Cholecystitis

Inflammation of the gallbladder
Acute/chronic/acute on chronic
Almost always from calculous cholecystitis (gallstones)
H/e - acalculous cholecystitis


Acute


Aetiology
90% gallstones - neck of GB/cystic duct obstruction
Acute acalculous - severely ill pt (Post major (non-biliary) surgery/Trauma/Burns/Organ failure/Sepsis/Postpartum)


Symptoms

Mild/transient/surg emerg

RUQ pain

Fever

Nausea

Vomiting

Less * = Jaundice

Pathology
Mucosal defences imbalanced with effects of bile salts
Detergent bile salts damage mucosal surface = inflammation
Initially - no infection - may supervene
Calculous
Stone impaction = bile stasis = increased intraluminal pressure = GB distention = decreased blood flow to mucosa = mucosal defences damaged
Acalculous
Ischaemic mucosal damage


Ix

Increased bilirubin = common bile duct obstruction

Increased WCC

Increased liver enzymes ('cholestatic')

GB: enlarged/tense/mottled
Wall: thickened/oedema/hyperaemic or green/black (gangrenous chol.)
*Gallstones
Pus
Mucosal perforation
Micro
Non-specific acute inflammation
Oedema
Vascular congestion
Neutrophils
Abscess formation
Necrosis

Tx
Spontaneously resolves: 1-10 days
* Recurrence
25% worsen - Sx
Acalculous
Insidious o/s
Possibly obscured by primary illness
Lack of diagnosis = fatal
Onset possible indolent in outpatients with chronic gallbladder ischaemia


Chronic Cholecystitis


*Asymptomatic


Aetiology
Recurr symptomatic acute episodes
90% Gallstones


Ix
Fibrotic serosa (dulled)
Wall: thickened/opaque/stiff
Mucosa: Well preserved
Variable subepithelial chronic inflammation and fibrosis
Diverticulas - with epithelium protruding through layers of GB wall (Rokitansky-Ashoff sinuses)

Cx
Cholangitis
Sepsis
Perf with abscess formation
Peritonitis
Cholecystenteric fistula
Gallstone ileus
Bacterial infection
Bile drainage to adjacent organs
...also - decompensation (of pre-existing disease - renal/hep/card/pulm)

IMP - Tx early & avoid Cx