Gallbladder

last updated: December 13, 2016

Orlando Debesa

Cholecystitis

  • inflammation of the gallbladder from cystic duct obstruction

  • leukocytosis with or without left shift

  • elevated aminotransferases

  • 5-10% acalculous

  • most common surgical emergency in the elderly with abdominal pain

  • bilirubin will be elevated in cholangitis (will have higher fever and appear more ill than cholecystitis)

  • ultrasound is procedure of choice

  • nuclear scintigraphy (HIDA scan) most sensitive and specific for cholecystitis

Cholelithiasis

  • gallstones in gallbladder

Biliary colic

  • pain caused by stone temporarily blocking the cystic duct

Choledocholithiasis

  • stone in common bile duct

  • usually significant elevation in alkaline phosphatase and transaminases

Cholangitis

  • bacterial infection superimposed on an obstruction of the biliary tree (gallstone, neoplasm or stricture)

Porcelain Gallbladder

  • uncommon manifestation of chronic cholecystitis

  • intramural calcification of the gallbladder wall

  • usually asymptomatic but are at increased risk of gallbladder carcinoma (bad prognosis)

Gallbladder volvulus 

  • rare condition in which there is a rotation of gallbladder around the axis of cystic duct and artery

  • observed on patients with significant weight loss, in which there is loss of pericholecystic fat

  • complications are related to torsion with vascular compromise and resultant gallbladder ischemia

  • US: gallbladder outside the normal anatomical fossa, wall thickening

Risk Factors

  • fair: more prevalent in Caucasian population 1

  • fat: BMI >30

  • female gender

  • fertile: one or more children

  • forty: age ≥40 -or- familial 

  • low fiber diet

Charcot's Triad

  • fever

  • RUQ pain

  • jaundice

Reynold's Pentad (Charcot's triad +)

  • mental status changes

  • hypotension

... but I would more especially commend the clinician who, in acute diseases, by which the bulk of mankind are cutoff, conducts the treatment better than others.
 
Hippocrates, 400 BC