Pathophysiology, Clinical Progression, and Complications of Cholelithiasis and Cholecystitis

Introduction

Cholelithiasis refers to the formation of gallstones, while cholecystitis is the inflammation of the gallbladder, often resulting from gallstones blocking bile flow. Understanding their pathophysiology, clinical progression, and complications helps in timely diagnosis and effective management.

Pathophysiology

Gallstone Formation

• Imbalance in bile composition (cholesterol, bilirubin, bile salts)
• Gallbladder stasis leading to stone formation
• Genetic predisposition and dietary influences

Inflammation and Progression

Gallstones obstruct the cystic duct, leading to bile retention and inflammation. Bacterial infection can exacerbate cholecystitis, causing severe complications.

Risk Factors

• Obesity and rapid weight loss
• Female gender and pregnancy
• Diabetes mellitus
• High-fat, low-fiber diet
• Genetic predisposition

Clinical Progression

Symptoms

• Right upper quadrant pain (often postprandial)
• Nausea and vomiting
• Jaundice in complicated cases

Diagnostic Approach

• Ultrasound for gallstone detection
• CT scan in suspected complications
• Liver function tests and white blood cell count

Complications

Acute and Chronic Conditions

• Gallbladder perforation
• Biliary sepsis
• Pancreatitis due to obstructed bile flow

Management and Treatment

Conservative Approach

• Low-fat diet and hydration
• Antibiotics for bacterial infections

Surgical Interventions

• Laparoscopic cholecystectomy (gold standard)
• Endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction

Conclusion

Early recognition and management of cholelithiasis and cholecystitis can prevent severe complications, improving patient outcomes.