Definition of Cholangitis and Epidemiology of Cholecystitis.

Definition of Cholangitis

• Can be broken down into its Greek origins: Chol- (bile), -ang- (vessel), -itis (inflammation)
• Inflammation or infection of the biliary tract.
• Most commonly caused by choledocolithiasis.
• Characterised by Charcot's triad: Fever, jaundice, and right upper quadrant pain
• Types
• Ascending cholangitis
• Primary sclerosing cholangitis (PSC) is a chronic, progressive,inflammatory disease characterized by fibrosis of the bile ducts. The cause is unknown, but a hypersensitivity reaction is implicated. Patients present with abnormalities of liver function tests and progressive intermittent obstructive jaundice, which may be associated with fever chills, night sweats, pain, and itching
• Secondary sclerosing cholangitis (SSC) is a chronic cholestatic biliary disease, characterized by inflammation, obliterative fibrosis of the bile ducts, stricture formation and progressive destruction of the biliary tree that leads to biliary cirrhosis.
• Cholangiohepatitis, or recurrent pyogenic cholangitis (RPC), is characterized by a recurrent syndrome of bacterial cholangitis that occurs in association with intrahepatic pigment stones and intrahepatic biliary obstruction.

Cholecystitis Epidemiology

Frequency

United States

An estimated 10-20% of Americans have gallstones, and as many as one third of these people develop acute cholecystitis. Cholecystectomy for either recurrent biliary colic or acute cholecystitis is the most common major surgical procedure performed by general surgeons, resulting in approximately 500,000 operations annually.

International

Cholelithiasis, the major risk factor for cholecystitis, has an increased prevalence among people of Scandinavian descent, Pima Indians, and Hispanic populations, whereas cholelithiasis is less common among individuals from sub-Saharan Africa and Asia.^3,4

Mortality/Morbidity

• Most patients with acute cholecystitis have a complete remission within 1-4 days. However, 25-30% of patients either require surgery or develop some complication.
• Patients with acalculous cholecystitis have a mortality rate ranging from 10-50%, which far exceeds the expected 4% mortality rate observed in patients with calculous cholecystitis. Emphysematous cholecystitis has a mortality rate approaching 15%.
• Perforation occurs in 10-15% of cases.

Race

• Pima Indian and Scandinavian people have the highest prevalence of cholelithiasis and, consequently, cholecystitis.
• Populations at the lowest risk reside in sub-Saharan Africa and Asia.
• In the United States, white people have a higher prevalence than black people.

Sex

• Gallstones are 2-3 times more frequent in females than in males, resulting in a higher incidence of calculous cholecystitis in females.
• Elevated progesterone levels during pregnancy may cause biliary stasis, resulting in higher rates of gallbladder disease in pregnant females.
• Acalculous cholecystitis is observed more often in elderly men.

Age

The incidence of cholecystitis increases with age. The physiologic explanation for the increasing incidence of gallstone disease in the elderly population is unclear. The increased incidence in elderly men has been linked to changing androgen-to-estrogen ratios.