ago. Did not show any thickening or anything else abnormal other than presence of gallstones, Cholecystitis was ruled out,
So how could I have chronic inflammation now? It wouldn't follow to have cholecystitis all of a sudden unless it was acute
Could my soreness just be lingering effects of a recent biliary colic attack rather than true gall bladder inflammation?
Brief Answer:
Both lead to inflammation. Therefore no difference.
Detailed Answer:
Hi,
The soreness is due to injury to gall bladder. They could be due to the recent biliary colic or due to chronic inflammation. That should not matter.
What we know for sure is that your gall bladder is inflamed chronically over a period of time due to the stone formation. And we know that the treatment is Surgery.
Recent biliary colic would definitely lead to effects of soreness as it is a Acute on Chronic insult. But, the treatment does not change.
You will still need to undergo surgery for the Gall bladder stones.
Biliary colic is also an effect of inflammation of the gall bladder wall. So, it is true gall bladder inflammation. There is no denying that.
Please do let me know if you need to clear any more doubts. I would want you to be completely aware of what is happening and why we advice what we do.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
Both lead to inflammation. Therefore no difference.
Detailed Answer:
Hi,
The soreness is due to injury to gall bladder. They could be due to the recent biliary colic or due to chronic inflammation. That should not matter.
What we know for sure is that your gall bladder is inflamed chronically over a period of time due to the stone formation. And we know that the treatment is Surgery.
Recent biliary colic would definitely lead to effects of soreness as it is a Acute on Chronic insult. But, the treatment does not change.
You will still need to undergo surgery for the Gall bladder stones.
Biliary colic is also an effect of inflammation of the gall bladder wall. So, it is true gall bladder inflammation. There is no denying that.
Please do let me know if you need to clear any more doubts. I would want you to be completely aware of what is happening and why we advice what we do.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
A little confused. When you say i have inflammation, dies this mean I have cholecystitis? If yes, this says to me go to emergency,
But I read earlier advice to be go to ER only if feeling sick. Which made perfect sense. Please advise.
Thank you so much for your detailed explanations. Very much appreciated.
But I read earlier advice to be go to ER only if feeling sick. Which made perfect sense. Please advise.
Thank you so much for your detailed explanations. Very much appreciated.
Brief Answer:
There are two types of inflammation - Acute and chronic.
Detailed Answer:
Hi,
Apologies for the delayed reply.
Let me try to resolve your confusion.
There are two types of inflammation - Acute and Chronic.
Acute inflammation is a sudden, severe insult to cells, tissues or organ systems. It presents with pain, redness, warmth of the area and loss of function of that part. It needs to be dealt with early or urgently.
Chronic inflammation is a long standing, slowly progressing insult with little or no overt symptoms. It is usually detected by slowly decreasing function of the organ system. There is usually no urgency in dealing with a chronic inflammation and planned treatment can be given like a planned Surgery.
You have a chronically inflamed Gall bladder due to the stone in the organ. There is therefore on emergency in your case. If you develop the acute symptoms that we had discussed earlier then it would be Acute on Chronic inflammation and then you would require a course of antibiotics which would tide over the crisis. Surgery however is safer to be done when there is no acute inflammation.
I hope I have decreased the confusion in your mind.
If not, please let me know.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
There are two types of inflammation - Acute and chronic.
Detailed Answer:
Hi,
Apologies for the delayed reply.
Let me try to resolve your confusion.
There are two types of inflammation - Acute and Chronic.
Acute inflammation is a sudden, severe insult to cells, tissues or organ systems. It presents with pain, redness, warmth of the area and loss of function of that part. It needs to be dealt with early or urgently.
Chronic inflammation is a long standing, slowly progressing insult with little or no overt symptoms. It is usually detected by slowly decreasing function of the organ system. There is usually no urgency in dealing with a chronic inflammation and planned treatment can be given like a planned Surgery.
You have a chronically inflamed Gall bladder due to the stone in the organ. There is therefore on emergency in your case. If you develop the acute symptoms that we had discussed earlier then it would be Acute on Chronic inflammation and then you would require a course of antibiotics which would tide over the crisis. Surgery however is safer to be done when there is no acute inflammation.
I hope I have decreased the confusion in your mind.
If not, please let me know.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello. Thanks for your latest reply. The pain has now migrated more to centre left of abdomen. I have an ultrasound scheduled for tomorrow. I am worried the gallstones may be causing pancreatitis. Although, I don't have other symptoms other than burning pain tightening all around rib cage. Not feeling unwell. How do gallstones cause pancreatitis? Is it by blocking bile duct? I am wondering if depending on if the ultraosund show no bile duct blockage, I can confidently rule out pancreatitis?
Brief Answer:
Pancreatitis is a rare complication of Gallstone disease.
Detailed Answer:
Hi,
Gallstones can cause Pancreatitis by a number of ways but its not very common, fortunately.
The stones can enter the duct and block the exit route of the bile duct and pancreatic duct as they empty into the duodenum through a common hole - Ampulla of Vater. This leads to back pressure in the Pancreas and inflammation thereafter.
Ultrasound can diagnose Pancreatitis but is not the best investigation for the same. It is operator dependant and Pancreas can be difficult to see in Obese individuals and if intestinal gas interferes with the study. So try to be fasting at least 12 to 14 hours before the Ultrasound. If then there is a doubt, the investigation of choice would be a CECT Abdomen. Blood tests like Serum Lipase and Amylase can also help indicate towards Pancreatic inflammation but not 100% surity.
But if there is no biliary dilatation and no stones in the ducts then you need not worry.
Do let me know.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
Pancreatitis is a rare complication of Gallstone disease.
Detailed Answer:
Hi,
Gallstones can cause Pancreatitis by a number of ways but its not very common, fortunately.
The stones can enter the duct and block the exit route of the bile duct and pancreatic duct as they empty into the duodenum through a common hole - Ampulla of Vater. This leads to back pressure in the Pancreas and inflammation thereafter.
Ultrasound can diagnose Pancreatitis but is not the best investigation for the same. It is operator dependant and Pancreas can be difficult to see in Obese individuals and if intestinal gas interferes with the study. So try to be fasting at least 12 to 14 hours before the Ultrasound. If then there is a doubt, the investigation of choice would be a CECT Abdomen. Blood tests like Serum Lipase and Amylase can also help indicate towards Pancreatic inflammation but not 100% surity.
But if there is no biliary dilatation and no stones in the ducts then you need not worry.
Do let me know.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you, some final questions just so that I understand correctly. F ultrasound shows no duct dilatation or stones in duct, then pancreatitis very unlikely? Even if pancreatitis not visualized?
Should I bother getting a blood test to confirm? Or is ultrasound better test to diagnose pancreatitis?
would a person with pancreatitis normally look and feel ill? As I mentioned, I am not feeling sick. Just ongoing burning Ache across rib cage. Started after eating cereal with lots if fibre yesterday. Could it be gas-related?
Actually Felling a little hungry now, if I can eat without problem - no nausea, no pain - would that also suggest that pancreatitis very unlikely?
Thanks for all your help.
Should I bother getting a blood test to confirm? Or is ultrasound better test to diagnose pancreatitis?
would a person with pancreatitis normally look and feel ill? As I mentioned, I am not feeling sick. Just ongoing burning Ache across rib cage. Started after eating cereal with lots if fibre yesterday. Could it be gas-related?
Actually Felling a little hungry now, if I can eat without problem - no nausea, no pain - would that also suggest that pancreatitis very unlikely?
Thanks for all your help.
Brief Answer:
I have given the protocol you should follow. Hope it helps.
Detailed Answer:
Hi,
Acute pancreatitis is a very painful condition and the pain goes right to the back. so much so that the patient has to sit bending forwards to decrease the pain.
Patient does look and feel ill during acute pancreatitis.
your pain seems related to Gastritis issues.
Getting a blood test would be additive to an Ultrasound to rule out Pancreatitis.
If ultrasound shows no duct dilatation then you need not worry at all.
And yes, if you fell well and are eating alright without any significant pain then Pancreatitis would be unlikely.
If Ultrasound does not see Pancreas and blood tests are normal then you need not worry at all. If blood tests are abnormal with non visualization of Pancreas on Ultrasound then go ahead with a CECT Abdomen. If Ultrasound suggestive of Pancreatitis, then do a CECT.
But the treatment of the gallstones is still at your discretion as I told you earlier.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
I have given the protocol you should follow. Hope it helps.
Detailed Answer:
Hi,
Acute pancreatitis is a very painful condition and the pain goes right to the back. so much so that the patient has to sit bending forwards to decrease the pain.
Patient does look and feel ill during acute pancreatitis.
your pain seems related to Gastritis issues.
Getting a blood test would be additive to an Ultrasound to rule out Pancreatitis.
If ultrasound shows no duct dilatation then you need not worry at all.
And yes, if you fell well and are eating alright without any significant pain then Pancreatitis would be unlikely.
If Ultrasound does not see Pancreas and blood tests are normal then you need not worry at all. If blood tests are abnormal with non visualization of Pancreas on Ultrasound then go ahead with a CECT Abdomen. If Ultrasound suggestive of Pancreatitis, then do a CECT.
But the treatment of the gallstones is still at your discretion as I told you earlier.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Yes, I will schedule for surgery soon.
When you say additive, do you mean optional? You said not to worry if no bile duct dilatation. Si If no bile duct dilatation on ultrasound tomorrow. is the blood test really needed? In other words, does normal bile duct and normal sized gallbladder effectively rule out both chiolecystitis and gallstone pancreatitis?
Think you so much fir your incredibly detailed answers , you are fantastic!
When you say additive, do you mean optional? You said not to worry if no bile duct dilatation. Si If no bile duct dilatation on ultrasound tomorrow. is the blood test really needed? In other words, does normal bile duct and normal sized gallbladder effectively rule out both chiolecystitis and gallstone pancreatitis?
Think you so much fir your incredibly detailed answers , you are fantastic!
Brief Answer:
Wait for the ultrasound and then lets decide.
Detailed Answer:
Hi, Additive means that the blood tests I mentioned will provide additional information than the Ultrasound. Suffice to say that if the Ultrasound does not see anything in the pancreas area then get the blood tests done and they would be able to indicate any problems with the pancreas. If the Ultrasound shows pancreatitis then the tests will be able to tell the severity of the Pancreatitis. If the Ultrasound shows a normal pancreas then there is no need to get the blood tests done.
So, it all depends upon the Ultrasound report.
normal report of both organs will rule out both suspicions. no need of any further investigations. That is true. Yes.
Im still here for any other help you need.
Good to help a patient who is inquisitive and concerned. It pleases me to be of help to you.
Take care,
Dr Rishi.
Wait for the ultrasound and then lets decide.
Detailed Answer:
Hi, Additive means that the blood tests I mentioned will provide additional information than the Ultrasound. Suffice to say that if the Ultrasound does not see anything in the pancreas area then get the blood tests done and they would be able to indicate any problems with the pancreas. If the Ultrasound shows pancreatitis then the tests will be able to tell the severity of the Pancreatitis. If the Ultrasound shows a normal pancreas then there is no need to get the blood tests done.
So, it all depends upon the Ultrasound report.
normal report of both organs will rule out both suspicions. no need of any further investigations. That is true. Yes.
Im still here for any other help you need.
Good to help a patient who is inquisitive and concerned. It pleases me to be of help to you.
Take care,
Dr Rishi.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Hello. Ultrasound done. Conclusion is no cholecystitis. Pancreas not fully visualized but looks normal. Bile duct not visualized. Absent XXXXXXX sign.
My one concern is gall bladder wall thickening 3mm. Doctor said this is not clinically significant, could be due to reading by technician, which can vary from technician to technician. My research on Internet says thickening 3mm or less may be related to fasting. Does gall bladder normally get larger on fasting, with some thickening? I had fasted about 21 hours before taking the test.
Previous ultrasound about two months ago showed no thickening? Buy I hadn't fastened for almost 24 hours, unlike this time. Should I be concerned with this 3mm thickening?
Also forgot to mention Ultrasound said XXXXXXX gallstones up to 12 mm in size. doctor said bile duct not blocked, even though was not visualized. He said blocked duct would appear on ULtrasound. Does all this sound reasonable to you?
My one concern is gall bladder wall thickening 3mm. Doctor said this is not clinically significant, could be due to reading by technician, which can vary from technician to technician. My research on Internet says thickening 3mm or less may be related to fasting. Does gall bladder normally get larger on fasting, with some thickening? I had fasted about 21 hours before taking the test.
Previous ultrasound about two months ago showed no thickening? Buy I hadn't fastened for almost 24 hours, unlike this time. Should I be concerned with this 3mm thickening?
Also forgot to mention Ultrasound said XXXXXXX gallstones up to 12 mm in size. doctor said bile duct not blocked, even though was not visualized. He said blocked duct would appear on ULtrasound. Does all this sound reasonable to you?
Brief Answer:
The report is good. Nothing else needs to be done.
Detailed Answer:
Hi,
All this sounds reasonable to me.
Your report is perfectly normal. 3mm gall bladder wall is also normal.
There is no need to ponder over 3mm GB wall at all. Fasting can increase it and it does vary from technician to technician. No need to worry about it. Thickness would be important only if it is localized to a small specific area, something we call focal wall thickening.
Bile duct blockage is extremely easy to see. If there is no blockage its a good sign. XXXXXXX stones is also good. 12 mm size suggests that you should undergo surgery.
You do not need any more investigations. You do not have Pancreatitis or Cholecystitis.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
The report is good. Nothing else needs to be done.
Detailed Answer:
Hi,
All this sounds reasonable to me.
Your report is perfectly normal. 3mm gall bladder wall is also normal.
There is no need to ponder over 3mm GB wall at all. Fasting can increase it and it does vary from technician to technician. No need to worry about it. Thickness would be important only if it is localized to a small specific area, something we call focal wall thickening.
Bile duct blockage is extremely easy to see. If there is no blockage its a good sign. XXXXXXX stones is also good. 12 mm size suggests that you should undergo surgery.
You do not need any more investigations. You do not have Pancreatitis or Cholecystitis.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
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Above answer was peer-reviewed by :
Dr. Prasad
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