Difference Between Cholecystitis and Cholelithiasis

Bile is a substance produced by the liver and stored in the gallbladder. It emulsifies the fat globules in the food we eat and enhances their water solubility and their absorption into the bloodstream. When the bile stored in the gallbladder is abnormally concentrated, some of its constituents can precipitate, forming stones inside the gallbladder. In medicine, this condition is identified as cholelithiasis. Cholelithiasis can inflame the tissues of the gallbladder. This inflammatory process happening inside the gallbladder is called cholecystitis. Thus, the key difference between cholecystitis and cholelithiasis is that cholecystitis is the inflammation of the gallbladder while cholelithiasis is the formation of gallstones. Cholecystitis is actually a complication of cholelithiasis which is either not diagnosed or not properly treated.

CONTENTS

1. Overview and Key Difference
2. What is Cholecystitis
3. What is Cholelithiasis
4. Similarities Between Cholecystitis and Cholelithiasis
5. Side by Side Comparison – Cholecystitis vs Cholelithiasis in Tabular Form
6. Summary

What is Cholecystitis?

The inflammation of the gallbladder is known as cholecystitis. In most occasions, this is due to an obstruction to the outflow of bile. Such an obstruction increases the pressure inside the gallbladder resulting in its distension which compromises the vascular supply to the gallbladder tissues.

Causes

• Gallstones
• Tumors in the gallbladder or biliary tract
• Pancreatitis
• Ascending cholangitis
• Trauma
• Infections in the biliary tree

Clinical Features

• Intense epigastric pain which radiates to the right shoulder or the back in the tip of the scapula.
• Nausea and vomiting
• Occasionally fever
• Abdominal bloating
• Steatorrhea
• Jaundice
• Pruritus

Investigations

• Liver function tests
• Full blood count
• USS
• CT scan is also performed sometimes
• MRI

Management

As in chronic pancreatitis, the treatment of gallbladder attacks also varies according to the underlying cause of the disease.

Lifestyle changes such as getting rid of obesity can be helpful in reducing the risk of gallbladder diseases.

Controlling the pain and minimizing the patient’s discomfort is the first part of the management. Strong analgesics like morphine may even be required in the most severe cases. Since inflammation of the gallbladder is the pathological basis of the disease, anti-inflammatory drugs are given to control the inflammation. If the obstruction in the biliary tree is due to a tumor, surgical resection of it should be carried out.

Complications

• Peritonitis due to perforation and the leakage of pus
• Intestinal obstruction
• Malignant transformation

What is Cholelithiasis?

Due to the increase in the concentration of bile, some of its constituents can precipitate inside the gallbladder forming gallstones. This condition is clinically identified as cholelithiasis.

Risk Factors for Cholelithiasis

• Advancing age
• Female gender
• Obesity
• Metabolic syndrome
• Inborn errors of metabolism
• Hyperlipidemia syndromes
• Different gastrointestinal diseases such as Crohn’s disease

Pathogenesis

Depending on the constituent that is precipitated during the formation of the gallstones, they are categorized into 2 main categories as cholesterol stones and pigment stones.

Cholesterol Stones

The formation of cholesterol stones is due to the following pathological conditions

• Supersaturation of bile with cholesterol
• Hypomotility of the gallbladder
• Accelerated cholesterol crystal nucleation
• Hypersecretion of mucus in the gallbladder

Pigment Stones

Pigment stones can be considered as a mixture of insoluble calcium salts and unconjugated bilirubin. Therefore, any condition that increases the amount of unconjugated bilirubin such as chronic hemolytic anemia increases the risk of getting pigment stones in the gallbladder. Infection of the biliary tract by certain pathogens including E.Coli and Ascaris lumbricoides is also known to predispose the formation of gallstones via the same mechanism.

Clinical Features

Gallstones can remain asymptomatic for a long period of time.

• The most prominent clinical feature of this condition is the biliary colic. Following a fatty meal due to the increase in the pressure inside the gallbladder, the patient feels an intense pain in the epigastric or right hypochondriac regions of the abdomen that can occasionally radiate to the shoulder or back.
• The subsequent inflammatory reactions taking place inside the gallbladder due to the presence of gallstones can give rise to other non -specific symptoms such as nausea, vomiting, loss of weight and appetite and etc.
• There can be jaundice which is the yellowish discoloration of the skin
• Steatorrhea and dark color urine are the other common manifestations

Investigations

• Abdominal USS
• ERCP
• Liver function tests and other blood tests

Management

The choice of medical treatments or surgical treatments depends on the severity of the symptoms.

• Oral bile acids can be given to dissolve the gallstones by diluting them.
• Extracorporeal Shock Wave Lithotripsy
• Percutaneous cholecystostomy
• The surgical removal of gallbladder is called cholecystectomy

Complications

• Perforation
• Peritonitis
• Fistulas
• Cholangitis
• Pancreatitis
• Gallbladder carcinoma

 What are the Similarities Between Cholecystitis and Cholelithiasis?

• Both conditions are associated with the gallbladder

• The prominent feature of both diseases is the severe pain which arises in the epigastric region that sometimes radiates to the back or shoulder.

What is the Difference Between Cholecystitis and Cholelithiasis?

Summary – Cholecystitis vs Cholelithiasis

Due to the increase in the concentration of bile, some of its constituents can precipitate inside the gallbladder forming gallstones. This condition is clinically identified as cholelithiasis. Cholecystitis, on the other hand, is the inflammation of the gallbladder. Cholecystitis is a complication of cholelithiasis. This is the difference between cholecystitis and cholelithiasis.

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References:

1. Kumar, Parveen J., and Michael L. Clark. Kumar & Clark clinical medicine. Edinburgh: W.B. Saunders, 2009.
2. Kumar, Vinay, Stanley Leonard Robbins, Ramzi S. Cotran, Abul K. Abbas, and Nelson Fausto. Robbins and Cotran pathologic basis of disease. 9th ed. Philadelphia, Pa: Elsevier Saunders, 2010.

Image Courtesy:

1. “Chronic recurrent cholecystitis, HE 4” By Patho – Own work (CC BY-SA 3.0) via Commons Wikimedia
2. “Gallstones” By BruceBlaus – Own work (CC BY-SA 4.0) via Commons Wikimedia