Cholelithiasis is the medical term for gallstones, and cholecystitis is inflammation of the gallbladder. The two are closely linked: gallstones are the most common cause of gallbladder inflammation, though they don’t always lead to it. More than 20 million people in the United States have gallstones, and the prevalence of symptomatic gallstone disease has doubled over the past three decades.
Cholelithiasis: What Gallstones Are
Gallstones form when substances in bile, the digestive fluid stored in your gallbladder, harden into solid pieces. About 73% of gallstones are cholesterol stones, made primarily of hardened cholesterol that accounts for roughly 77% of the stone’s weight. The remaining stones are pigment stones, formed mainly from calcium and bilirubin (a waste product from broken-down red blood cells). Pigment stones tend to be smaller and darker.
Many people with gallstones never know they have them. Roughly 10% to 15% of people with gallstones have no symptoms at all, and of that group, only about 20% go on to develop problems. The trouble starts when a stone shifts and temporarily blocks the duct that drains bile from the gallbladder.
What Biliary Colic Feels Like
The classic symptom of a gallstone causing a blockage is called biliary colic. You’ll feel a steady, intense pain under your right ribcage that can radiate to your right shoulder or back. It often strikes shortly after a large or fatty meal, because fat in your small intestine triggers the gallbladder to squeeze and release bile. When a stone is blocking the exit, that squeezing creates a sharp spike in pressure.
An episode typically lasts anywhere from 20 minutes to a few hours, then resolves on its own once the stone shifts. If the pain doesn’t go away after several hours and continues to worsen, that’s a signal the situation has progressed beyond simple biliary colic into something more serious: cholecystitis.
Cholecystitis: When the Gallbladder Becomes Inflamed
Cholecystitis develops when the gallbladder contracts repeatedly against a cystic duct that stays blocked by a stone. This persistent obstruction causes inflammation, swelling, and reduced blood flow to the gallbladder wall. Unlike biliary colic, the pain doesn’t fade after a few hours. It remains constant and gets progressively worse, often accompanied by fever.
Cholecystitis can be acute (a sudden flare) or chronic. Chronic cholecystitis develops when gallstones cause repeated low-grade inflammation over months or years, gradually scarring and thickening the gallbladder wall. Acute cholecystitis is a medical emergency that needs prompt treatment to prevent complications like infection or rupture of the gallbladder.
About 10% of acute cholecystitis cases occur without any gallstones at all. This is called acalculous cholecystitis, and it tends to develop in people who are already critically ill, recovering from major surgery, dealing with severe burns or sepsis, or receiving nutrition entirely through an IV. Prolonged fasting and rapid weight loss also raise the risk. In these cases, the gallbladder becomes inflamed due to stagnant bile and poor blood flow rather than a physical blockage.
Risk Factors for Gallstones
Several factors increase your likelihood of developing gallstones. The well-known risk profile skews toward older adults, women, people with obesity, and those with diabetes. Ethnicity plays a role too: American Indian/Alaska Native and Hispanic populations have notably higher rates, while Black and Asian populations generally have lower prevalence. Rapid weight loss, smoking, and having had multiple pregnancies also increase risk.
On the protective side, higher physical activity, moderate alcohol consumption, and higher serum cholesterol levels are all associated with lower gallstone risk. Women develop gallstones more frequently than men and seek medical care for them at higher rates, but men with gallstone disease actually have higher mortality rates.
How Each Condition Is Diagnosed
Abdominal ultrasound is the first imaging test used for both conditions. It’s fast, widely available, and excellent at spotting gallstones. For detecting acute cholecystitis specifically, ultrasound has a sensitivity of about 71% and a specificity of 85%, meaning it catches most cases but can miss some.
Doctors diagnose acute cholecystitis by looking for a combination of local signs (pain or tenderness under the right ribcage, a palpable mass), systemic signs of inflammation (fever, elevated white blood cell count), and confirmatory imaging findings. All three categories together point to a definitive diagnosis.
When ultrasound results are inconclusive, a HIDA scan can help. This test tracks a radioactive tracer as it moves through your liver and into your bile ducts. In a healthy gallbladder, the tracer fills the gallbladder within about an hour. If the cystic duct is blocked, the tracer never reaches the gallbladder at all, confirming the obstruction that’s driving the inflammation.
Treatment for Gallstones and Cholecystitis
If your gallstones aren’t causing symptoms, treatment usually isn’t necessary. Your doctor may simply monitor you over time. Once gallstones start causing biliary colic or cholecystitis, though, the standard treatment is surgical removal of the gallbladder, almost always done laparoscopically through a few small incisions. This procedure is the definitive treatment for symptomatic gallstones, acute and chronic cholecystitis, and several related conditions.
Most people recover from laparoscopic gallbladder removal within one to two weeks. Your body adjusts to digesting food without a gallbladder by having bile flow directly from the liver into the small intestine. Some people notice looser stools for a few weeks after surgery, but this typically resolves on its own.
For acute cholecystitis, surgery is ideally performed early, within the first few days of symptoms. If surgery needs to be delayed because of other health issues, antibiotics and supportive care can control the infection temporarily until the gallbladder can be safely removed.
Complications to Watch For
The most serious complication of untreated gallstones is gallstone pancreatitis. This happens when a stone slips out of the gallbladder and travels down the bile duct to the junction where the bile duct and pancreatic duct meet. If the stone lodges there, it can block drainage from the pancreas, trigger bile to flow backward into the pancreatic duct, or cause local inflammation. Any of these can set off acute pancreatitis, which causes severe upper abdominal pain that often radiates to the back, along with dramatically elevated levels of digestive enzymes in the blood (three or more times the normal level).
Other potential complications include infection of the gallbladder (which can become life-threatening if the gallbladder wall dies or ruptures), blockage of the common bile duct leading to jaundice, and infection of the bile ducts themselves. These complications are the reason symptomatic gallstones are treated surgically rather than simply managed with pain relief.