Chapter 203 Cholecystitis in Pregnancy
ETIOLOGY AND PATHOGENESIS
Causes: The metabolic alteration leading to cholesterol stones (gallstones) is thought to be a disruption in the balance between hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase and cholesterol 7α-hydroxylase. HMG-CoA controls cholesterol synthesis, whereas cholesterol 7α-hydroxylase controls the rate of bile acid formation. Patients who form cholesterol stones have elevated levels of HMG-CoA and depressed levels of cholesterol 7α-hydroxylase. This change in ratio increases the risk of precipitation of cholesterol. During pregnancy, there is an increased rate of bile synthesis and a reduced rate of gallbladder emptying, increasing the risk of stone formation and obstruction.
