10/28/2019 Cholelithiasis & Cholecystitis

Cholelithiasis & Cholecystitis

Description
The most common disorder of the biliary system is cholelithiasis (stones in the gallbladder). Cholecystitis
(inflammation of the gallbladder) is usually associated with cholelithiasis. The stones may be lodged in the neck of
the gallbladder or in the cystic duct. Cholecystitis may be acute or chronic, with these conditions also occurring
together.

Gallbladder disease is a common health problem in the United States. It is estimated that 8% to 10% of adults in
the United States have cholelithiasis.

The incidence of cholelithiasis is higher in women, multiparous women, and person over 40 years old.
Other factors that seem to increase the incidence of gallbladder disease are sedentary lifestyle, familial
tendency, and obesity.
There is an especially high incidence of gallbladder disease in the Native American population, especially
in the Navajo and Pima tribes.
During an acute attack of cholecystitis the gallbladder is edematous and hyperemic. It may be distended
with bile or pus. The cystic duct is also involved and may become occluded.
The wall of the gallbladder becomes scarred after an acute attack. Decreased functioning occurs if large
amounts of tissue are fibrosed.
When a stone is lodged in the ducts or when stones are moving through the ducts, spasms may result. This
sometimes produces severe pain, which is termed biliary colic. The pain can be accompanied by
tachycardia, diaphoresis, and prostration. The severe pain may last up to 1 hour, and when it subsides
there is residual tenderness in the right upper quadrant.
Symptoms of chronic cholecystitis include a history of fat intolerance, dyspepsia, heartburn, and
flatulence.

Pathophysiology
The actual cause of gallstones is unknown. Cholelithiasis develops when the balance that keeps cholesterol, bile
salts, and calcium in solution is altered so that precipitation of these substances occurs. Conditions that upset this
balance include infection and disturbances in the metabolism of cholesterol. Mixed cholesterol stones, which are
predominantly cholesterol, are the most common gallstones.

The stones may remain in the gallbladder or migrate to the cystic duct or common bile duct. They cause pain as
they pass through the ducts and may lodge in the ducts and cause obstruction. Stasis of bile in the gallbladder can
lead to cholecystitis.

Cholecystitis is most commonly associated with obstruction resulting from gallstones or biliary sludge.
Cholecystitis without obstruction from stones can occur as a result of trauma, extensive burns, prolonged
immobility and fasting, and prolonged parenteral nutrition. Bacteria reaching the gallbladder by the vascular or

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10/28/2019 Cholelithiasis & Cholecystitis

lymphatic route or chemical irritants in the bile can also produce cholecystitis. Escherichia coli, streptococci, and
salmonellae are the most common causative bacteria. Other etiologic factors include adhesions, neoplasms,
anesthesia, and opioid drugs.

(Lewis, Bucher, Heitkemper, & Harding, 2017)

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