Gallbladder
Cholecystitis
Acute calculous cholecystitis

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 5 February 2018, last major update September 2012

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Acute calculous cholecystitis[TIAB] gallbladder

See also: Acute cholecystitis, Acute acalculous cholecystitis
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Cite this page: Gulwani, H. Acute calculous cholecystitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/gallbladderacutecalculouscholecystitis.html. Accessed April 18th, 2019.
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)
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