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Difference between revisions of "Chronic cholecystitis"
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Chronic cholecystitis (view source)
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Gallbladder_cholesterolosis_micro.jpg | |||
| Width = | |||
| Caption = Gallbladder cholesterolosis - often seen together with chronic cholecystitis. [[H&E stain]]. | |||
| Micro = entrapped epithelial crypts, fibrosis/muscular hypertrophy of gallbladder wall, +/-foamy macrophages | |||
| Subtypes = | |||
| LMDDx = [[acute cholecystitis]], [[gallbladder adenocarcinoma]], [[gallbladder adenomyoma]], [[intestinal metaplasia of the gallbladder]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = +/-strawberry-like appearance, yellow stones, fibrotic wall | |||
| Grossing = | |||
| Site = [[gallbladder]] | |||
| Assdx = [[obesity]] | |||
| Syndromes = | |||
| Clinicalhx = biliary colic, usu. fertile fat females forty years or less | |||
| Signs = | |||
| Symptoms = constant right upper quadrant pain after a meal (biliary colic) | |||
| Prevalence = very common | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = good, benign | |||
| Other = | |||
| ClinDDx = | |||
}} | |||
'''Chronic cholecystitis''', abbreviated '''CC''', is a very common pathology of the [[gallbladder]] and increasing in prevalence with the expanding waist lines. | |||
==General== | |||
===Epidemiology=== | |||
*Female, [[obese|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.<ref name=pmid21879282>{{Cite journal | last1 = Kim | first1 = HJ. | last2 = Park | first2 = JH. | last3 = Park | first3 = DI. | last4 = Cho | first4 = YK. | last5 = Sohn | first5 = CI. | last6 = Jeon | first6 = WK. | last7 = Kim | first7 = BI. | last8 = Choi | first8 = SH. | title = Clinical usefulness of endoscopic ultrasonography in the differential diagnosis of gallbladder wall thickening. | journal = Dig Dis Sci | volume = 57 | issue = 2 | pages = 508-15 | month = Feb | year = 2012 | doi = 10.1007/s10620-011-1870-0 | PMID = 21879282 }}</ref> | |||
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.<ref name=pmid21879282/> | |||
==Microscopic== | |||
Features:<ref name=Ref_GLP439>{{Ref GLP|439}}</ref> | |||
*Thickening of the gallbladder wall - due to fibrosis/muscular hypertrophy - '''key feature'''. | |||
*Chronic inflammatory cells - usu. "minimal". | |||
**Lymphocytes - most common. | |||
*Rokitansky-Aschoff sinuses - common.<ref>URL: [http://www.whonamedit.com/synd.cfm/983.html http://www.whonamedit.com/synd.cfm/983.html]. Accessed on: 29 October 2011.</ref> | |||
**Entrapped epithelial crypts -- pockets of epithelium in the wall of the gallbladder. | |||
*+/-Foamy macrophages in the lamina propria ([[cholesterolosis of the gallbladder]]). | |||
DDx: | |||
*[[Gallbladder adenomyoma]]. | |||
*[[Acute cholecystitis]] - more inflammation, lack Rokitansky-Aschoff sinuses, +/-mucosal erosions. | |||
*Cholecystectomy for [[gallstone pancreatitis]] - intraepithelial [[neutrophil]] clusters common, history essential. | |||
*[[Intestinal metaplasia of the gallbladder]] - goblet cells present, may be focal. | |||
*[[Gallbladder adenocarcinoma]]. | |||
==Sign out== | |||
<pre> | |||
GALLBLADDER, CHOLECYSTECTOMY: | |||
- CHRONIC CHOLECYSTITIS. | |||
- CHOLELITHIASIS. | |||
</pre> | |||
===Liver present=== | |||
<pre> | |||
GALLBLADDER, CHOLECYSTECTOMY: | |||
- CHRONIC CHOLECYSTITIS. | |||
- CHOLELITHIASIS. | |||
- SMALL AMOUNT OF LIVER WITHOUT APPARENT PATHOLOGY. | |||
</pre> | |||
===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== | |||
*[[Acute cholecystitis]]. | |||
*[[Gallbladder]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Gallbladder]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||