A Histopathological and Histochemical Study of Cholecystitis.

Gallstones are a major cause of morbidity throughout the world, necessitating hospitalization and cholecystectomy. Gallbladder is known to play crucial role in the formation of gallstones. Therefore, understanding the interaction between gallbladder mucosa and bile is an important step towards understanding the pathogenesis of gallstone disease. Cholesterol saturated ‘lithogenic’ bile, originating from the liver and considered an important factor in gallstone formation, has been found in healthy individuals1. Lithogenic bile therefore cannot be the only factor involved in the process. Other factors such as supersaturation of bile with calcium2, gallbladder mucus, prostaglandins and functional failure of electrolyte absorption by gallbladder mucosa also may influence gallstone formation. Biliary calcium can reduce the solubility of cholesterol3 rendering the bile lithogenic. Apart from being a critical initiating factor, calcium is physically incorporated into gallstones as well. I. The normal gallbladder epithelium contains sulphated acid mucins with traces of neutral and sialomucins .The sulphomucin content decreases in chronic calculus cholecystitis II. In chronic calculus cholecystitis with severe (Grade III) inflammation (as against mild inflammation) : 1) Total acid mucin content is decreased. 2) This decrease is due to HID positive (sulpho) mucin. 3) Neutral mucin and sialomucin contents are increased. 4) There is a higher incidence of Gastric metaplasia and pigment stones . III.Pigment gallstones tend to have an association with : 1) Severe inflammation 2) Higher degree of fibrosis 3) Gastric metaplasia 4) Presence of sialomucins More number of cases need to be studied to see whether high risk group consisting of pigment stones → severe inflammation → gastric metaplasia → sialomucin emerges. If it does, will be of therapeutic and prognostic significance