Gallbladder Pathology

Sludge

• Accumulation of calcium, cholesterol and mucus in bile, sludge thickens bile & is gravity dependent. Hepatization → GB is isoechoic to the liver due to being full of bile

• USA: Low-level echoes, homogenous, no shadowing & mobile

Cholelithiasis

• Most common GB disease, composed of cholesterol,

• S/S: asymptomatic, RUQ pain after fatty meals, N/V, pain that radiate to shoulder

• USA: Echogenic foci that shadow and move

Acute Cholecystitis

• Sudden inflammation of the GB, usually caused by cystic duct obstruction

• S/S: RUQ pain, fever, leukocytosis

• USA: Wall thicker than 3mm, +Murphy’s sign, pericholecystic fluid, sludge, enlarged GB

Chronic Cholecystitis

• Fibrosis of GB wall from multiple attacks of acute cholecystitis

• USA: Wall thickening & cholelithiasis, WES (wall. Echo, shadow) sign

Emphysematous Cholecystitis

• Gas invades GB wall, lumen & possibly biliary ducts. complication of acute cholecystitis.

• USA: Prominent bright echo along anterior wall w/ ring down/comettail artifact. Large gas- packed bag or WES echo shadow, w/ posterior fuzzy shadowing.

Gangrenous Cholecystitis

• GB wall thickened & edematous, focal areas of exudate, hemorrhage & necrosis.

• S/S: General Ab pain

• USA: Focal thickening striations of GB wall, intraluminal echos and membranes. Pericholecystic fluid, cholelithiasis.

Gallbladder Perforation

• Rupture of GB, may develop a few days to weeks after onset of symptoms. Usually occurs in GB fundus after duct obstruction, GB distention & ischemia/ necrosis. Significant mortality rate

• S/S: Ab pain, leukocytosis, fever

• USA: Gallstones, thick GB wall, “hole” sign, pericholecystic abscess, gallstones freefloating in the ascites around the liver

Acalculous Cholecystitis

Cholecystitis that occurs without cholelithiasis

Gallbladder Polyps

• Tiny soft tissue structures that adhere to GB wall. Commonly found in middle third of GB and < 10 mm diameter. Cholesterol polyps are most common

• USA: Small, well-defined echogenic projections from GB wall.

Porcelain Gallbladder

• Most common in elderly women, Calcium incrustation of GB wall. Associated w/ gallstones.

• S/S: asymptomatic

• USA: Bright echo in GB region w/ posterior shadowing

Cholesterolosis (Strawberry GB)

• Deposits of cholesterol across GB wall. May be localized or diffuse

• USA: Multiple small echogenic polyps, do not shadow & are stationary

Gallbladder Carcinoma

• Most common cancer of biliary tract, most occur in GB fundus. Most cancers are adenocarcinoma. Late diagnosis = 5-yearsurvival rate is 5-12%

• S/S: weight loss, anorexia, RUQ pain, jaundice, N/V, hepatomegaly

• USA: Inhomogeneous, polyploid lesion w/ irregular margins, localized wall thickening, mass that replaces GB, calcification of GB wall, vascular

Adenomyomatosis

• Occurs with diffuse or localized hyperplasia of GB mucosa that extends into the muscular layer, causing the layers to divide (Rokitansky-Aschoff sinuses).

• S/S: Asymptomatic, cholelithiasis symptoms

• USA: Echogenic foci w/in the duct w/ or w/o dilation

Bile Duct Carcinoma (Cholangiocarcinoma/Klatskin Tumor)

• Malignant disease along the biliary tract, Klatskin’s tumor when in perihilar region. Labs: ↑ bilirubin, abnormal LFTs, positive CEA.

• S/S: painless jaundice, pruritis, ab pain, anorexia, malaise, weight loss.

• Liver mass or mass arising from inside the ducts. Intrahepatic biliary dilation. Collapsed GB.

Cholangitis (Primary Sclerosing Cholangitis)

• Inflammation of the bile ducts. Sclerosing cholangitis is associated with ulcerative colitis. Can also be Oriental, AIDS & acute obstructive suppurative cholangitis

• S/S: fever, ab pain & jaundice

• USA: Biliary dilation & thickened duct walls

Choledochal Cyst

• Can be congenital, focal or diffuse cystic dilation of biliary tree. Can result from pancreatic juices refluxing into bile duct. 5 types (I - V).

• S/S: abdominal mass, pain, fever, jaundice

• USA: In RUQ. Cyst may have sludge, stones or neoplasm inside

Caroli’s Disease

• Rare congenital abnormality where communicating cavernous ectasia of intrahepatic ducts characterized by congenital segmental saccular cystic dilation of major hepatic ducts.

• USA: Multiple cystic structures in area of the ductal system converge toward the porta hepatis