Yellowing of the skin (jaundice) may occur but is often mild. Severe jaundice suggests another cause of symptoms such as choledocholithiasis. People who are old, have diabetes, chronic illness, or who are immunocompromised may have vague symptoms that may not include fever or localized tenderness. Complications
A number of complications may occur from cholecystitis if not detected early or properly treated. Signs of complications include high fever, shock and jaundice. Complications include the following:
Gangrene
Gallbladder rupture
Empyema
Fistula formation and gallstone ileus
Rokitansky-Aschoff sinuses

Gangrene and gallbladder rupture
Cholecystitis causes the gallbladder to become distended and firm. Distension can lead to decreased blood flow to the gallbladder, causing tissue death and eventually gangrene. Once tissue has died, the gallbladder is at greatly increased risk of rupture (perforation), which can cause sharp pain. Rupture can also occur in cases of chronic cholecystitis. Rupture is a rare but serious complication that leads to abscess formation or peritonitis. Massive rupture of the gallbladder has a mortality rate of 30%. Empyema
Untreated cholecystitis can lead to worsened inflammation and infected bile that can lead to a collection of pus inside the gallbladder, also known as empyema. The symptoms of empyema are similar to uncomplicated cholecystitis but greater severity: high fever, severe abdominal pain, more severely elevated white blood count. Fistula formation and gallstone ileus
The inflammation of cholecystitis can lead to adhesions between the gallbladder and other parts of the gastrointestinal tract, most commonly the duodenum. These adhesions can lead to the formation of direct connections between the gallbladder and gastrointestinal tract, called fistulas.
In medicine, bilirubinuria is an abnormality in which conjugated bilirubin is detected in the urine.The term "biliuria" is very similar, but more general. It refers to the presence of any bile pigment in the urine. Conjugated bilirubin is detected in urine at bilirubinemia of approximately 30-34 mmol/L or 2 mg/dL. In this concentration of conjugated bilirubin in the blood appears as yellowness of the mucous membranes and sclera. Causes
The most common cause of bilirubinuria is hepatocellular disease. More rare causes include inherited disorders, such as Dubin–Johnson syndrome and Rotor syndrome.Although Gilberts syndrome and Crigler–Najjar syndrome are characterized by increased bilirubin in the serum, the bilirubin in these inherited disorders is not conjugated and thus not excreted in the urine. The increase of stercobilin (urobilin) in the feces and urine is caused by the enhanced intracellular hemolysis of erythrocytes. Formed an unconjugated bilirubin entering the intestine, gives a large number of stercobilinogen (urobilinogen). Last absorbed into the blood and passes into the urine. Diagnosis
in order To properly

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