Cholecystitis is nearly always associated with a certain grade of hepatitis or pancreatitis, or both. The degree of inflammation in the liver and in the pancreas is often so slight that it is recognized with difficulty. Cholecystitis does not always mean that the infection in the liver and pancreas will also be severe. In certain cases, the disease seems farther advanced in the liver or pancreas than in the gallbladder, suggesting that it was primary in the liver or pancreas and secondary in the gallbladder. It is possible that infection may progress in this manner; nevertheless, all the evidence indicates that the infection is primary in the gallbladder. Graham1 has recently called attention to the intimate association between the gallbladder and the liver through the lymphatics, and has suggested that in certain cases the gallbladder may be infected through the lymphatics from the liver. A study of these lymphatics
JUDD ES. RELATION OF THE LIVER AND THE PANCREAS TO INFECTION OF THE GALLBLADDER. JAMA. 1921;77(3):197–201. doi:10.1001/jama.1921.02630290033010
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