Cholecystitis

Frequently asked questions

What are the morphological forms of acute cholecystitis in pathology?

Pathology distinguishes the following morphological forms of acute cholecystitis:

• Catarrhal.
• Fibrinous — a fibrinous exudate forms on the mucosal surface with possible foci of necrosis.
• Purulent (phlegmonous) — characterized by neutrophilic infiltration of the wall, possible abscess formation, and purulent exudate in the lumen.
• Gangrenous — may be accompanied by mucosal ulceration, sloughing membranes, and gas accumulation in the gallbladder wall.
• Eosinophilic — a rare form in which more than 90% of the leukocytes in the infiltrate are eosinophils.

What are Rokitansky-Aschoff sinuses?

Rokitansky-Aschoff sinuses (Rokitansky–Aschoff sinuses) are cystic epithelial outpouchings extending into the muscular layer of the gallbladder wall. They form as a result of epithelial and smooth muscle hyperplasia, leading to organ wall thickening. Small gallstones may form within these spaces. These structures are a hallmark of gallbladder adenomyomatosis and are also identified during microscopic examination in chronic cholecystitis alongside mucosal atrophy, lymphomacrophagic infiltration, and sclerosis.

What are the main etiologic factors of acute cholecystitis?

The primary causes of acute cholecystitis are cholelithiasis and superimposed infection. The following etiologic factors are distinguished:

• Cholelithiasis — the main cause, leading to bile outflow obstruction by a calculus and smooth muscle spasm.
• Infection — bacterial agents entering via ascending or descending routes.
• Enzymatic injury — reflux of pancreatic juice into the gallbladder causing mucosal damage.
• Parasitic infestation — infection with helminths (e.g., Ascaris).
• Viral etiology — viral involvement established in recent studies.
• Other factors — toxic and allergic influences.

What is the mechanism of obstructive jaundice in complicated cholecystitis?

The mechanism of obstructive (extrahepatic) jaundice in complicated cholecystitis is based on impaired bile outflow into the duodenum. The obstruction can result from biliary tract blockage by gallstones in cholelithiasis or extrinsic compression due to acute cholecystitis with a pericholecystic inflammatory process. Pathogenesis includes the following stages:

• Impaired transport — caused by biliary tract obstruction.
• Biliary system engorgement — accumulation of bile in proximal segments.
• Biliary hypertension — increased pressure in bile canaliculi.
• Capillary damage — stretching and rupture of their walls.

Prolonged ductal hypertension causes epithelial proliferation, further exacerbating cholestasis.

What is the primary cause of chronic cholecystitis?

The chronic form of the disease develops as a direct consequence of preceding acute cholecystitis.

Why is gallbladder empyema dangerous?

Empyema occurs due to cystic duct obstruction, leading to pus accumulation within the organ cavity and a high risk of perforation.

Which cells appear in the infiltrate during an exacerbation of chronic cholecystitis?

During an exacerbation, leukocytes are added to the cellular infiltrate.