Cholelithiasis and Cholecystitis
1.Definitions
a. Cholelithiasis: formation of stones (calculi) within the gallbladder or biliary duct system
b. Cholecystitis: inflammation of gall bladder
c. Cholangitis:  inflammation of the biliary ducts
2.Pathophysiology
a.Gallstones form due to
  1.Abnormal bile composition
  2.Biliary stasis
  3.Inflammation of gallbladder
b.Most gallstones are composed primarily of bile (80%); remainder are composed of a mixture of bile components
c.Excess cholesterol in bile is associated with obesity, high-cholesterol diet and drugs that lower cholesterol levels
d.If stones from gallbladder lodge in the cystic duct
  1. There can be reflux of bile into the gallbladder and liver
  2. Gallbladder has increased pressure leading to ischemia and inflammation
  3. Severe ischemia can lead to necrosis of the gall bladder
  4. If the common bile duct is obstructed, pancreatitis can develop

Risk factors for cholelithiasis
a.Age
b.Family history, also Native Americans and persons of northern European heritage
c.Obesity, hyperlipidemia
d.Females, use of oral contraceptives
e.Conditions which lead to biliary stasis:  pregnancy, fasting, prolonged parenteral nutrition
f.Diseases including cirrhosis, ileal disease or resection, sickle-cell anemia, glucose intolerance

Manifestations of cholelithiasis
a.Many persons are asymptomatic
b.Early symptoms are epigastic fullness after meals or mild distress after eating a fatty meal
c.Biliary colic (if stone is blocking cystic or common bile duct): steady pain in epigastric or RUQ of abdomen lasting up to 5 hours with nausea and vomiting
d.Jaundice may occur if there is obstruction of common bile duct

Manifestations of acute cholecystitis
a.Episode of biliary colic involving RUQ pain radiating to back, right scapula, or shoulder; the pain may be aggravated by movement, or deep breathing and may last 12 – 18 hours
b.Anorexia, nausea, and vomiting
c.Fever with chills

Complications of cholecystitis
a.Chronic cholecystitis occurs after repeated attacks of acute cholecystitis; often asymptomatic
b.Empyema:  collection of infected fluid within gallbladder
c.Gangrene of gall bladder with perforation leading to peritonitis, abscess formation
d.Pancreatitis, liver damage, intestinal obstruction

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