What causes chronic cholecystitis?

Bacterial infection

Bacterial infection is one of the most important etiological factors of chronic acalculous cholecystitis. Sources of infection can be diseases of the nasopharynx and paranasal sinuses (chronic tonsillitis, sinusitis); oral cavity (stomatitis, gingivitis, periodontitis); urinary system (cystitis, pyelonephritis); sexual system (prostatitis, urethritis); gynecological diseases (adnexitis, endometritis); infectious diseases of the intestine; viral liver damage.

Infection penetrates into the gallbladder in three ways:

• hematogenous (from a large circle of blood circulation along the hepatic artery, from which the vesicle artery flows);
• ascending (from the intestine); The penetration of infection in this way contributes to the deficiency of the sphincter of Oddi, gastric hypoecretion, syndromes of maldigestia and malabsorption);
• lymphogenous (by lymphatic pathways from the intestine, genital area, hepatic and peritoneal pathways).

The most frequent pathogens causing chronic cholecystitis are E. Coli and enterococcus (mainly with the ascending pathway of gallbladder infection); Staphylococci and streptococci (with hematogenous and lymphatic pathways of infection); very rarely Proteus, sticks of typhoid and paratyphoid, yeast fungi. In 10% of cases, the cause of chronic cholecystitis are hepatitis B and C viruses, as evidenced by clinical observations and data of the morphological study of the gallbladder, confirming the possibility of developing chronic cholecystitis after acute acute hepatitis B and C. Quite often the cause of chronic acalculous cholecystitis is penetration into the biliary a bladder of mixed microflora.

[1], [2], [3]

Parasitic infestation

Some researchers point to the possible role of opisthorchiasis in the development of chronic acalculous cholecystitis. Opisthorchiasis can affect both the gallbladder and hepatic tissue with the development of intrahepatic cholestasis and reactive inflammation. In rare cases, the cause of chronic stone-free cholecystitis is ascariasis.

Until now, there is no consensus on the role of lamblia in the development of chronic acalculous cholecystitis. AL Myasnikov, NL Dehkan-Khodzhaeva considered lambliasis a possible cause of chronic effeminate cholecystitis. It is believed that Giardia is a disease that occurs at a subclinical level. Giardia can cause a decrease in the defenses of the body, functional disorders of the biliary tract, 4-5 times increase the pathogenic properties of Escherichia coli. Many researchers believe that the role of lamblia in the etiology of chronic cholecystitis is questionable, since giardia in bile can not last long, they die. It is possible that lamblia, found in the vesicle and hepatic bile, comes from the duodenum. It is believed that lambliasis cholecystitis does not exist. Convincing morphological data on the penetration of lamblia into the wall of the gallbladder is not, and this is the main argument against giardiasis cholecystitis.

But this does not mean that giardia does not play a role in the development of chronic acalculous cholecystitis. Probably, it is more correct to consider that lamblia contribute to the development of chronic cholecystitis.

Duodenobiliary reflux

Duodenobiliary reflux develops with chronic duodenal stasis with increased pressure in the duodenum, deficiency of the sphincter of Oddi, chronic pancreatitis. With the development of duodenobiliary reflux, duodenal contents are thrown with activated pancreatic enzymes, which leads to the development of non-bacterial "enzymatic", "chemical" cholecystitis.

In addition, duodenobiliary reflux promotes stagnation of bile and infection in the gallbladder.

[4], [5], [6]

Allergy

It is known that food and bacterial allergens can cause the development of chronic cholecystitis, which is confirmed by the morphological detection of signs of inflammation and eosinophils in the gallbladder wall, while at the same time there is no bacterial infection (toxic-allergic cholecystitis).

[7], [8]

Chronic inflammatory diseases of the digestive system

Chronic hepatitis, liver cirrhosis, chronic diseases of the intestine, pancreas are very often complicated by the development of chronic cholecystitis, since they contribute firstly to penetration into the gallbladder infection, and secondly, the inclusion of pathogenetic factors of chronic cholecystitis. Particularly important are the diseases of the choledocho-duodenopancreatic zone.

[9], [10], [11], [12]

Acute cholecystitis

The previously transferred acute cholecystitis may in some cases lead to the development of chronic cholecystitis.

[13], [14]

Predisposing factors

The development of chronic cholecystitis is facilitated by the following factors:

1. Bile stasis, which can be due to:
   • dyskinesia of the biliary tract, primarily hypomotor hypotension;
   • obesity and pregnancy (these conditions increase intra-abdominal pressure and complicate the outflow of bile from the gallbladder);
   • psychoemotional stressful situations (at the same time dyskinesias of bile ducts develop);
   • violation of the diet (eating helps to empty the gallbladder, rare meals predispose to stagnation of bile in the bladder); the abuse of fatty and fried foods causes spasms sphincters of Oddi and Lutkens and hypertonic dyskinesia of the bile ducts;
   • lack or insufficient maintenance of plant fiber (coarse fibers), which are known to contribute to the liquefaction of bile and the emptying of the gallbladder;
   • hypokinesia;
   • congenital anomalies of the gallbladder.
2. Reflex influences from the abdominal organs with the development of inflammatory processes in them (chronic pancreatitis, colitis, gastritis, peptic ulcer, etc.). This leads to the development of dyskinesia biliary tract and congestion of bile in the gallbladder.
3. Dysbacteriosis of the intestine. With dysbacteriosis of the intestine, favorable conditions are created for the infection to ascend the pathway into the gallbladder.
4. Metabolic disorders that contribute to changes in physico-chemical properties and composition of bile (obesity, diabetes, hyperlipoproteinemia, gout, etc.).
5. Hereditary complication with chronic cholecystitis.