Pathophysiology, Clinical Progression, and Complications of Cholelithiasis and Cholecystitis

Understanding Cholelithiasis and Cholecystitis

Cholelithiasis refers to the presence of gallstones in the gallbladder, while cholecystitis is the inflammation of the gallbladder, often due to gallstone obstruction. These conditions are common in general medicine, leading to significant morbidity.

Pathophysiology

Gallstone Formation

Gallstones are primarily composed of cholesterol, bilirubin, and calcium salts. They form due to imbalances in bile composition, leading to crystallization.

Inflammatory Response in Cholecystitis

Acute cholecystitis is characterized by neutrophilic infiltration, edema, and ischemia, often resulting in gallbladder wall thickening. Chronic cholecystitis involves prolonged inflammation, fibrosis, and loss of gallbladder function.

Clinical Progression

• Acute Cholecystitis - Presents with right upper quadrant pain, fever, and leukocytosis.
• Chronic Cholecystitis - Manifests as recurrent epigastric discomfort with intolerance to fatty meals.

Complications

Untreated cholecystitis may lead to complications such as perforation, gallbladder empyema, and choledocholithiasis. Timely diagnosis and intervention are crucial.

Management and Treatment

Management involves supportive care, antibiotics, and cholecystectomy for severe cases.