Gallbladder disorders Flashcards
Composition of pigment gallstones
Calcium salts and unconjugated bilirubin
US shows highly reflective echoes with posterior acoustic shadowing. Pt switching to lateral decubitus shows motility.
Gallstones
Complications of cholelithiasis
Cholecystitis
Empyema
Perforation
Cholangitis
Obstructive cholestasis
Pancreatitis
Gallbladder carcinoma
Bouveret syndrome
Occurs occasionally, when a large gallstone erodes directly into an adjacent loop of the small bowel, generating an intestinal obstruction
Bouveret syndrome
Common places for a gallstone to lodge in acute calculous cholecystitis
Gallbladder neck
Cystic duct
Associated conditions that may cause acute acalculous cholecystitis
Major surgery/trauma
Sepsis
Burns
DM
Immunosuppression
Infection
Pt presents with sudden RUQ pain radiating to R shoulder. US shows enlarged and edematous gallbladder with no gallstones. They have diabetes.
Acute acalculous cholecystitis
Gallbladder empyema
Accumulation of pus, biliary sludge, and hemorrhage
Gallbladder is transformed to a green-black necrotic organ
Gangrenous cholecystitis
Complication of gangrenous cholecystitis
Perforation cause peritonitis
Symptoms of chronic cholecystitis
Vague upper abdominal pain and intolerance for fatty foods
Reactive epithelial proliferation with infolding within the muscularis of the mucosa of the gallbladder, and buried crypts of epithelium within the gallbladder wall
Rokitansky-Aschoff sinuses, associated with chronic cholecystitis
Porcelain gallbladder
Extensive dystrophic calcification of the gallbladder wall
Atrophic, chronically obstructed, often dilated gallbladder that may contain only clear secretions
Hydrops of the gallbladder
Caused by rupture of Rokitansky-Aschoff sinuses and accumulation of macrophages with ingested biliary phospholipids (xanthoma cells)
Xanthogranulomatous cholecystitis
Gallbladder appears shrunken, nodular, and chronically inflamed with a massively thickened wall. There are foci of necrosis and hemorrhage.
Xanthogranulomatous cholecystitis
Charcot triad of cholangitis
Jaundice
Fever
RUQ pain
Complications of hydrops of the gallbladder
Empyema
Perforation
Gangrene
Caused by prolong cystic duct obstruction causing the bile in the gallbladder to be reabsorbed and replaced by a clear mucinous fluid.
Hydrops/mucocele of the gallbladder
Risk increased with empyema
Sepsis
Perforation
Symptoms of empyema
High fever
Severe RUQ
Marked leukocytosis
Prostration
Reynold pentad of cholangitis
RUQ pain
Fever
Jaundice
Confusion
Shock
Complications of choledocholithiasis
Cholangitis
Hepatic abscess
Chronic liver disease
Precursor lesions of gallbladder caricnoma
Flat in site lesions with varying grades of dysplasia
Intracholecystic papillary tubular neoplasm
Intestinal metaplasia
Most common location of gallbladder adenocarcinoma
Fundus
Name of adenocarcinoma that occurs at the junction of the R and L hepatic ducts
Perihilar cholangiocarcinoma/Klatskin tumor
Risk factors for extrahepatic cholangiocarcinoma
Gallstones
Inflammatory disease of colon
PSC
Liver fluke infestation
Hepatolithiasis
