Pretend you are a teacher preparing a quiz for the text I will provide. 
            Each quiz question should follow the format below. 
            Ensure that you carefully recheck the questions and answers for accuracy. 
            The output should be a ready-to-use list of dictionaries for the Python eval function:

            [

                    "question": "WRITE THE QUESTION HERE",
                    "options": ["A) OPTION_1", "B) OPTION_2", "C) OPTION_3", "D) OPTION_4"],
                    "answer": INDEX_OF_CORRECT_ANSWER_IN_OPTIONS_LIST,
                    "explanation": "EXPLAIN WHY THE ANSWER IS CORRECT"

            ]

            Text:
             Syndrome (Stone eroding through gallbladder into the duodenum 
through a fistula can cause gastric outlet obstruction), gallbladder carcinoma. 
 
 
56 
 
Cholecystitis 
Inflammation of gallbladder. 
• Acute, chronic, or acute superimposed on chronic. 
• Mostly association with gallstones 
• One of the most common indications for abdominal surgery. 
Acute Cholecystitis 
Acute Calculous Cholecystitis: 
• Acute Inflammation of gallbladder that contain stones. 
• In 90% of cases caused by obstruction of gallbladder neck or cystic ducts 
• Impacted stone------ bile stasis ------ mucosal irritation (concentrated bile) ----- 
inflammation and edema----increased pressure----ischemia---bacterial 
invasion (suppurative infection) 
Acute Acalculous Cholecystitis: 
• Acute Inflammation of gallbladder without stones. 
• Between 5-12% of gallbladders removed for acute cholecystitis contain no 
gallstones. Mostly occur in seriously ill patients  
• critically ill patient---due to ischemia and bile stasis (sepsis, dehydration, 
major surgery, sever trauma, severe burns 
Gross finding 
• The thickened wall and congested mucosa of gallbladder.  
• The impacted gallstone in the neck of the gallbladder is often seen. 
Microscopic finding 
• Neutrophilic infiltration of gall bladder wall 
• Edema and vascular congestion 
• Mucosal ulceration and necrosis 
 
 
57 
 
Clinical features 
Symptoms:  
• Localized abdominal pain: sever, constant .6 hours, progressive RUQ 
pain radiating to the right scapular region, worsens with deep breathing 
and movement. 
• Systemic inflammatory signs (fever, tachycardia(sepsis), 
• GIT symptoms (nausea, vomiting, anorexia, dyspepsia, mild jaundice) 
Signs: Murphy’s sign positive, generalized abdominal tenderness (rebound 
tenderness and rigidity) 
Laboratory test: leukocytosis, elevated CRP, serum amylase/lipase, LFT. 
Imaging: US (first line test) 
Complications: 
Gangrenous cholecystitis----- perforation----chronic cholecystitis----
gallstone Ileus 
Management 
Supportive treatment (NPO), IV fluid, IV antibiotic, pain control 
Surgery: Emergency Cholecystectomy, ERCP (Endoscopic Retrograde 
Cholangiopancreatography (to remove impacted stone 
 
Chronic Cholecystitis: 
• Long term Inflammation of gallbladder often due to repeated episodes of 
gallstones obstruction. 
• Develop gradually and lead to fibrosis, reduced gallbladder motility, and wall 
thickening, over the time it becomes shrunken, thick-walled, and non-
functional 
 
58 
 
Gross finding 
• Gallbladder usually shrunken and fibrotic with thickened firm gray, white wall 
• The lumen may contain gallstone and thick bile sludge 
Microscopic finding 
• Chronic inflammatory cells infiltration  
• Rokitansky-Aschoff sinuses 
• fibrosis in the wall  
• hyper atrophy of muscularis 
Clinical features 
Symptoms:  
• Mild recurrent RUQ abdominal pain after fatty meals.  
• GIT symptoms (nausea, vomiting, anorexia, dyspepsia, mild jaundice) 
Signs: Murphy’s sign negative 
Laboratory te

            Quiz: