Pathophysiology: Cholecystitis

Non modifiable factors Modifiable factors

-Age (40 years old and above) -Obesity
-Gender/sex (female) -Rapid weight loss and diet
-Genetic predisposition -Lack of physical activity
-Estrogen levels -Long-term total parenteral nutrition
-Oral contraceptives
-Pregnancy

Genetic & Demography Change in Bile Decreased contractility Increased

Composition of bile flow intraluminal
Pressure
Bile Stasis

Contraction of substances present in bile Stimulates smooth Increase

muscle contraction tension to
Precipitation of bile substances duodenum

Bile substance will increase in size

Stones migrate to gall bladder RUQ abdominal Pain

Obstruction of the flow in bile Radiating pain to lower back

Impaired Hepatic uptake Collection of soluble No bile reaches the GIT
of bilirubin bilirubin in the urine

Cholesterol salts Escape of bilirubin to GUT No bile in small Decrease bile

In the skin intestine for fat in the duodenum
Digestion
Jaundice Sterobilin
Emulsification of fats
Clay-colored stool
Presence of Nausea and Vomiting
Bile in the urine

Dark yellow urine

Obstructed cystic duct

Bile duct obstructed already
Gall bladder becomes distended
RUQ pain
 Cholecystitis is an inflammation of the gallbladder wall and nearby abdominal lining. Cholecystitis is usually
caused by a gallstone in the cystic duct, the duct that connects the gallbladder to the hepati c duct. The
presence of gallstones in the gallbladder is called c h o l e l i t h i a s i s . C h o l e l i t h i a s i s i s t h e
p a t h o l o g i c s t a t e o f s t o n e s o r c a l c u l i w i t h i n t h e gallbladder lumen. A common digesti ve
disorder worldwide, the annual overall cost of  c h o l e l i t h i a s i s i s a p p r o x i m a t e l y $ 5 b i l l i o n
i n t h e U n i t e d S t a t e s , w h e r e 7 5 - 8 0 % o f   gallstones are of the cholesterol type, and
a p p r o x i m a t e l y 1 0 - 2 5 % o f g a l l s t o n e s a r e  bilirubinate of either black or brown pigment. In Asia,
pigmented stones predominate ,although recent studies have shown an increase in cholesterol stones in the
Far East. Gallstones are crystalline structures formed by concreti on (hardening) or
accreti on( a d h e r e n c e o f p a r ti c l e s , a c c u m u l a ti o n ) o f n o r m a l o r a b n o r m a l b i l e
c o n s ti t u e n t s . According to various theories, there are four possible explanati ons for stone
formati on. First, bile may undergo a change in composition. Second, gallbladder stasis may lead to bile stasis.
Third, infection may predispose a person to stone formation. Fourth, genetics and demography can affect stone
formation. Risk factors associated with development of gallstones include heredity, Obesity, rapid
weight loss, through diet or surgery, age over 60, Nati ve American or Mexican American racial
makeup, female gender-gallbladder disease is more common in women t h a n i n m e n . W o m e n w i t h h i g h
estrogen l e v e l s , a s a r e s u l t o f p r e g n a n c y , hormone  replacement therapy, o r t h e u s e o f b i r t h
c o n t r o l p i l l s , a r e a t p a r ti c u l a r l y h i g h r i s k f o r   gallstone formation, Diet-Very low calorie diets,
prolonged fasting, and low-fiber /high-cholesterol/high-starch diets all may contribute to gallstone formation.

Someti mes, persons with gallbladder disease have few or no symptoms. Others, however, will
eventually develop one or more of the following symptoms; (1) Frequent  bouts of indigesti on,
especially aft er eati ng fatt y or greasy foods, or certain vegetables such as cabbage, radishes, or pickles,
(2) Nausea and bloating (3) Attacks of sharp pains i n t h e u p p e r r i g h t p a r t o f t h e a b d o m e n . T h i s p a i n
o c c u r s w h e n a g a l l s t o n e c a u s e s a blockage that prevents the gallbladder from emptying (usually
by obstructi ng the cysti cduct). (4) Jaundice (yellowing of the skin) may occur if a gallstone becomes stuck in
the common bile duct, which leads into the intestine blocking the flow of bile from both the gallbladder and
the liver. This is a serious complicati on and usually requires immediate treatment.

The only treatment that cures gallbladder disease is surgical removal of

t h e gallbladder, called cholecystectomy. Generally, when stones are present and causing
symptoms, or when the gallbladder is infected and infl amed, removal of the organ is usually
necessary. When the gallbladder is removed, the surgeon may examine the bile ducts, sometimes
with X rays, and remove any stones that may be lodged there. The ducts are not removed so that the liver
can conti nue to secrete bile into the intesti ne. Most  patients experience no further symptoms after
cholecystectomy. However, mild residual symptoms can occur, which can usually be controlled with a special diet
and medication