GB and Bile Ducts

  • Asymptomatic 
  • Biliary Colic (1-4 % annual incidence)
  • Acute Cholecystitis (20 % of the symptomatic patients if left untreated)
    • In small number of patients, Acute cholecystitis can coexist with 
      • Choledocholithiasis
      • Cholangitis
      • Gallstone pancreatitis

Acute Calculous Cholecystitis 
  • Pathogenesis
    • Obstruction of the cystic duct in the presence of bile supersaturated with cholesterol.  Brief impaction may cause pain only, but if impaction is prolonged over many hours, inflammation can result. With inflammation, the gallbladder becomes enlarged, tense, and reddened, and wall thickening and an exudate of pericholecystic fluid may develop. The inflammation is initially sterile in most cases, but secondary infection with microorganisms in the Enterobacteriaceae family or with enterococci or anaerobes occurs in the majority of patients 
      • Gangrenous Cholecystitis: GB Wall may get gangrenous 
      • Emphysematous Chelecysitits: Gas forming organism causing superinfection

Gallstones BMJ 2014

Primary Sclerosing Cholangitis