Pathophysiology
Clinical meaning
Cholecystitis pathogenesis involves gallstone impaction in the cystic duct (90% of cases) leading to bile stasis, intraluminal pressure elevation, mucosal ischemia, and inflammatory cascade activation. Prostaglandins and lysolecithin released from damaged mucosa propagate inflammation. Secondary bacterial infection occurs in 50-75% of cases. Complications include empyema (pus-filled gallbladder), gangrenous cholecystitis, perforation with peritonitis, cholecystoenteric fistula, and gallstone ileus. The clinician must formulate the differential diagnosis, order and interpret imaging and labs, prescribe empiric antibiotics, manage pain, and coordinate surgical timing.