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What provokes acute cholecystitis?
Last reviewed: 23.04.2024
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[Pathogenesis of acute cholecystitis
In 96% of cases, the disease begins with obturation of the cystic duct with stone, stasis of bile and irritation of the gallbladder wall. Lipids can penetrate through the sinuses of Rokitansky-Ashoff and also cause irritation. By increasing the pressure in the cavity of the gallbladder, the blood vessels of its wall are pinched, which can lead to a heart attack and gangrene.
Obturation of the common biliary and pancreatic ducts causes the regurgitation of pancreatic enzymes, which explains some cases of development of acanthine-free acute cholecystitis.
An important role in the pathogenesis of the disease is infection. Bacteria deconjugate bile salts with the formation of toxic bile acids, which damage the mucous membrane of the gallbladder.
Pathomorphology
The gallbladder is dull, grayish-red, with richly vascularized adhesions to surrounding tissues. The gallbladder is usually stretched, but as the inflammation subsides, its wall contracts and thickens. The cavity of the gallbladder contains a cloudy liquid or pus (empyema of the gallbladder), the neck can be obturated with a stone.
Histologically, hemorrhages and moderate edema, most pronounced on the 4th day and decreasing to the 7th day, are detected. As far as the resolution of acute inflammation develops fibrosis.
The lymph nodes around the cervix of the gallbladder and along the common bile duct are enlarged.
Bacteriological study. The intestinal microflora is usually sown from the wall of the gallbladder and the bile contained in it (approximately 75% of the cases are anaerobes).