PA24.8 | Cholelithiasis & Cholecystitis — Summary & Reflection

KEY TAKEAWAYS

Gallstones (Cholelithiasis)
• Cholesterol stones: supersaturation + stasis + nucleation; 5 Fs risk profile; radiolucent
• Black pigment stones: haemolysis/cirrhosis → excess unconjugated bilirubin; sterile bile; radiopaque
• Brown pigment stones: biliary infection → bacterial β-glucuronidase; soft, laminated; form in ducts

Cholecystitis
• Acute calculous: stone obstructs cystic duct → chemical irritation → ischaemia → secondary infection
• Acalculous: critically ill patients; ischaemia + stasis without stone
• Chronic: Rokitansky-Aschoff sinuses, fibrosis, metaplasia; porcelain gallbladder as endpoint

Complications cascade
Empyema → perforation → biliary peritonitis → mucocele → gallstone ileus (Rigler's triad)
Choledocholithiasis → obstructive jaundice → Charcot's triad (ascending cholangitis) → Reynolds' pentad → pancreatitis

Gallbladder carcinoma
Adenocarcinoma; stones + chronic inflammation → metaplasia → dysplasia → carcinoma; high incidence in India; poor prognosis

Key distinguishers: Murphy's sign (acute cholecystitis), Charcot's triad (ascending cholangitis), Rigler's triad (gallstone ileus)

REFLECT

Return to the patient in the opening hook — the 42-year-old woman with the classic 5 F profile.

1. She has cholesterol stones. Walk through all three pathogenic pillars (supersaturation, stasis, nucleation) and identify which F factors contribute to each pillar specifically.
2. On follow-up, she develops fever, rigors, and jaundice three weeks later. Which complication has supervened, and what is the anatomical pathway? What would you look for on blood tests?
3. Her mother also had gallbladder problems and died of a 'stomach tumour.' If your patient's ultrasound eventually shows a thickened, calcified gallbladder wall, what is the most appropriate management recommendation and why?

Discuss with a peer before your next tutorial. Use the complications schematic from this SDL to trace the pathological progression step by step.