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Acute cholecystitis is inflammation of the gallbladder wall, most commonly caused by gallstone obstruction of the cystic artery or duct. It presents with severe right upper quadrant pain, fever, and nausea, requiring prompt medical evaluation and often surgical intervention.
Gallstone impaction in the cystic duct or Hartmann's pouch causes bile stasis and increased intraluminal pressure, leading to gallbladder wall ischemia and inflammation. Secondary bacterial infection may occur, with E. coli and Klebsiella being common pathogens that can progress to gangrenous cholecystitis or perforation.
The classic triad of right upper quadrant pain, fever, and leukocytosis (Charcot's triad when jaundice is present) guides diagnosis, supported by positive Murphy's sign on examination. Ultrasound showing gallbladder wall thickening, pericholecystic fluid, and gallstones confirms the diagnosis, with HIDA scan reserved for equivocal cases.
Key imaging focus: Gallstones, wall thickening >3mm, pericholecystic fluid, Murphy sign on US