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

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Cholelithiasis

• gallstones in gallbladder

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Biliary colic

• pain caused by stone temporarily blocking the cystic duct

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Choledocholithiasis

• stone in common bile duct

• usually significant elevation in alkaline phosphatase and transaminases

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Cholangitis

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

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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)

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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