Cholecystitis

A Cause For Pain

Background
• Presence of gallstones in the gallbladder.
• Spectrum ranges from asymptomatic,
colic, cholangitis, choledocholithiasis,
cholecystitis.
• Colic is a temporary blockage,
cholecystitis is inflammation from
obstruction of cystic duct, cholangitis is
infection of the biliary tree.
Cholecystitis is inflammation of the gallbladder, usually
resulting from a gallstone blocking the cystic duct.

Gallbladder inflammation usually results from a gallstone

blocking the flow of bile.

Typically, people have abdominal pain that lasts more than

6 hours, fever, and nausea.

Ultrasonography can usually detect signs of gallbladder

inflammation.
The gallbladder is removed, often using a laparoscope.

Cholecystitis is the most common problem resulting from

gallbladder stones.

It occurs when a stone blocks the cystic duct, which

carries bile from the gallbladder.

Cholecystitis is classified as acute or chronic.

Pathophysiology
• Three types of stones, cholesterol, pigment,
mixed.
• Formation of each types is caused by
crystallization of bile.
• Cholesterol stones most common.
• Bile consists of lethicin, bile acids,
phospholipids in a fine balance.
• Impaired motility can predispose to stones.
 Pathophysiology

• Sludge is crystals without stones. It may

be a first step in stones, or be independent
of it.

• Pigment stones (15%) are from calcium

bilirubinate. Diseases that increase RBC
destruction will cause these. Also in
cirrhotic patients, parasitic infections.
Acute Cholecystitis: Acute cholecystitis begins
suddenly, resulting in severe, steady pain in the upper
abdomen.

At least 95% of people with acute cholecystitis have

gallstones.

The inflammation almost always begins without

infection, although infection may follow later.

Inflammation may cause the gallbladder to fill with fluid

and its walls to thicken.

Rarely, a form of acute cholecystitis without gallstones

(acalculous cholecystitis) occurs.
Critical illnesses such as serious injuries, major burns,
and bodywide infections (sepsis) Intravenous feedings for
a long time Fasting for a prolonged time A deficiency in
the immune system It can occur in young children,
perhaps developing from a viral or another infection.
Chronic Cholecystitis: Chronic cholecystitis is
gallbladder inflammation that has lasted a long time.

It almost always results from gallstones.

It is characterized by repeated attacks of pain (biliary

colic).

In chronic cholecystitis, the gallbladder is damaged by

repeated attacks of acute inflammation, usually due to
gallstones, and may become thick-walled, scarred, and
small.

The gallbladder usually contains sludge (microscopic

particles of materials similar to those in gallstones), or
gallstones that either block its opening into the cystic duct
or reside in the cystic duct itself.