Causes of Cholecystitis
The causes of cholecystitis, or inflammation of the gallbladder, can vary significantly. Cases are often categorized into acute and chronic types, which are explained in further detail below:
- Acute Cholecystitis: This condition appears suddenly and leads to intense pain in the upper abdomen, typically manifesting abruptly.
- Chronic Cholecystitis: This form of cholecystitis occurs repeatedly and is accompanied by swelling and enlargement of the gallbladder over time. In most cases, chronic cholecystitis arises from recurrent episodes of acute cholecystitis, often instigated by gallstones which are the primary cause of acute inflammation. The repeated acute episodes can thicken the gallbladder wall, resulting in its contraction and a consequent reduction in its effectiveness for storing and excreting bile.
Gallstones
Inflammation due to gallstones is known as Calculous Cholecystitis. As previously noted, gallstones represent the most common cause of cholecystitis. It is noteworthy that this cause is generally considered less severe than other potential triggers. The mechanism by which gallstones induce inflammation involves the obstruction of the cystic duct, which carries bile from the gallbladder to the common bile duct. This blockage prevents bile from being emptied, leading to accumulation and increased pressure within the gallbladder, ultimately causing inflammation. In some cases, this inflammation may be complicated by bacterial infection.
Additionally, it is important to recognize the potential for inflammation to occur due to biliary sludge, a mixture of bile and small cholesterol crystals that can also block bile flow.
Other Causes
Acalculous Cholecystitis refers to inflammation of the gallbladder that occurs in the absence of gallstones. This form is rarer and generally more serious than calculous cholecystitis, indicating inflammation without stones, although biliary sludge may be present. Chronic illness or trauma often precipitates acalculous cholecystitis, which can occur due to:
- Major surgical procedures.
- Serious medical conditions such as severe lacerations, extensive burns, sepsis, or systemic infections.
- Prolonged periods of fasting or food deprivation.
- Immunodeficiency conditions.
- Extended intravenous feeding.
- Vasculitis, which can disrupt blood flow to the gallbladder due to conditions like polyarteritis nodosa or systemic lupus erythematosus.
- Tumors, which may obstruct bile flow and lead to accumulation and inflammation in the gallbladder.
- Scarring of the bile ducts, impeding bile flow and causing inflammation.
- Viral infections that may trigger episodes of cholecystitis, including human immunodeficiency virus (HIV), which can lead to AIDS.
Risk Factors for Cholecystitis
Given that gallstones are the most significant risk factor for cholecystitis, understanding the factors that contribute to gallstone formation can also shed light on the prevalence of cholecystitis. While it may be challenging to pinpoint every factor promoting gallstone development, the following key factors are widely recognized:
- Genetic history, particularly maternal lineage, as familial ties may increase susceptibility to gallstones.
- Diabetes mellitus.
- Kidney failure or end-stage renal disease.
- Hyperlipidemia or elevated lipid levels in the body.
- Rapid weight loss.
- Obesity.
- Older age.
- Pregnancy.
- Inflammatory bowel disease, such as Crohn’s disease.
- Coronary artery disease.
- Prolonged labor during childbirth, which may increase the risk of gallbladder damage and subsequent inflammation in the weeks following delivery.