Difference between revisions of "Chronic cholecystitis"

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#redirect [[Gallbladder#Chronic_cholecystitis]]
{{ 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]]

Revision as of 15:13, 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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