Chronic cholecystitis pathophysiology
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]
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Pathophysiology
Acute cholecystitis
Cholecystitis is caused by obstruction of bile duct due to impaction of gall stone[1] . Gall stone impaction leads to damage to mucosal surface of gall bladder and bile stasis. Factors which induce cholecystits are
- Lithogenic bile
- Duct obstruction
Acute inflammation is not always necessary for the development of acute cholecystitis.
Gallstones are one of the major causes of cholecystitis. These cause physical obstruction to the lumen of the neck or cystic duct. This is results in increase in intraluminal pressure. Degree and duration of obstruction are the two main factors which determine the progression of obstruction. [2]
- If obstruction is partial and of short duration, patient may experience biliary colic and in long term may progress to chronic cholecystitis.
- If obstruction is complete and longer duration, patient develops acute cholecystitis.
Chronic Cholecystitis
There are few studies suggesting role of pancreatic biliary reflux as a co factor for the development of chronic cholecystitis. Occult pancreatic biliary reflux can be diagnosed by measuring levels of biliary amylase levels. [3]
Acute Acalculous Cholecystitis
- Gallbladder ischemia/reperfusion injury[4]
- Prolonged periods of ischemia to gall bladder leads to disruption of normal mucosal surface.
- Lipopolysaccharides are exposed leading to activation various coagulation cascades.
- Reperfusion leads to increase humoral response which leads to further damage causing cholecystitis.
- Bile Stasis[4]
- Loss of fluids, opiod drugs, positive pressure ventilation other factors cause increase in concentration of bile in the biliary tracts.
- Bile contains phosphatidyl choline, which in increased concentration can cause mucosal disruption.
Pathology
- Chornic cholecystitis
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References
- ↑ Roslyn JJ, DenBesten L, Thompson JE, Silverman BF (1980). "Roles of lithogenic bile and cystic duct occlusion in the pathogenesis of acute cholecystitis". American Journal of Surgery. 140 (1): 126–30. PMID 7396076. Retrieved 2012-08-20. Unknown parameter
|month=ignored (help) - ↑ "Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines". Retrieved 22 September 2012.
- ↑ Amr AR, Hamdy HM, Nasr MM, Hedaya MS, Hassan AM (2012). "Effect of pancreatic biliary reflux as a cofactor in cholecystitis". Journal of the Egyptian Society of Parasitology. 42 (1): 121–8. PMID 22662601. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ 4.0 4.1 "Acute acalculous cholecystitis - Surgical Treatment - NCBI Bookshelf". Retrieved 2012-08-20.