Clinical features

Chronic cholecystitis more commonly affects females. The patients fall into two groups: young or middle-aged overweight women where there is often histological evidence of inflammation of the gallbladder; and elderly women who have shrunken, grossly thickened and chronically inflamed gallbladders.

The clinical presentation may vary from classic severe biliary colic to vague or nonspecific complaints:

• daily pain: occurs in the right upper quadrant or epigastrium. Often the pain is accompanied by nausea and vomiting. The pain is exacerbated by fatty or large meals. It may radiate around to the back.
• intermittent episodes of nausea, reflux symptoms food intolerance, or bloating (1)

Patients sometimes have tenderness in right hypochondrium, just below the ninth rib where the edge of the rectus abdominis muscle crosses the costal margin.

Note:

• chronic cholecystitis patients may be misdiagnosed and treated for gastritis, ulcer disease, or irritable bowel syndrome without appreciable improvement in their complaints (1)

Reference:

• (1) Elwood DR. Cholecystitis. Surg Clin North Am. 2008;88(6):1241-52