Acute cholecystitis pathophysiology

Acute cholecystitis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Acute cholecystitis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Guidelines for Management
Case Studies
Case #1
Acute cholecystitis pathophysiology On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Acute cholecystitis pathophysiology All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Acute cholecystitis pathophysiology
CDC on Acute cholecystitis pathophysiology
Acute cholecystitis pathophysiology in the news
Blogs on Acute cholecystitis pathophysiology
Directions to Hospitals Treating Psoriasis
Risk calculators and risk factors for Acute cholecystitis pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

The exact pathogenesis of [disease name] is not fully understood.

OR

It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].

OR

[Pathogen name] is usually transmitted via the [transmission route] route to the human host.

OR

Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.

OR

[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].

OR

The progression to [disease name] usually involves the [molecular pathway].

OR

The pathophysiology of [disease/malignancy] depends on the histological subtype.

Pathophysiology

Pathogenesis

The pathogenesis of acute cholecystitis involves the following:

• Inflammation of the gallbladder is termed as cholecystitis. Acute calculous cholecystitis is usually caused by the mechanical obstruction due to gallstones. Acute acalculous cholecystitis is caused predominantly by the gallbladder stasis.
  • Obstruction of the gallbladder:
    • Gallstones are the most common cause of physical obstruction of the gallbladder usually at the neck or in the cystic duct. The obstruction causes an increased pressure as the gallbladder mucosa continues to produce mucus. This raised pressure may cause the venous congestion which is followed by the arterial congestion. Eventually, the raised pressure and stasis leads to the gallbladder ischemia and necrosis.
      • There are two major types of gallstones:
        • Cholesterol gallstones:
          • Cholesterol gallstones are the most predominant form of the gallstones. They account for approximately 80% of the total gallstones.
          • The formation of gallstones is dependant on the following factors:
            • Cholesterol supersaturation in the bile
            • Crystal nucleation
            • Gallbladder dysmotility
            • Gallbladder absorption
        • Pigmented gallstones:
          • There are two types of pigmented gallstones.
            • Black stones
              • Black stones consist of calcium bilirubinate and mucin glycoproteins.
              • Black stones are predominantly associated with hemolytic conditions or cirrhosis (as a result of increased levels of unconjugated bilirubin).
              • These stones are usually located in the gallbladder.
            • Brown stones
              • Brown stones are usually associated with bacterial infection.
              • Brown stones are usually located elsewhere in the biliary tree as opposed to the gallbladder.
    • Mechanical obstruction of the gallbladder as a result of polyps, malignancy, an infestation of the gallbladder with parasites, foreign bodies, and trauma may also lead to the acute cholecystitis.
  • Gallbladder stasis:
    • Gallbladder stasis is usually due to the lack of gallbladder stimulation.
    • This leads to concentration of the bile salts with a build-up of pressure within the organ. An increased intraluminal pressure results in ischemia and necrosis of the gallbladder.
    • The gallbladder stasis also facilitates the proliferation of the bacterias such as Escherichia coli, Klebsiella, Bacteroides, Proteus, Pseudomonas, and Enterococcus faecalis. This can also cause an inflammatory reaction in the gallbladder.

Genetics

• [Disease name] is transmitted in [mode of genetic transmission] pattern.
• Genes involved in the pathogenesis of [disease name] include [gene1], [gene2], and [gene3].
• The development of [disease name] is the result of multiple genetic mutations.

Associated Conditions

The following conditions are associated with acute cholecystitis:

• Diabetes
• Insulin resistance
• Cardiovascular diseases
• Non-alcoholic fatty liver disease (NAFLD)
• Gastrointestinal malignancies
  • Gastric cancer
  • Hepatocellular carcinoma
  • Cholangiocarcinoma
  • Pancreatic cancer
  • Cancer of the ampulla of Vater

Gross Pathology

• On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Microscopic Pathology

• On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].