Cholecystitis

Overview
  • Cholecystitis is inflammation of the gallbladder and is almost always is due to the presence of gallstones. Inflammation may occur over actue or chronic time scales and each is discussed separately below.
Acute Cholecystitis
  • Etiology
    • Acute cholecystitis is almost always due to obstruction of the outlet of the gallbladder or the cystic duct with a gallstone.
  • Morphology
    • The gallbladder is often enlarged and tense, appearing red or reddish due to subserosal hemorrhages. The gallbladder lumen is often full of pyogenic, hemorrhagic, and fibrinous exudate.
  • Clinical Consequences
    • The "Biliary Colic" of cholelithiasis generally lengthens, resulting in extended right upper quadrant abdominal pain that may radiate to the shoulder due to irritation of the diaphragm. Fever, nausea, vomiting together with leukocytosis are often observed.
Chronic Cholecystitis
  • Etiology
    • Chronic Cholecystitis may arise from repeated bouts of acute cholecystitis or from chronic irritation of gallstones rolling around in the gallbladder.
  • Morphology
    • The chronically inflamed gallbladder may possess a variety of morphologies but in general some fibrosis of the gallbladder wall is present
  • Clinical Consequences
    • The clinical consequences of chronic cholecystitis are usually mild and may include some slight right upper quadrant abdominal pain and weight loss. Frequently, individuals with chronic cholecystitis come to attention due to a supervening bout of acute cholecystitis.
Complications
  • Both acute and chronic cholecystitis share a set of potential complications. Gallbladder perforation or rupture usually results in a local abdominal abscess as the omentum limits spread of the gallbladder luminal contents. In some cases severe rupture can yield diffuse peritonitis. Cholangitis may result as static bile is prone to infection. Cholecystoenteric fistulas can form between the gallbladder and the adjacent GI tract, usually the duodenum. In some cases, gallstones can migrate into the alimentary tract which may result in bowel obstruction, termed "Gallstone Ileus".