PATHOPHYSIOLOGY OF CHOLECYSTITIS

Modifiable factor Non-modifiable factor

Rapid , through diet or surgery o Heredity

Diet (High-fat and High-Cholesterol Diet) o Age (40 y/o)
o Sex (Female)

Bile must become The solute precipitate must come together and
supersaturated with from solution as solid fuse to form stones
cholesterol and calcium crystals

Gallstones

Obstruction of the cystic duct and common bile duct

Jaundice

Distention of the gall bladder

Venous and lymphatic Proliferation of Localized cellular Areas of

drainage is impaired bacteria irritation or ischemia may
infiltration or both occur
take place

Sign and Symptoms

Severe pain in your upper right or center abdomen.
Pain that spreads to your right shoulder or back.
Tenderness over your abdomen when it's touched.
Nausea.
Vomiting.
Fever

CHOLECYSTITIS
Signs and symptoms of cholecystitis may include:

 Severe pain in your upper right or center abdomen.

 Pain that spreads to your right shoulder or back.
 Tenderness over your abdomen when it's touched.
 Nausea.
 Vomiting.
 Fever

The gallbladder’s job is to hold a digestive juice called bile. It releases bile into your small intestine when
your body needs it to break down fats. But if the path to your small intestine is blocked, bile gets trapped.
That backup can irritate your gallbladder. That’s how cholecystitis happens.
Nausea and vomiting are common symptoms. They often show up after you’ve eaten a big or especially
fatty meal.
It’s easy to mistake cholecystitis for other health problems, but another telltale sign is intense pain -- in
your belly, in your back, or under your right shoulder blade.

Cholecystitis
What Is It?
Published: April, 2019

Cholecystitis is an inflammation of the gallbladder. The gallbladder is the small sac-like organ located
in the upper right side of the abdomen, just below the liver. It is attached to the main duct that carries
bile from the liver into the intestine. The gallbladder temporarily stores bile, which is a liquid that
contains a fat-digesting substance produced in the liver. During a meal, the gallbladder contracts, and
bile moves from the gallbladder through small, tube-like passages (called the cystic duct and the
common bile duct) into the small intestine. Here, bile mixes with food to help break down fats.

Cholecystitis usually develops when a person has gallstones, which are rock-like deposits that form
inside the gallbladder. If a gallstone blocks the cystic duct (the outflow from the gallbladder), bile
becomes trapped in the gallbladder. Chemicals in the trapped bile or a bacterial infection can then lead
to inflammation of the gallbladder.
 There are two types of cholecystitis:

 Acute cholecystitis is the sudden inflammation of the gallbladder that causes marked
abdominal pain, often with nausea, vomiting, and fever.
 Chronic cholecystitis is a lower intensity inflammation of the gallbladder that lasts a long time.
It may be caused by repeat attacks of acute cholecystitis. Chronic cholecystitis may cause intermittent
mild abdominal pain, or no symptoms at all. Damage to the walls of the gallbladder leads to a
thickened, scarred gallbladder. Ultimately, the gallbladder can shrink and lose its ability to store and
release bile.
Gallstones alone can cause episodes of crampy abdominal pain without any infection. This is called
biliary colic.

Women are more likely than men to get gallstones. The risk of gallstones also is higher in:

 Anyone older than age 60

 Women who are pregnant or have had several pregnancies
 Women who take estrogen replacement therapy or birth control pills
 Obese people
 People who have lost weight rapidly
 People who eat a high-fat diet

Symptoms
Symptoms of acute cholecystitis may include:

 Pain. You may feel this discomfort in the center of the upper abdomen, just below the
breastbone, or in the upper right portion of the abdomen, near the gallbladder and liver. In some
people, the pain extends to the right shoulder. Symptoms typically start after eating.
 Fever and possibly chills
 Nausea and/or vomiting
 Jaundice (yellowing of the skin or eyes), dark urine and pale, grayish bowel movements. These
symptoms appear when gallstones pass out of the gallbladder and into the common bile duct, blocking
the flow of bile out of the liver.
When gallstones in the common bile duct block the flow of bile from the liver to the intestine, the
patient may develop a serious infection of the bile ducts called cholangitis. The typical symptoms of
cholangitis are fever, right upper abdominal pain, and jaundice. Another possible problem that may
occur when gallstones pass into the common bile duct is acute pancreatitis (inflammation of the
pancreas). Because the duct from the pancreas also flows into the common bile duct, stones there can
block the pancreas, which causes it to become inflamed. Like cholangitis, acute pancreatitis can be
serious.

The major symptom of chronic cholecystitis is usually intermittent pain. However, some people do
not have any symptoms. If there is pain, it is usually mild, and comes and goes. These rather
nonspecific symptoms accompany many other illnesses, so you may not be diagnosed with chronic
cholecystitis until you have an episode of more severe symptoms during a sudden attack.

Diagnosis
Symptoms of acute cholecystitis may include:

 Pain. You may feel this discomfort in the center of the upper abdomen, just below the
breastbone, or in the upper right portion of the abdomen, near the gallbladder and liver. In some
people, the pain extends to the right shoulder. Symptoms typically start after eating.
 Fever and possibly chills
 Nausea and/or vomiting
 Jaundice (yellowing of the skin or eyes), dark urine and pale, grayish bowel movements. These
symptoms appear when gallstones pass out of the gallbladder and into the common bile duct, blocking
the flow of bile out of the liver.
When gallstones in the common bile duct block the flow of bile from the liver to the intestine, the
patient may develop a serious infection of the bile ducts called cholangitis. The typical symptoms of
cholangitis are fever, right upper abdominal pain, and jaundice. Another possible problem that may
occur when gallstones pass into the common bile duct is acute pancreatitis (inflammation of the
pancreas). Because the duct from the pancreas also flows into the common bile duct, stones there can
block the pancreas, which causes it to become inflamed. Like cholangitis, acute pancreatitis can be
serious.

The major symptom of chronic cholecystitis is usually intermittent pain. However, some people do
not have any symptoms. If there is pain, it is usually mild, and comes and goes. These rather
nonspecific symptoms accompany many other illnesses, so you may not be diagnosed with chronic
cholecystitis until you have an episode of more severe symptoms during a sudden attack.

Expected Duration
If you have biliary colic, the pain or discomfort may go away or become less severe after several hours
if a trapped gallstone passes out of the cystic duct on its own. Your abdomen may continue to ache
mildly for about 24 hours.

If you have acute cholecystitis, however, and infection and inflammation continue, your symptoms
may get worse and you could develop complications, including a hole in the inflamed gallbladder wall
(gallbladder perforation) and an infection that spreads to the lining of the abdomen (peritonitis). This is
why people with cholecystitis usually are treated and observed in a hospital until their symptoms
improve.

Symptoms of chronic cholecystitis may be present for years before a diagnosis is made. Surgery to
remove the gallbladder will prevent symptoms from coming back.

Prevention
Because gallstones cause cholecystitis, you may be able to avoid cholecystitis by controlling the risk
factors that can lead to the formation of gallstones. These include watching your weight and avoiding a
high-fat diet.

The gallbladder’s job is to hold a digestive juice called bile. It releases bile into your small intestine when your
body needs it to break down fats. But if the path to your small intestine is blocked, bile gets trapped. That backup
can irritate your gallbladder. That’s how cholecystitis happens.

Nausea and vomiting are common symptoms. They often show up after you’ve eaten a big or especially fatty
meal.

It’s easy to mistake cholecystitis for other health problems, but another telltale sign is intense pain -- in your belly,
in your back, or under your right shoulder blade.

If you don’t see a doctor and get treatment, it can lead to dangerous infections or become a long-term condition.
The most common solution is surgery to remove your gallbladder.

MODIFIABLE
Although there are many risk factors which would increase the likelihood of developing gallbladder disease, two of
the major causes are obesity and rapid weight-loss; therefore, gallbladder disease is an important issue for a patient
with obesity.
Obesity- Being overweight increases the amount of cholesterol in the bile, which increases the risk of gallstones.
Around 25% of people who are severely obese (with a body mass index of over 40) have gallstones. It is believed
that the risk is higher if the excess body weight is around the stomach. Obesity. Obesity is a significant risk factor
for the development of cholesterol gallstones due to elevated production and secretion of cholesterol.
Rapid weight loss- Rapid weight loss can increase the risk of gallstones. As the body metabolizes fat during rapid
weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones. Rapid weight loss-
meaning 3 or more pounds (lbs) per week, can trigger gallstones for the same reasons as obesity — it alters the
balance of cholesterol, lecithin, and bile acids, and prevents the gallbladder from emptying adequately. Rapid
weight loss- Bariatric surgery and very-low-calorie diets increase risk of gallstone formation, possibly due to
increased concentrations of bile constituents
Diet- When the levels of cholesterol are high or supersaturated, cholesterol crystals begin to form, which may lump
together to form gallstones. Diets high in fat and low in fiber may increase the risk of gallstones.

Medications- Drugs implicated in the development of cholelithiasis include clofibrate, octreotide, and ceftriaxone.
Physical inactivity- Exercise may reduce gallstone risk. Findings from the Health Professionals Follow-Up Study
suggested that the risk of symptomatic cholelithiasis could be reduced by 30 minutes of daily aerobic exercise.
Young or middle-aged men (65 years or younger) who were the most physically active had half the risk for
developing gallstones, compared with those who were least active. In older men, physical activity cut risk by 25%.
[2] Physical activity is also associated with reduced gallstone risk in women.

NON MODIFIABLE
Heredity- Gene mutation that affects the movement of cholesterol from the liver to the bile duct as well as defects
in certain proteins may also increase your risk of developing a gallbladder disease
Family history- Gallstones are more than twice as common in first-degree relatives of individuals with gallstones.
Age- People over 60 are more likely to develop gallstones than younger people.
Sex Female- Females are more likely to develop gallstones in all age groups, probably due to the effects of
estrogens. This increased risk is most notable in young women, who are affected 3-4 times more often than men of
the same age. Gender- Women are twice as likely to develop gallstones than men.

Diabetes - People with diabetes generally have high levels of fatty acids, called triglycerides, which increase the
risk for gallstones.
Estrogen- Excess estrogen from pregnancy, hormone replacement therapy, or birth control pills appears to increase
cholesterol levels in bile and decrease gallbladder movement, both of which can lead to gallstones.
Ethnicity- Native Americans have the highest rates of gallstones in this country and seem to have a genetic
predisposition to secrete high levels of cholesterol in bile.