Acute Cholecystitis: Pathogenesis and clinical findings
Gallstone blocks the cystic duct, backing up bile into the gallbladder
Gallstones causing physical trauma to gallbladder wall
Irritation of adjacent diaphragm, stimulates phrenic nerve (C3-C5)
Activates stretch receptors of visceral peritoneum, stimulates foregut autonomic nerves (T5-T8)
Inflammatory mediator (i.e. prostaglandin) release by gallbladder and systemic inflammatory response
Thickened gallbladder wall on ultrasound (gold standard test)
On inspiration, the diaphragm pushes the gallbladder downward
Irritation of parietal peritoneum, stimulates somatic nerves
↑ Permeability of vessels with systemic inflammation, which leak
fluid from the blood into the interstitial space
Radiating pain to the back and right shoulder
Dull, diffuse abdominal pain referred to the epigastric region
Fever, nausea/vomiting, tachycardia
Positive Murphy’s sign (pain upon palpation of right upper quadrant [RUQ] on inspiration)
Persistent RUQ pain, abdominal guarding and peritoneal signs
Dehydration
Authors: Yan Yu, Vina Fan Reviewers: Dean Percy, Mirna Matta, Crystal Liu, Ben Campbell Maitreyi Raman* * MD at time of publication
Inflammation self-perpetuates
Irritation of inner gallbladder wall/mucosa
↑ Gallbladder lumen pressure
Intraluminal pressure exceeds arterial pressure
↓ Blood flow to gallbladder
Gallbladder ischemia
Local inflammation, loss of gallbladder mucosal integrity
Bacterial invasionàtransmural inflammation of gallbladder
Without treatment, prolonged ischemia and inflammation of the gallbladder
Gallbladder gangrene (20%)
Gallbladder perforation (20%)
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published August 4 2019, updated May 16 2022 on www.thecalgaryguide.com