Cholecystitis and Cholangitis

Definition of Cholecystitis
• It is defined as inflammation of the gallbladder.
• The Inflammation can be sterile or bacterial. (50-75% of cases)
• Occur most commonly due to obstruction of the cystic duct from cholelithiasis(gallstones, 90%). Remaining 10% are a calculous.
• More common in females by 2-3 times and increases with age.
• "fair, female, fat, and fertile" RF of cholecystitis.
• It is said that less common in Asia because of decrease choleithiasis incidence. If there are pigmented stones are more common compared to cholesterol stones.

Pathophysiology of Cholangitis
• Etiology – Biliary tract obstruction, Elevated intraluminal pressure, Infection of bile, Biliary tract manipulation/stents and Autoimmune (chronic liver disease).
• Biliary tract obstruction +Bacterial ascend from duodenum or portal venous blood  Diminish host antibacterial defences  Increase small bowel bacterial colonization
• Increase biliary pressure  Push infection into biliary canaliculi, hepatic veins and lymphatics  Bacteremia (25-40%),
• Autoimmune  Inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts  Portal hypertension and cirrhosis.