Cholecystitis is an inflammation of the gallbladder that is usually caused by gallstones obstructing the cystic duct and causing bile stasis. This leads to irritation, infection, and eventual necrosis of the gallbladder wall. Gallstones form due to factors like cholesterol, bilirubin, calcium salts, and may be pigment, cholesterol, or mixed types. Complications include biliary colic, acute and chronic cholecystitis, cholangitis, pancreatitis and cancer. Diagnosis involves imaging like ultrasound and HIDA scan, while treatment consists of laparoscopic cholecystectomy to remove the gallbladder.

1. CHOLECYSTITIS & CHOLELITHIASIS
PREPARED BY: JEGAN. S. NADAR

2. CHOLECYSTITIS
 By definition, cholecystitis is an inflammation of the gallbladder wall and
nearby abdominal lining.
Abdominal wall
Gallbladder
Jegan Nadar

3. PATHOPHYSIOLOGY
❖ Can be caused by an obstruction, gallstone or a tumor.
❖ 90% of all cases caused by gallstones.
❖ The exact cause of gallstone formation is unknown.
❖ When there is an obstruction, gallstone or tumor it prevents bile from leaving the
gallbladder.
❖ Bile gets trapped and acts as an irritant which causes cellular infiltration within 3 –
4 days
Jegan Nadar

4. ❖ This infiltration causes an inflammatory process – the gallbladder becomes
enlarged and edematous.
❖ Eventually this occlusion along with bile stasis causes the mucosal lining of the
gallbladder to become necrotic.
❖ Bacterial growth occurs due to ischemia
NECROTIC GALLBLADDER
Jegan Nadar

5. ❖ Rupture of the gallbladder becomes a danger, along with spread of
infection of the hepatic duct and liver.
❖ If the disease is severe and interferes with the blood supply it can cause the
gallbladder to become gangrenous.
Gangrenous
gallbladder
Gallstones
Jegan Nadar

6. STAGES OF ACUTE CHOLECYSTITIS
❖ Gallbladder has a grayish
appearance & is edematous.
❖ There is an obstruction of the
cystic duct and the gallbladder
begins to swell.
❖ It no longer has the "robin egg
blue" appearance of a normal
gallbladder.
❖ As acute cholecystitis progresses, the
gallbladder begins to become
necrotic and gets a speckled
appearance as the wall begins to
die.
❖ Gallbladder undergoes
gangrenous change and the wall
becomes very dark green or
black.
❖ This is the stage when perforation
occurs.
Jegan Nadar

7. CHOLELITHIASIS
❖ The presence of gallstones in the gallbladder is called cholelithiasis.
Jegan Nadar

8. GALLSTONES
❖ Small, pebble-like substances
❖ Multiple or solitary
❖ May occur anywhere within the biliary tree
❖ Have different appearance - depending on
their contents
Jegan Nadar

9. TYPES OF GALL STONES
PIGMENT STONES
CHOLESTEROL
STONES
MIXED STONES
Jegan Nadar

10. PIGMENT STONES
❖ Small
❖ Friable
❖ Irregular
❖ Dark
❖ Made of bilirubin and calcium salts
❖ Less than 20% of cholesterol
❖ Risk factors:
➢ Haemolysis
➢ Liver cirrhosis
➢ Biliary tract infections
➢ Ileal resection
Jegan Nadar

11. CHOLESTEROL STONES
❖ Large
❖ Often solitary
❖ Yellow, white or green
❖ Made primarily of cholesterol (>70%)
❖ Risk factors: 6 “F” :
◼ Female
◼ Forty
◼ Fertile
◼ Fat
◼ Fair
◼ Family History Jegan Nadar

12. MIXED STONES
❖ Multiple
❖ Faceted
❖ Consist of:
➢ Calcium salts
➢ Pigment
➢ Cholesterol (30% - 70%)
❖ 80% - associated with chronic cholecystitis

14. COMPLICATIONS OF GALLSTONES
❖ In the GB:
◼ Biliary colic
◼ Acute and chronic cholecystitis
◼ Carcinoma
❖ In the bile ducts:
◼ Obstructive jaundice
◼ Pancreatitis
◼ Cholangitis
Jegan Nadar

15. SYMPTOMS
❖ Pain in the RUQ
▪ Most common and typical symptom
▪ May last for a few minutes to several hours
▪ Mostly felt after eating a heavy and high-fat meal
❖ Pain under right shoulder when lifting up arms
❖ Fever, nausea and vomiting
❖ Jaundice (obstruction of the bile duct passage)
❖ Acute pancreatitis (gallstone enters the duct leading to pancreas and blocks it) Jegan Nadar

16. DIAGNOSIS
❖ Ultrasound
❖ Computerized tomography (CT) scan
❖ Cholescintigraphy (HIDA scan)
❖ Endoscopic retrograde cholangiopancreatography (ERCP)
❖ Blood tests
Performed to look for signs of infection, obstruction, pancreatitis, or jaundice
Jegan Nadar

17. TREATMENT
◼ Surgery: Cholecystectomy
(gallbladder removal)
◼ Two surgical options
❖ Open cholecystectomy
❖ Laparoscopic
cholecystectomy
Jegan Nadar

18. NONSURGICAL TREATMENT
❖ Oral dissolution therapy
➢ Ursodeoxycholic acid - to dissolve cholesterol gallstones
➢ Months or years of treatment may be necessary before all stones dissolve
❖ Contact dissolution therapy
➢ Experimental procedure
➢ Involves injecting a drug directly into the gallbladder to dissolve cholesterol stones
Jegan Nadar

19. NONSURGICAL TREATMENT
❖ Oral dissolution therapy
➢ Ursodeoxycholic acid - to dissolve cholesterol gallstones
➢ Months or years of treatment may be necessary before all stones dissolve
❖ Contact dissolution therapy
➢ Experimental procedure
➢ Involves injecting a drug directly into the gallbladder to dissolve cholesterol stones
Jegan Nadar

20. Thank You