Acute Cholecystitis & Cholangitis

About Acute Cholecystitis & Cholangitis

Acute cholecystitis is inflammation of the gallbladder wall, typically caused by gallstone obstruction of the cystic duct, while cholangitis is infection and inflammation of the bile ducts. Both conditions represent serious biliary emergencies that require prompt recognition and treatment to prevent life-threatening complications including sepsis, perforation, and biliary cirrhosis.

Pathophysiology

Cholecystitis develops when gallstones or biliary sludge obstruct the cystic duct, causing gallbladder distension, ischemia, and secondary bacterial infection. Cholangitis occurs when bacteria ascend from the duodenum or spread hematogenously to infected bile ducts, often in the setting of biliary obstruction from stones, strictures, or malignancy, creating the classic Charcot's triad of fever, jaundice, and right upper quadrant pain.

Clinical Reasoning

Diagnosis relies on clinical presentation, laboratory findings including elevated inflammatory markers and liver enzymes, and imaging studies such as ultrasound or MRCP to identify gallbladder wall thickening, ductal dilatation, or obstructing stones. Early recognition is crucial as both conditions can rapidly progress to septic shock, requiring immediate broad-spectrum antibiotics, biliary decompression via ERCP or percutaneous drainage, and surgical intervention when indicated.