1. Dr. Samina Qamar FCPS Histopathology
Basic Pathology
Dr. Samina Qamar
FCPS Histopathology

2. CHRONIC CHOLECYSTITIS

3.  The opened gallbladder contains a single large gallstone • The wall of the gallblader is thickened • The mucosal lining has lost all of its normal appearance with the shaggy roughened surface indicating extensive necrosis and ulceration

4. CHRONIC CHOLECYSTITIS
Etiology •Unknown
Pathogenesis •The pathogenesis of chronic cholecystitis is not well understood. •There may be a history of repeated attacks of acute cholecystitis. •However, in many instances, it appears to arise without any antecedent disease. •In one-third to one-quarter of cases, bacteria may be cultured from the fluids from within the gall bladder.

5. CHRONIC CHOLECYSTITIS
Epidemiology •Chronic cholecystitits occurs in the same age group as acute cholecystitis, predominantly women in the year age group.
Fat, fertile, female, forty.
•This is almost always associated with cholelithiasis.

6. CHRONIC CHOLECYSTITIS
Clinical •May be aymptomatic or present as acute cholecystitis on a background of chronic disease.
•Other manifestations may be of biliary colic (due to the stones invariably present with chronic cholecystitis), fistula formation, hydrops of the gallbladder or perforation.

7. CHRONIC CHOLECYSTITIS
General Gross Description •Grossly, the gall bladder may be enlarged, normal in size, or shrunken.
•This serosa also shows evidence of prior inflammatory processes in the form of fibrin or fibrous deposition.
•The wall is often thickened 2-3 times normal size.

8. CHRONIC CHOLECYSTITIS
General Micro Description •Microscopically, the walls shows involvement of chronic inflammation in the form of macrophages, lymphocytes and plasma cells.
•Outpouchings of the mucosa through the muscle of the gall bladder wall (Rokitansky - Aschoff Sinuses) are a characteristic, but not diagnostic, feature of chronic cholecystitis

10. Inflammatory cells

11. Plasma Cell

12. Macrophage

13. Lymphocyte

14. Acute appendicitis

15. Acute appendicitis-Whole mount view

16. Acute appendicitis

17. Appendix

18. Acute appendicitis

19. Acute Appendicitis

20. Neutrophil

21. Acute appendicitis

22. GANGRENE FOOT

23. WET GANGRENE

24. GANGRENE /MICROSCOPIC VIEW

25. GANGRENE

26. GANGRENE

27. THANK YOU