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Bruce M. White
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Debra Dreger
SENIOR EDITOR
Contributors:
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EXECUTIVE DIRECTOR
OF OPERATIONS
Jean M. Gaul
PRODUCTION DIRECTOR
Suzanne S. Banish
PRODUCTION ASSOCIATES
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ADVERTISING/PROJECT MANAGER
Kishore V. Gaddipati, MD
Resident in Internal Medicine, University of Virginia, RoanokeSalem Program, Roanoke, VA
Deborah D. Chavis
NOTE FROM THE PUBLISHER:
This publication has been developed without
involvement of or review by the American
Board of Internal Medicine.
Table of Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Cholecystitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Cholangitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
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Liver Abscesses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
AIDS-Related Biliary Tract Infections . . . . . . . . . . . 10
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Cover Illustration by Christine Schaar
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CHOLECYSTITIS
DEFINITION, EPIDEMIOLOGY, AND ETIOLOGY
Acute cholecystitis is an inflammation of the gallbladder resulting from obstruction of the cystic duct
and subsequent bacterial invasion and overgrowth. In
the United States, cholelithiasis is the cause of cystic
duct obstruction in more than 90% of cases of acute
cholecystitis, with women being affected 2 times more
often than men.1 The pathologic process of cholecystitis may be acute, chronic, ormore often than nota
combination of both types. For example, it has been
shown that approximately 95% of gallbladders excised
for acute cholecystitis exhibit fibrosis and other signs of
chronic inflammation.2
Under physiologic conditions, the bile is sterile, and
bactibilia is always a secondary event. Gallstone impaction of the cystic duct or of the common bile duct is
thought to alter the local microenvironment, allowing
the overgrowth of bacteria in the duodenum and invasion of the biliary tree through the ampulla of Vater.
Moreover, previous endoscopic manipulations or surgical interventions involving the biliary tract predispose
patients to polymicrobial infections, including infections by anaerobes or Pseudomonas aeruginosa.