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GALL BLADDER
Gallbladder, also known as the cholecyst, is a small hollow organ where bile is stored and concentrated before it is released into the small intestine.
It receives and stores bile, produced by the liver, via the common hepatic duct, and releases it via the common bile duct into the duodenum, where the bile helps in the digestion of fats.

CHOLECYSTITIS
Cholecystitis or infl ammation of the gallbladder may be acute, chronic, or acute superimposed on chronic. Though chronic is more common, acute cholecystitis is a surgical
Emergency.

CAUSES
SEVERE ILLNESS
BILE DUCT BLOCKAGE
INFECTION
TUMOR
GALLSTONES

TYPES OF CHOLECYSTITIS
CHRONIC ACUTE

CHRONIC CHOLECYSTITIS
Chronic cholecystitis is the commonest type of clinical gallbladder disease. Th ere is almost constant association of chronic cholecystitis with cholelithiasis.
PATHOGENESIS
The association of chronic cholecystitis with mixed and combined gallstones is virtually always present. However, it is not known what initiates the infl ammatory response in the gallbladder wall. Possibly, supersaturation of the bile with cholesterol predisposes to both gallstone formation and infl am mation. In some patients, repeated attacks of mild acute cholecystitis result in chronic cholecystitis.

GROSS IMAGE
Gross photo of a distended gallbladder with a thin wall and multiple intraluminal pigmented gallstones.

GROSS IMAGE
Gross photo of a contracted gallbladder with a thickened, fibrotic wall, roughened serosal adhesions and a single pigmented gallstone removed from its intraluminal location.

MORPHOLOGIC FEATURES
The gallbladder is generally contracted but may be normal or enlarged .
The wall of the gallbladder is thickened which
on cut section is grey-white due to dense fibrosis or may be even calcified.
The mucosal folds may be intact, thickened,
or flattened and atrophied.
The lumen commonly contains multiple mixed stones or a combined stone.

Chronic cholecystitis characterized by gallbladder wall thickening secondary to muscularis hypertrophy, with a dilated Rokitansky-Aschoff sinus and adjacent transmural lymphoid aggregate.
Chronic cholecystitis characterized by a thickened gallbladder wall secondary to muscularis hypertrophy with associated Rokitansky-Aschoff sinuses, chronic inflammation and inspissated bile.

HISTOLOGICAL MORPHOLOGY
1. Thickened and congested mucosa but occasionally mucosa may be totally destroyed.
2. Penetration of the mucosa deep into the wall of the gallbladder up to muscularis layer to form RokitanskyAschoff ’sinuses.
3. Variable degree of chronic infl ammatory reaction, consisting of lymphocytes, plasma cells and macro- phages, present in the lamina propria and subserosal layer.
4. Variable degree of fi brosis in the subserosal and subepithelial layers.

Chronic cholecystitis with pyloric gland metaplasia (left), a common form of mucosal metaplasia in this setting, and cholesterolosis (right) characterized by clusters of foamy macrophages in superficial lamina propria.
The hyalinizing cholecystitis variant of chronic cholecystitis, characterized by effacement of normal gallbladder wall structures by laminar, paucicellular hyaline fibrosis with patchy lymphoplasmacytic inflammation.

A few morphologic variants of chronic chole cystitis are
considered below:
Cholecystitis glandularis, when the mucosal folds fuse
together due to infl ammation and result in formation of
crypts of epithelium buried in the gallbladder wall.
 Porcelain gallbladder is the pattern when the gallbladder
wall is calcifi ed and cracks like an egg-shell.
 Acute on chronic cholecystitis is the term used for the
morphologic changes of acute cholecystitis superimposed
on changes of chronic cholecystitis.

Mucosal atrophy with accessory peribiliary mucous glands and lamina propria fibrosis secondary to chronic cholecystitis.
Chronic cholecystitis with lamina propria based lymphoid aggregates and focal intestinal metaplasia. There is no evidence of dysplasia.

Complications
If untreated, cholecystitis can lead to a number of serious complications, including:
Infection within the gallbladder. If bile builds up within your gallbladder, causing cholecystitis, the bile may become infected.
Death of gallbladder tissue. Untreated cholecystitis can cause tissue in the gallbladder to die (gangrene). It's the most common complication, especially among older people, those who wait to get treatment and those with diabetes. This can lead to a tear in the gallbladder, or it may cause your gallbladder to burst.
Torn gallbladder. A tear (perforation) in your gallbladder may result from gallbladder swelling, infection or death of tissue.

PREVENTION
You can reduce your risk of cholecystitis by taking the following steps to prevent gallstones:
Lose weight slowly. Rapid weight loss can increase the risk of gallstones.
Maintain a healthy weight. Being overweight makes you more likely to develop gallstones. To achieve a healthy weight, reduce calories and increase your physical activity. Maintain a healthy weight by continuing to eat well and exercise.
Choose a healthy diet. Diets high in fat and low in fiber may increase the risk of gallstones. To lower your risk, choose a diet high in fruits, vegetables and whole grains.

DIAGONISTIC
To diagnose cholecystis, your health care provider will likely do a physical exam and discuss your symptoms and medical history. Tests and procedures used to diagnose cholecystitis include:
Blood tests. Your health care provider may order blood tests to look for signs of an infection or signs of gallbladder problems.
Imaging tests that show your gallbladder. Abdominal ultrasound, endoscopic ultrasound, computerized tomography (CT) scan or magnetic resonance cholangiopancreatography (MRCP) can be used to create pictures of your gallbladder and bile ducts. These pictures may show signs of cholecystitis or stones in the bile ducts and gallbladder.
A scan that shows the movement of bile through your body. A hepatobiliary iminodiacetic acid (HIDA) scan tracks the production and flow of bile from your liver to your small intestine. A HIDA scan involves injecting a radioactive dye into your body, which attaches to bile-producing cells. During the scan, the dye can be seen as it travels with the bile through the bile ducts. This can show any blockages.

CLINICAL FEATURES
Vomiting
Tenderness over your abdomen when it's touched
Nausea
Pain that spreads to your right shoulder or back
Severe pain in your upper right or center abdomen
FEVER

TREATMENT
Treatment for cholecystitis usually involves a hospital stay to control the inflammation in your gallbladder. Sometimes, surgery is needed.
At the hospital, your health care provider will work to control your symptoms. Treatments may include:
Fasting. You may not be allowed to eat or drink at first in order to take stress off your inflamed gallbladder.
Fluids through a vein in your arm. This treatment helps prevent dehydration.
Antibiotics to fight infection. If your gallbladder is infected, your provider likely will recommend antibiotics.
Pain medications. These can help control pain until the inflammation in your gallbladder is relieved.
Procedure to remove stones. You may have a procedure called an endoscopic retrograde cholangiopancreatography (ERCP). During this procedure that uses dye to highlight the bile ducts, instruments can be used to remove stones blocking the bile ducts or cystic duct.

TREATMENT
Gallbladder drainage. In some cases, such as when surgery to remove the gallbladder is not an option, gallbladder drainage (cholecystostomy) may be done to remove infection. Drainage is done through the skin on the abdomen (percutaneous) or by passing a scope through the mouth (endoscopic).
Your symptoms are likely to decrease in 2 to 3 days. However, gallbladder inflammation often returns. Most people with cholecystitis eventually need surgery to remove the gallbladder.
Gallbladder removal surgery
The procedure to remove the gallbladder is called a cholecystectomy. Usually, this is a minimally invasive procedure, involving a few tiny cuts (incisions) in your abdomen (laparoscopic cholecystectomy). An open procedure, in which a long incision is made in your abdomen, is rarely required.
The timing of surgery depends on the severity of your symptoms and your overall risk of problems during and after surgery. If you're at low surgical risk, surgery may be performed during your hospital stay.
Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder. Even without your gallbladder you can still digest food.