150. Diseases of the gallbladder and bile ducts (cholecystitis, cholangitis, cholestasis) - etiology, pathogenesis, clinical manifestations.

Diseases of the gallbladder and bile ducts (cholecystitis, cholangitis, cholestasis) - etiology, pathogenesis, and clinical manifestations.

Cholecystitis

Etiology

• Gallstones (calculous cholecystitis) —most common cause (>90%).
• Acalculous cholecystitis (no stones) —critical illness, trauma, burns, sepsis.

Pathogenesis

1. Cystic duct obstruction by gallstone → bile stasis.
2. Increased intraluminal pressure → ischemia of gallbladder wall.
3. Secondary bacterial infection (e.g., E. coli, Enterococcus, Klebsiella) → further inflammation.

Clinical manifestations

• Right upper quadrant (RUQ) pain (steady, may radiate to right shoulder).
• Fever.
• Nausea, vomiting.
• Positive Murphy’s sign (pain and inspiratory arrest during deep palpation in RUQ).

Cholangitis - infm of bile duct

Etiology

• Ascending bacterial infection due to bile duct obstruction:
• Choledocholithiasis (stone in common bile duct).
• Biliary strictures (post- surgery, primary sclerosing cholangitis).
• Tumors (cholangiocarcinoma, pancreatic cancer).

Pathogenesis

1. Obstruction of common bile duct → increased biliary pressure.
2. Bacterial ascent from duodenum → infection of intrahepatic and extrahepatic ducts.
3. Inflammation and potential systemic spread (sepsis).

Clinical manifestations

• Charcot’s triad:
• RUQ pain.
• Fever with chills.
• Jaundice.
• Reynolds’ pentad (if severe with sepsis):
• Charcot’s triad plus hypotension and mental confusion.