Clinical meaning
Cholecystitis pathogenesis involves gallstone impaction in the cystic duct (90% of cases) leading to bile stasis, intraluminal pressure elevation, mucosal ischemia, and inflammatory cascade activation. Prostaglandins and lysolecithin released from damaged mucosa propagate inflammation. Secondary bacterial infection occurs in 50-75% of cases. Complications include empyema (pus-filled gallbladder), gangrenous cholecystitis, perforation with peritonitis, cholecystoenteric fistula, and gallstone ileus. The clinician must formulate the differential diagnosis, order and interpret imaging and labs, prescribe empiric antibiotics, manage pain, and coordinate surgical timing.
Diagnosis & workup
Diagnostics & workup: - Order RUQ ultrasound as first-line imaging: sensitivity >95% for gallstones - Order HIDA scan (cholescintigraphy) if US equivocal: non-filling of gallbladder confirms cystic duct obstruction - Order CBC with differential: leukocytosis >12,000 with left shift - Order CMP including LFTs: elevated ALP, GGT; elevated direct bilirubin if CBD involvement - Order lipase to rule out concurrent gallstone pancreatitis - Consider MRCP or EUS if CBD stone suspected before surgical referral - Order blood cultures if sepsis suspected