Difference between revisions of "Chronic cholecystitis"

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DDx:
DDx:
*[[Gallbladder cholesterolosis]] and chronic cholecystitis.
*[[Gallbladder adenomyoma]].
*[[Gallbladder adenomyoma]].
*[[Acute cholecystitis]] - more inflammation, lack Rokitansky-Aschoff sinuses, +/-mucosal erosions.
*[[Acute cholecystitis]] - more inflammation, lack Rokitansky-Aschoff sinuses, +/-mucosal erosions.

Revision as of 15:19, 27 September 2013

Chronic cholecystitis
Diagnosis in short

Gallbladder cholesterolosis - often seen together with chronic cholecystitis. H&E stain.
LM entrapped epithelial crypts, fibrosis/muscular hypertrophy of gallbladder wall, +/-foamy macrophages
LM DDx acute cholecystitis, gallbladder adenocarcinoma, gallbladder adenomyoma, intestinal metaplasia of the gallbladder
Gross +/-strawberry-like appearance, yellow stones, fibrotic wall
Site gallbladder
Associated Dx obesity
Clinical history biliary colic, usu. fertile fat females forty years or less
Symptoms constant right upper quadrant pain after a meal (biliary colic)
Prevalence very common
Prognosis good, benign

Chronic cholecystitis, abbreviated CC, is a very common pathology of the gallbladder and increasing in prevalence with the expanding waist lines.

General

Epidemiology

  • Female, fat, fertile, family history, forty (though now getting younger... as people get fatter).

Etiology

  • Cholelithiasis.
  • Thick bile (acalculous cholecystitis).

Clinical (classic)

  • Constant right upper quadrant pain after a fatty meal.
  • Positive Murphy's sign (physical exam, with ultrasound).

Gross

  • +/-Cholelithiasis - strongly associated pathology.
  • +/-Strawberry-like appearance - common (due to gallbladder cholesterolosis).
    • Small ridges (microvillus architecture) + yellow.
      • Normal gallbladder mucosa = smooth, green.
  • +/-Congestion/erythema.
  • +/-Wall thickening - typically ~ 6-7 mm.[1]

Note:

  • Wall thickening (due to congestion/edema) is the important gross finding in acute cholecystitis.
  • Wall thickenss greater than 10 mm should raise the suspicion of malignancy.[1]

Microscopic

Features:[2]

  • Thickening of the gallbladder wall - due to fibrosis/muscular hypertrophy - key feature.
  • Chronic inflammatory cells - usu. "minimal".
    • Lymphocytes - most common.
  • Rokitansky-Aschoff sinuses - common.[3]
    • Entrapped epithelial crypts -- pockets of epithelium in the wall of the gallbladder.
  • +/-Foamy macrophages in the lamina propria (cholesterolosis of the gallbladder).

DDx:

Sign out

GALLBLADDER, CHOLECYSTECTOMY: 
- CHRONIC CHOLECYSTITIS. 
- CHOLELITHIASIS.

Liver present

GALLBLADDER, CHOLECYSTECTOMY: 
- CHRONIC CHOLECYSTITIS. 
- CHOLELITHIASIS.
- SMALL AMOUNT OF LIVER WITHOUT APPARENT PATHOLOGY.

Micro

The sections shows gallbladder wall with Rokitansky-Aschoff sinuses and a moderate mixed inflammatory infiltrate predominantly consisting of lymphocytes. No nuclear atypia is seen.

See also

References

  1. ↑ 1.0 1.1 Kim, HJ.; Park, JH.; Park, DI.; Cho, YK.; Sohn, CI.; Jeon, WK.; Kim, BI.; Choi, SH. (Feb 2012). "Clinical usefulness of endoscopic ultrasonography in the differential diagnosis of gallbladder wall thickening.". Dig Dis Sci 57 (2): 508-15. doi:10.1007/s10620-011-1870-0. PMID 21879282.
  2. ↑ Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 439. ISBN 978-0443066573.
  3. ↑ URL: http://www.whonamedit.com/synd.cfm/983.html. Accessed on: 29 October 2011.
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