Gall Bladder

Pathology of the Gallbladder

• The gallbladder can contain stones, indicated by imaging or clinical evidence.

Clinical Symptoms of Gallbladder Disease

• Common symptoms include:

  • Fat intolerance: Difficulty digesting fats, leading to discomfort after meals.

  • Epigastric pain: Pain in the upper abdomen, linked to gallbladder function.

  • Jaundice: Yellowing of the skin and eyes, indicating possible biliary obstruction.

  • Abdominal pain: General pain in the abdominal area possibly related to gallbladder issues.

  • Chills and fever: Symptoms that may arise during an acute episode, especially in cholecystitis.

  • RUQ pain: Pain in the right upper quadrant that may radiate to the right shoulder or back.

Congenital Gallbladder Abnormalities

• Various congenital defects can influence gallbladder health, including:

  • Gallbladder Agenesis: Complete absence of the gallbladder.

  • Anomalous Gallbladder Location: Abnormal positioning which may affect function.

  • Gallbladder Duplication: Two gallbladders present; incidence of 1 in 3000 to 4000 cases.

  • Septated Gallbladder: Divided into chambers, causing potential complications.

  • Gallbladder Diverticulum: Rare outpouching of the gallbladder wall.

Anomalous Gallbladder Location

• Commonly observed locations include:

  • Left side: Behind the left lobe of the liver.

  • Intrahepatic: Inside the liver tissue.

  • Suprahepatic: On top of the liver, near the diaphragm.

  • Retrohepatic: Behind the right lobe of the liver.

Gallbladder Duplication

• Features:

  • Each gallbladder has different cystic ducts.

  • Normal emptying observed after meals in both gallbladders.

Septate Gallbladder

• Description:

  • May be partial or complete; chambers share openings.

  • Quite rare and can pose risk for cholecystitis symptoms due to congenital origin.

Gallbladder Diverticula

• Characteristics:

  • Rare; presents as an outpouching.

  • Usually singular and varies in size.

Disorders of the Gallbladder

• Common disorders include:

  • Cholelithiasis (gallstones): Small biliary structures, potentially multiple.

  • Sludge: Contains cholesterol, calcium, and bilirubin.

  • Cholecystitis: Inflammation of the gallbladder.

  • Porcelain Gallbladder: Calcification and potential cancer risk.

  • Adenomyomatous hyperplasia: Benign overgrowth of the wall.

  • Gallbladder polyps: Growths within the gallbladder.

  • Gallbladder carcinoma: Malignant tumors affecting the gallbladder.

Cholelithiasis (Gallstones)

• Characteristics:

  • Can form anywhere in the biliary tree.

  • Symptoms include RUQ pain, nausea, vomiting, and possible jaundice.

Symptoms of Gallstones

• Indications of complications include:

  • Worsening symptoms if stones obstruct the gallbladder neck or cystic duct.

Diagnostic Imaging for Gallstones

• Ultrasound is the preferred modality:

  • Identifies stone mobility and differentiates between gallstones and polyps.

  • Criteria for diagnosis includes:

    • Echogenic focus

    • Posterior shadow

    • Stone mobility.

Biliary Sludge and its Evaluation

• Predisposing Factors: Pregnancy, rapid weight loss, fasting, and certain medical treatments.

• Evolution: May resolve spontaneously or develop into gallstones; 10-15% can become symptomatic.

• Ultrasound Findings: Soft echoes that shift with patient position; can appear as artifact called pseudosludge.

Tumefactive Sludge

• Characteristics:

  • Mobile echogenic structures resembling a tumor, but typically with distinguishing mobility.

Milk of Calcium

• Presentation:

  • Thick viscous material with high calcium; shows layering and shadowing on ultrasound.

Gallbladder Wall Assessment

• Normal wall thickness is less than 3 mm. Thickening can indicate:

  • Chronic conditions like cholecystitis or ascites.

  • Factors causing thickening include AIDS, congestive heart failure, and tumors.

Gallbladder Inflammation: Cholecystitis

• Most common complication from gallstones, leading to acute or chronic inflammation.

• Clinical Findings: Severe RUQ pain, nausea, vomiting, and fever.

• Ultrasound Findings: Impaction, wall thickening, distention, and pericholecystic fluid may be present.

Complications of Cholecystitis

• Include:

  • Empyema, gangrenous cholecystitis, and perforation.

  • Empyema: Gallbladder filled with pus due to obstruction.

  • Gangrenous Cholecystitis: Severe inflammation affects blood supply, leading to tissue decay.

Gallbladder Carcinoma

• Appears commonly with cholelithiasis; prognosis is often poor with high mortality rates.

• Signs and Ultrasound findings include:

  • Wall thickening and potential liver invasion.

Summary of Types of Cholecystitis

• Acute Calculous: Stone obstruction leading to inflammation.

• Acute Acalculous: Occurs without stones; affects severely ill patients.

• Chronic: Often asymptomatic but can lead to complications such as pancreatitis and increased cancer risk.

Important Notes on Gallbladder Pathology

• Monitoring and imaging are critical for detecting abnormalities.

• Surgical involvement may become necessary for acute complications and chronic conditions.

• Routine assessment of gallbladder function and scanning for anomalies can help in early detection and management of gallbladder diseases.