The liver, gallbladder and pancreas
C. Simon Herrington in Muir's Textbook of Pathology, 2020
Initially, acute cholecystitis is usually the result of an injury to the gallbladder mucosa caused by gallstones, perhaps by obstruction of the cystic duct. However, in fully developed cases, there is often superimposed infection by bowel commensal bacteria, which further amplifies the acute inflammatory response. Histologically, there is ulceration of the mucosa with vascular congestion, oedema, and exudation. The neutrophil polymorph infiltrate may extend throughout the entire thickness of the gallbladder wall. A dilated, pus-filled gallbladder is known as empyema and there is a danger of rupture. Obstruction of the cystic duct with no infection may result in the accumulation of sterile mucus, which distends the gallbladder to produce a mucocele.
Acute Cholecystitis
Savio George Barreto, Shailesh V. Shrikhande in Dilemmas in Abdominal Surgery, 2020
Most of the patients with acute cholecystitis present with right-upper quadrant abdominal pain lasting several hours, with or without pyrexia. They may have varying degrees of nausea, anorexia, jaundice, and abdominal pain with radiation to the right shoulder or interscapular area. On clinical examination, right-upper quadrant tenderness with arrest of respiration by deep palpation at the tip of the ninth costal cartilage at the height of inspiration (Murphy’s sign) is a pathognomonic sign. As the disease process advances with local adhesions, a right-upper quadrant mass may be palpable. In general, diagnosis of acute cholecystitis is determined using the combination of clinical symptoms, blood tests, and radiological findings. In addition, it is very important to confirm the duration from the onset of the symptoms to the first visit because that is needed to determine the therapeutic strategy.
The upper gastrointestinal tract, common conditions, and recommended treatments
Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus in Psychogastroenterology for Adults, 2019
Gallstones (concretions of concentrated bile contents, usually cholesterol; Figure 2.2) occur most commonly in the gallbladder and are increasingly common with age (up to 40% in the elderly). In the majority of those with gallstones, they do not cause problems. Blockage of the outlet of the gallbladder can lead to pain (biliary colic) or inflammation (cholecystitis). If the gallstones move down the bile ducts, they may cause either blockage (causing pain and jaundice) or infection (cholangitis). Cholecystitis and cholangitis require treatment with antibiotics and removal of the gallstones, either surgically or endoscopically. Passage of gallstones through the bile duct can also lead to pancreatitis, with severe upper abdominal pain requiring admission to hospital and careful support with fluid replacement and management of complications such as abscesses and cysts. For more information about gallstones see [9].
Regional variations in Sweden over time regarding the surgical treatment of acute cholecystitis: a population-based register study
Published in Scandinavian Journal of Gastroenterology, 2022
Jakob Holmberg Larsson, Johanna Österberg, Gabriel Sandblom, Lars Enochsson
Acute cholecystitis is caused by an obstruction of the gallbladder neck or the cystic duct, in most cases due to gallstones, leading to distension and an ensuing bacterial or chemical inflammation of the gallbladder. If left untreated, it can cause perforations, fistulae, abscess formation or chronic cholecystitis. In the early stages of acute cholecystitis, the gallbladder is surrounded by oedema, making it easier to identify the different tissue layers, resulting in generally less complicated surgery [3,4]. If surgery is delayed, the local inflammation causes a gradual replacement of the oedema with regenerative tissue, which makes it more problematic to identify the tissue layers and the surgical dissection thus more challenging. According to the WSES updated guidelines [5] as well as the 2018 Tokyo guidelines [6], early laparoscopic cholecystectomy is the standard of care for patients with acute calculous cholecystitis.
Distinct lipid profile in haemolytic anaemia-related gallstones compared with the general gallstone
Published in Annals of Medicine, 2023
Ziqi Wan, Xiaoyin Bai, Chengqing He, Yueyi Zhang, Ying Wang, Kaini Shen, Li Meizi, Qiang Wang, Wu Dongsheng, Yunlu Feng, Aiming Yang
Patients in the case group were diagnosed with gallstones after 9 (0–52) years of anaemia diagnosis. Thirty-eight patients had acute cholecystitis pertinent to gallstones, including five cases complicated by cholangitis and six by acute pancreatitis. Total bilirubin was 81.0 ± 52.9 μmol/L and 463.7 ± 383.3 μmol/L in the absence and presence of acute gallstone-related diseases, respectively (p < 0.001). Direct bilirubin was 12.7 ± 6.3 μmol/L and 311.0 ± 278.6 μmol/L, respectively (p < 0.001). The ratio of direct/total bilirubin was 0.21 ± 0.12 and 0.60 ± 0.22 for asymptomatic cases and acute cases (p < 0.001), respectively. GGT and LDH were also significantly higher in acute cases than in asymptomatic cases (p < 0.001 and p = 0.02, respectively). Other parameters were not significantly different. Seventy-seven patients in the control group experienced acute diseases. The ratio of direct/total bilirubin for acute cases was not significantly different from that of the case group (p = 0.827), whereas the level of total bilirubin was significantly lower than that of the case group (p < 0.001).
Method for adequate macroscopic gallbladder examination after cholecystectomy
Published in Acta Chirurgica Belgica, 2020
Bartholomeus J. G. A. Corten, Wouter K. G. Leclercq, Peter H. van Zwam, Rudi M. H. Roumen, Cees H. Dejong, Gerrit D. Slooter
The gallbladder is a sac-like organ that is divided into the fundus, body, infundibulum (also known as Hartmann pouch), neck and cystic duct. An endoluminal transition surface zone from the neck to the cystic duct may contain undulating folds or valves known as ‘spiral valves of Heister’ [6,7]. A normal gallbladder has a smooth and glistening serosa and is endoluminally lined with folded mucosa [8–11] (Figure 2(a,b)). If intact, the gallbladder is usually filled with green-brown bile. Discolored bile may be indicative of a gallbladder outlet obstruction, either by stones or a tumor. Acute cholecystitis may present as an enlarged and distended gallbladder, with thickened wall with edema and hemorrhage (Figure 2(c,d)), congested vessels, serosal and or mucosal exudate, ulcers with blood clots and or pus. In case of an acute cholecystitis or cholangitis an enlarged lymph node may be situated within the triangle of Calot, known as Mascagni’s or Lund’s node and sometimes erroneously referred to as Calot’s node [12].
Related Knowledge Centers
- Abdominal Pain
- Ascending Cholangitis
- Biliary Colic
- Inflammation
- Gallstone
- Gallbladder
- Pancreatitis
- Cystic Duct
- Quadrants & Regions of Abdomen
- Common Bile Duct Stone