Cholecystitis

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.