What is the pathophysiology of cholecystitis?

The pathogenesis of acute cholecystitis is primarily due to obstruction of biliary outflow by a stone. Other rare causes may be stricture, kinking of the cystic duct, intussusception of a polyp, torsion of the gallbladder, pressure of an overlying lymph node on the cystic duct, or inspissated and concentrated bile.

How does TPN cause cholecystitis?

Fasting during TPN leads to gallbladder stasis due to lack of hormonal stimulation. Most stones in this setting are pigment stones. Ultrasound and hepatobiliary scans are complementary in the early diagnosis especially of acalculous cholecystitis.

What is Ch cholecystitis?

Chronic cholecystitis is swelling and irritation of the gallbladder that continues over time. The gallbladder is a sac located under the liver. It stores bile that is made in the liver. Bile helps with the digestion of fats in the small intestine.

Does TPN contract the gallbladder?

TPN did not alter gallbladder or hepatic bile lithogenic index. Two of five 28-day TPN animals developed biliary sludge, and one of these animals formed pigment gallstones. TPN without lipid decreased serum cholesterol concentration.

Why does TPN cause cholestasis?

Severe cholestasis induced by total parental nutrition (TPN-IC) is characterized by bile duct regeneration, portal inflammation, and fibrosis. Its progression could be very rapid, and in some patients liver cirrhosis may develop in few months.

How painful is cholecystitis?

The most common sign that you have acute cholecystitis is abdominal pain that lasts for several hours. This pain is usually in the middle or right side of your upper abdomen. It may also spread to your right shoulder or back. Pain from acute cholecystitis can feel like sharp pain or dull cramps.

What is the etiology of chronic cholecystitis?

Chronic cholecystitis mostly occurs in the setting of cholelithiasis. The proposed etiology is recurrent episodes of acute cholecystitis or chronic irritation from gallstones invoking an inflammatory response in the gallbladder wall. Sometimes the term is used to describe abdominal pain resulting from dysfunction in the emptying of the gallbladder.

What is the pathophysiology of emphysematous cholecystitis?

This leads to a condition known as emphysematous cholecystitis. However, the bacterial contamination is secondary to biliary obstruction because the bile is seen to be sterile in the early stages of gallbladder wall inflammation. The pathophysiology of acalculous cholecystitis is not very well understood.

What are the symptoms of acalculous cholecystitis?

This is especially seen in cases of acalculous cholecystitis due to the reestablishment of cystic duct patency. The symptoms of cholecystitis are quite obvious, which greatly helps in the diagnosis. The common triad which helps diagnose this condition is jaundice, upper-right quadrant pain, and fever.

Are there any lab values that are normal for cholecystitis?

Most laboratory values will remain normal in cholecystitis unless there is retrograde involvement of the liver or pancreas. According to Zakko, S. & Afdhal, N., elevations in inflammatory markers such as C-reactive protein may also be present (2018a).