Cholecystitis

Acute cholecystitis is usually a mechanical problem first. A gallstone becomes lodged in the cystic duct, preventing the gallbladder from emptying. Bile stasis raises intraluminal pressure, stretches the wall, and impairs local perfusion. The inflamed wall becomes vulnerable to bacterial overgrowth and progressive tissue injury. A useful image is a sealed reservoir under pressure: the gallbladder keeps secreting and concentrating bile, but its outlet is blocked. Fluids, antibiotics, and analgesia can stabilize the patient, but they do not remove the obstruction. Definitive management therefore centres on source control. Gallstones alone do not establish acute cholecystitis. Many people have asymptomatic stones. The diagnosis depends on linking a local inflammatory pain pattern with systemic inflammation and characteristic imaging findings.