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| Acute Cholecystitis |
| Etiology •Acute cholecystitis is usually associated with blockage of the cystic duct by a stone. •Mechanical obstruction, chemical inflammation, and bacterial infection are believed to play a role. •A vast majority of patients are believed to become symptomatic due to bacterial infection. •Organisms cultured from the gallbladders include Escherichia coli, Klebsiella species, group D Streptococcus, Staphylococcus, and Clostridium. |
| Pathogenesis •Three factors contribute to the onset of inflammation - stasis of bile in the gall bladder, release of lysolecithin, and super-infection with bacteria., |
| Epidemiology •Much more common in women, particularly in middle aged, obese women who have had several children. |
| General Gross Description •Grossly, the gallbladder is enlarged, tense and shows evidence of acute inflammation in the form of congestion, edema, and serositis with the deposition of fibrin on the surface. •The obstructing stone may be readily found in the cystic duct or in the neck of the gallbladder. •Usually the gallbladder contains several additional stones. •The wall of the gallbladder most often shows evidence of both acute and chronic inflammation. •In extremely acute and severe cases, there may be necrosis of sections of the wall of the gallbladder, referred to as gangrenous cholecystitis. |
| General Microscopic Description •The microscopic features are classical for acute inflammation and include hyperemia, polymorphonuclear leukocyte infiltration, edema and in severe cases, necrosis of the wall of the gall bladder. |
| Clinical Correlation •Symptoms begin as an attack of pain the right upper quadrant, which increases in frequency and intensity. •Pain may radiate to the interscapular area or shoulder and may increase with deep inspiration. •Gastrointestinal symptoms including nausea, vomiting and loss of appetite are commonly seen. •Jaundice is unusual, but may occur late in the course of the disease. •Fever, chills and rigor are sometimes seen. •The characteristic triad of cholecystitis includes pain in the right upper quadrant, fever and elevated white cell count in the range of 10,000 - 15,000/ml. •Acute calculus cholecystitis can occur with remarkable rapidity and constitutes an acute emergency. |
| References • Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 888 • Harrison's Principles of Internal Medicine, 13th Ed: Isselbach et. al. (eds). New York, McGraw-Hill, 1994, pp.1508 |
| Acute Cholecystitis |
| Synopsis by: T.V.Rajan, M.D., Ph.D. (T57000M41000)[581] |
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