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Cholecystitis Pathophysiology

Cholecystitis Pathophysiology

Cholecystitis is a condition, wherein the gallbladder gets inflamed. This article provides information regarding the same.
Dr. Sumaiya Khan
Last Updated: Jan 21, 2018
The gallbladder is a small, sac-like, non-vital organ that aids in the digestive process. It stores and concentrates the bile produced in the liver. It is located in the concavity of the liver, which is known as the gallbladder fossa. It is connected to the biliary tree via the cystic duct, which then joins the common hepatic duct to form the common bile duct. There are many different gallbladder diseases that can affect the functioning of this sac-like organ. One of the most common conditions affecting this organ is cholecystitis, which is inflammation of the gallbladder. Following are the details regarding the cholecystitis pathophysiology, that is, the way this disease progresses and what exactly happens when there is inflammation of the gallbladder:
Acute Cholecystitis Pathophysiology
One of the most common types of cholecystitis is acute cholecystitis. This is when the onset of inflammation of the gallbladder is sudden and intense, with fast progression of the disease. More often that not, the inflammation is caused due to obstruction of the bile duct due to gallstones (cholelithiasis). This condition is known as calculous cholecystitis. There are other causes of acute cholecystitis as well, such as ischemia, chemical poisoning, motility disorders, infections with protozoa, collagen disease, allergic reactions, etc. The obstruction results in gallbladder distension, which results in edema of the cells lining the gallbladder. This in turn results in ischemia, which spurs on inflammatory mediators, especially prostaglandins, which further aggravates the inflammation. The lining wall of the gallbladder may eventually undergo necrosis and gangrene, which is known as gangrenous cholecystitis.
The inflammation of the gallbladder wall can either be bacterial or sterile in nature. In cases where it is bacterial, there is normally an acute infection with gas-forming organisms, which may lead to the formation of gas in the wall or the lumen of the gallbladder. This leads to a condition known as emphysematous cholecystitis. However, the bacterial contamination is secondary to biliary obstruction because the bile is seen to be sterile in the early stages of gallbladder wall inflammation.
Acalculous Cholecystitis Pathophysiology
The pathophysiology of acalculous cholecystitis is not very well understood. It is said that the causative factors may be many and interlinked. Functional cystic duct obstruction is normally present and is related to biliary sludge or even bile inspissation. This inspissation is caused due to dehydration, which leads to an increase in the viscosity of bile, thereby causing bile stasis. This may be spurred on by trauma, or due to systemic disease or disorder. Other reasons include burns, multisystem organ failure, and parenteral nutrition. In some cases, patients that have sepsis may have direct gallbladder wall lining inflammation. This is because, the bile is an extremely favorable growth medium for bacteria, and the infections in this space develop rapidly, especially when they are spurred on by a systemic infection. Acalculous cholecystitis may occur with or without localized or generalized tissue ischemia and obstruction.
At times, there may be spontaneous resolution of acute cholecystitis which may occur within five to seven days after the onset of the symptoms. This is especially seen in cases of acalculous cholecystitis due to the reestablishment of cystic duct patency.
The symptoms of cholecystitis are quite obvious, which greatly helps in the diagnosis. The common triad which helps diagnose this condition is jaundice, upper-right quadrant pain, and fever. A proper healthy diet helps to considerably mitigate these symptoms. To properly diagnose and understand how this condition progresses, a person needs to understand the pathophysiology of cholecystitis. This gives a better understanding of the prognosis and severity of this disease.
Disclaimer: This HealthHearty article is for informative purposes only, and should not be used as a replacement for expert medical advice.