Snapshot A 45-year-old obese woman presents to the emergency room with steady, severe, aching pain in the upper right quadrant that radiates to the right scapula. The onset was acute and occurred 30 minutes after lunch. She also reports nausea with vomiting. On physical exam, it is noted that she stops breathing on deep palpation of the right quadrant. Laboratory studies show an absolute neutrophillic leukocytosis with a left shift. Introduction Clinical definitionacute inflammation of the gallbladder, often in the setting of gallstones or biliary sludgeacalculous cholecystitisetiologygallbladder stasishypoperfusioninfectionoften seen invery ill patientsassociated with high mortalitycalculous cholecystitisetiologygallstone impaction resulting in inflammationmore commonEpidemiologydemographicsfemale > maleadultsrisk factorsgallstonesF'sFatFemaleFortyFlatulentFertilehormone replacement therapyobesityhypertriglyceridemiaetiologyEEEK bugsE. coliEnterobacterEnterococcusKlebsiellaPathogenesisblockage of cystic duct by gallstones can lead to distention of gallbladder, inflammation, and infection Presentation Symptoms login to view 7 more bullets Physical exam login to view 15 more bullets Imaging Right upper quadrant ultrasound login to view 6 more bullets Cholescintigraphy (HIDA scan) login to view 4 more bullets Computed tomography (CT) of abdomen and pelvis login to view 7 more bullets Studies Studies login to view 3 more bullets Diagnostic criteria login to view 8 more bullets Differential Acute pancreatitis login to view 3 more bullets Treatment First-line login to view 12 more bullets Second-line login to view 3 more bullets Complications Ascending cholangitis Gallbladder perforation