The etiology and pathogenesis

S. P. Fedorov wrote: "the Basic value of the infection, the stagnation of bile and cholesterolemia in the origin of gallstones should be regarded as fully established. You cannot only be attributed to each of these factors is exceptional, single cause in the origin of even one of a kind of stones. More properly seen in all cases of lithogenic the result of the combined action of at least two main factors in different, however, the proportions for this or that category of stones".
In the pathogenesis of gallstones is of great importance to the relationship between jelchnokamenna salts (holatni) and cholesterol in bile. In norm in the absence of stones holedoholitijazom ratio is 15 : 1, and in cholelithiasis it sharply decreases and reaches 6 : 1. The data obtained in the study of bile received during operations: in individuals, free from gallstones, holedoholitijazom ratio was 2:1, in the presence of stones - 13 : 1, acute inflammation of the bladder - 3:1, in chronic inflammation - 5:1 (A. L. Myasnikov, 1956). Thus, at a bile stone disease is confronted with the so-called dyscholia that makes the reason of this disease perverted the work of the liver. Hence the relationship stone formation with a previous acute hepatitis or existing chronic hepatitis.
The site of the formation of gallstones is a gall bladder, but does not exclude the possibility of their education in intrahepatic bile passages. On Ashoff, S. P. Fedorov and others, it is customary to distinguish between the following types of gallstones: 1) stones of metabolic origin, 2) stones of inflammatory origin and 3) combined stones.
Recently proved that the value of infectious factor as the cause cholecystitis in review and that other entities, not bacteria are primarily responsible for the emergence of cholecystitis. Under normal conditions the development of descending from the liver or the rising of intestinal infection in the gallbladder is impossible due to the bactericidal properties of bile (with the exception of the wand Ebert Foundation that causes typhoid cholecystitis). In pathological same circumstances infection usually accumulates on the already damaged mucosa of the gallbladder.
Most often the primary damage to the mucous gallbladder is caused by chemical irritation her for bile stasis. With long-term stagnation of bile in a gall bladder out of her soaked up the water and salts of bilious acids. The increased concentration of bile pigments, lime, cholesterol causes irritation of the mucosa of the bladder. At the same time lowering the content of bile acids in the bile leads to lower bacteriostatic properties of the latter. Increases the osmotic pressure in the bladder, causing the tension him with severe swelling of the walls. Sinuses Rokitanskйho-Asifa passing inside the gallbladder to serosa, can be mechanically weak point where possible break from prirastajte. The pressure in the bladder can cause compression of blood vessels in the wall with a heart attack or her angreneaza.
Stasis cystic contents occur most often due to blocking of the cystic duct stone or dyskinesia of the gallbladder and ways. Known value can change the position of the gallbladder and ducts during pregnancy, the compression of the bile duct nearby tumors and enlarged lymph nodes, inflammatory and neoplastic processes in the field of Vater's papilla, some features of the anatomical location of the gallbladder and the cystic duct, preventing the outflow of bile. Throw the pancreatic juice can be irritating to the gallbladder wall (P. C. Kravchenko, V. E. Volkov, 1962; Mester 1960). Damage to the latter can also be caused by disorders of blood circulation in the vessels feeding it, with the formation of focal heart attacks. This occurs in cases where the scene of hypertensive crises are the vessels of the abdominal cavity, including the gallbladder (I. Century Davydov, 1958), nodular the nodosa, twisting of the gallbladder.
R. A. Luria (1935) and M. P. Konchalovsky (1936) argued the possibility of an allergic nature of some forms of cholecystitis. Often cholecystitis develops as a consequence of the epidemic hepatitis (A. L. Myasnikov, S. M. RISS, A. I. Khazanov and others). Bacterial infection develops as a result of implantation of bacteria on the already damaged mucosa of the gallbladder. The way of penetration of microorganisms in the bile is different, but most important is interagency, rising from duodenal ulcer infection.
Data about germs, sowing of the bile of patients with cholecystitis, heterogeneous. Most often detect intestinal and precisional coli, Streptococcus and Staphylococcus. Duodenal content is not only the germs of bilious ways, but coming from the mouth, stomach. Therefore, the study does not detect it reliably pathogen inflammation of the gallbladder. Comparative analysis of microflora of duodenal contents and bile obtained directly from the gallbladder during the operation (C. M. Polyak, 1962), shows that most often in the gall bladder is E. coli. Streptococci, staphylococci and yeast-like fungi often inoculated of duodenal content than are in the gall bladder.
A special issue is the so-called giardiasis cholecystitis. Still not installed capacity of Giardia cause inflammation in the gallbladder wall. However, Giardia can cause dyskinesia it and thus provoke and maintain inflammation caused by other agents.
The denial of the value of Giardia as the cause, directly causes inflammation of the gallbladder, encourages be considered common terms "lamblia cholecystitis", "lamblia angiocholitis" failed. The combination of invasion by Giardia and cholecystitis more correct to designate "giardiasis, cholecystitis".