Pathology - Acute and Chronic Cholecystitis
Acute cholecystitis can be caused by gallstones obstructing the cystic duct (calculous) or by obstruction from bile sludge (acalculous). Acalculous cholecystitis can result from severe injuries or burns, infections such as CMV, Cryptococcus, or Salmonella, postoperative conditions, or prolonged parenteral feeding. Chronic cholecystitis is a common consequence of gallstones and is characterized by recurring episodes of acute cholecystitis. Cholecystitis predominantly affects women over the age of 40. Acute gallbladder condition presents with an enlarged and discolored gallbladder, possibly showing an obstructing stone at the neck and cloudy or purulent bile in the lumen. Microscopic findings include a thickened and swollen wall with an inflammatory infiltration and vascular congestion. Chronic condition characterized by the thickening of the gallbladder wall due to significant fibrosis. Microscopic subepithelial fibrosis with mononuclear infiltrate; protrusion of mucosal epithelium through wall (Rokitansky-Aschoff sinuses). Symptoms include nausea, vomiting, fever, tenderness in the right upper quadrant upon palpation, and the presence of Murphy sign (inspiratory arrest with probing of the right upper quadrant). Laboratory results show elevated ALP levels, leukocytosis, and slightly increased bilirubin levels. Chronic symptoms include nausea, vomiting, repeated episodes of colicky discomfort in the right upper quadrant, and intolerance to fatty foods. Possible complications involve bacterial superinfection, sepsis, and gallbladder perforation or blockage. Treatment includes antibiotics, cholecystectomy, and ERCP to remove gallstones.
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