LIVER CHANGES ASSOCIATED WITH CHOLECYSTITIS

Aims-To investigate the histopathological changes in the livers of pat ients undergoing cholecystectomy and to relate these changes to the un derlying biliary tract pathology. Methods-Liver changes in 67 patients undergoing cholecystectomy were investigated. Sixty three had gall st ones, one cholesterolosis only, and there were three cases of acute ac alculous cholecystitis. Results-Only 34% of the patients had completel y normal liver biopsy specimens. The most clinically important patholo gy was found in 11 of the 14 patients with choledocholithiasis: three of these had cholangitis and eight had features of large bile duct obs truction (four also had chronic cholestasis and portal-portal linking fibrosis). Non-specific reactive hepatitis was the most common abnorma lity in the remaining 53 patients with cholecystitis alone, and was fo und in 18. A further four patients had chronic cholestasis without fib rosis and early primary biliary cirrhosis was a coincidental finding i n another. Clinical symptoms were poorly correlated with gall bladder and liver pathology apart from an association between jaundice and cho ledocholithiasis. Liver function tests of obstructive pattern were not ed in 23 of 58 patients, most of whom had choledocholithiasis or non-s pecific reactive hepatitis. Bile cultures were positive in 10 of 42 pa tients, predominantly in cases of cholangitis and acute cholecystitis. Conclusions-Cholangitis and extensive fibrosis associated with large bile duct obstruction are common findings in patients with choledochol ithiasis. The liver disease may progress to secondary biliary cirrhosi s if the obstruction is not relieved, emphasising the need for early s urgery. A peroperative liver biopsy may be useful to exclude cirrhosis in these patients, but is unlikely to be informative in those with ch olecystitis alone.