Gallbladder & extrahepatic bile ducts
Cholecystitis
Acute calculous cholecystitis
Author: Hanni Gulwani, M.B.B.S.
Last author update: 1 September 2012
Last staff update: 5 March 2021
Copyright: 2003-2024, PathologyOutlines.com, Inc.
PubMed Search: Acute calculous cholecystitis[TIAB] gallbladder
See also: Acute cholecystitis
Cite this page: Gulwani H. Acute calculous cholecystitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/gallbladderacutecalculouscholecystitis.html. Accessed April 25th, 2024.
Definition / general
- 90% of cases
- Mean age 60 years, 60% women
- Abdominal pain, right upper quadrant tenderness, nausea, vomiting, fever, leukocytosis, mild jaundice
- 50% of those with jaundice have coexisting choledocholithiasis
- Due to stone impaction, versus biliary colic, which is due to intermittent obstruction
- 50% have bacterial infection (E. coli, Enterobacter, Enterococcus, Klebsiella, Clostridium, Peptostreptococcus, Bacteroides)
- 1% mortality
- Perforation unlikely if early operation
Pathophysiology
- Chronic obstruction causes increased intraluminal pressure, vascular compromise, stasis and concentration of bile within lumen, mucosal damage, release of cellular enzymes, release of inflammatory mediators such as lysolecithin and prostagladins
- Gall bladder volume increases as acute cholecystitis progresses to gangrene or empyema
- Gallstone formation is associated with poorer contractility and larger volume in gallbladders that contain stones (World J Gastroenterol 2010;16:4341)
- As the weight, volume and size of the stone increases, gall bladder mucosa changes from cholecystitis, hyperplasia, metaplasia, dysplasia, to carcinoma (Trop Gastroenterol 2012;33:39)
- Eosinophils accumulate in gallbladder mucosa in young patients (Pol J Pathol 2011;62:41)
