1. Gallstone Disease

2. Definitions
Acute calculous cholecystitis = occlusion of the cystic duct by gallstone leading to gallbladder inflammation
Chronic calculous cholecystitis = recurrent episodes of cystic duct obstruction leading to chronic inflammation

3. Bile
Bile
Bile salts
Phospholipids
Cholesterol

4. Types of Gallstones Mixed (80%) Pure cholesterol (10%) Pigmented (10%)
Black stones (associated with cirrhosis and hemolysis)

5. Gallstone Pathogenesis
(1) cholesterol supersaturation in bile (2) Reduced bile salts-illeal resection (3) Increased hemolysis ,

6. Gallstone Risk Factors
“Female, Fat, Forty, Fertile”
Obesity
Fatty diet DM
Ileal resection
Hemolytic states
Cirrhosis
Bile duct stasis
Hyperlipidemia

7. Gallstone Complications
Gallstone ileus
gallstone pancreatitis
Acute cholecystitis
GB gangrene
GB perforation
GB empyema (pus in the GB)
Choledochohlithiasis
Cirrhosis
Cholangitis
Pancreatitis

8. Diagnostic Criteria for Acute Cholecystitis, According to Tokyo Guidelines
Table 1. Diagnostic Criteria for Acute Cholecystitis, According to Tokyo Guidelines.
Strasberg S. N Engl J Med 2008;358:

9. Cholecystitis: Management
NPO, IVF, IV antibiotics
Non-operative
Operative: cholecystectomy