Chronic cholecystitis pathophysiology

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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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Overview

Pathophysiology

Chronic Cholecystitis

Gallstones are one of the major causes of cholecystitis. These cause physical obstruction to the lumen of the neck or cystic duct. This results in an increase in the intraluminal pressure. The degree and duration of obstruction are the two main factors that determine its progression.[1][2][3]

  • Partial obstruction of short duration may cause biliary colic. Long-term obstruction may progress to chronic cholecystitis.
  • Some studies suggest that the pancreatic biliary reflux plays a role in the development of chronic cholecystitis.

Acute Acalculous Cholecystitis

Gallbladder Ischemia/Reperfusion Injury[4]

  • Prolonged periods of ischemia to the gall bladder leads to disruption of the normal mucosal surface.
  • Lipopolysaccharides are exposed leading to activation of various coagulation cascades.
  • Reperfusion leads to an increased humoral response which leads to further damage causing cholecystitis.

Bile Stasis[4]

Pathology

Chornic Cholecystitis

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Histological image of chronic cholecystitis; Low magnification. By Nephron - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=30991393 Source:[5]


References

  1. 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)
  2. Kalloo AN, Kantsevoy SV (2001). "Gallstones and biliary disease". Prim. Care. 28 (3): 591–606, vii. PMID 11483446.
  3. Ahmed A, Cheung RC, Keeffe EB (2000). "Management of gallstones and their complications". Am Fam Physician. 61 (6): 1673–80, 1687–8. PMID 10750875.
  4. 4.0 4.1 "Acute acalculous cholecystitis - Surgical Treatment - NCBI Bookshelf". Retrieved 2012-08-20.
  5. "Acute cholecystitis - Libre Pathology".


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