THE GALLBLADDER

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THE GALLBLADDER
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I. General Information A. Function to
store concentrate bile. 1. 35 50 ml of
bile stored 2. 90 of water removed
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• Genl Info., cont
• Regulated by Cholecystokinin (CCK)
• 1. A hormone. Causes
• a. contraction of Gallbladder b.
  relaxation of sphincter of Oddi.
• 2. Bile is released when fatty foods
  enter duodenum.

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Genl Info., cont D. Without
fat 1. poor emptying of Gallbladder 2.
formation of sludge, gallstones E. Anatomy of
Biliary Tract 1. Ducts originate in
liver a. R/L hepatic ducts b. Common
hepatic duct
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Anatomy, cont 2. Cystic duct a.
Takes bile to/ from GB b. Two way duct
3. Common bile duct a. Takes bile to
duodenum
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• Gallbladder Diseases
• A. Cholelithiasis (stones, calculi)
• 1. Most calculi will cause shadows
• 2. Easily recognized
• 3. Layered stones cast more
  prominent shadows

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Cholelithiasis, cont 4. Shadowing
influenced by composition of stone 5.
Types of gall stones a. Pure Cholesterol
1. 10 of stones 2. Large
3. Solitary
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Cholelithiasis, cont b. Pure Bilirubin
1. less than 10 of stones 2. Small
3. Multiple 4. Associated with
hemolytic disorders (why??)
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Cholelithiasis, cont c. Mixed stones
Most Common 1. Large up to 3 cm 2.
Multiple 3. Associated with
cholecystitis
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Cholelithiasis, cont 4. Greater
cholesterol amount greater
echogenicity 5. Cholesterol stones a.
more echogenic b. float more easily
(why??)
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Cholelithiasis, cont 6. Incidence
Common in U.S. a. 8 of males b. 20 of
females 7. Predisposing Factors a. Changes
in bile composition b. Bile stasis
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Cholelithiasis

• Note layered stones in the gall bladder
• Note single stones in the neck, cystic duct, and
  CBD

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Cholelithiasis, cont 8. Complications
of cholelithiasis a. Cholecystitis b. Bilary
tract obstruction c. Peritonitis
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• Gall Bladder Diseases, cont
• B. Cholecystitis (inflammation)
• 1. May be Acute or Chronic
• 2. Acute Cholecystitis
• a. Onset
• 1. Sudden, painful
• 2. Infection develops within 24
  hrs

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• Cholecystitis, cont
• b. Signs/Symptoms
• 1. Acute pain
• 2. Sweating
• 3. Nausea, vomiting
• 4. Tender GB

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Cholecystitis, cont c. Treatment 1.
Cholecystectomy 2. More than 50 will rupture
GB without surgery
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Cholecystitis, cont 2. Chronic
Cholecystitis a. Signs/symptoms 1. Less
severe pain 2. History of indigestion, fat
intolerance 3. GB usually
contracted
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Cholecystitis, cont b. With cholelithiasis
-(90 cases are concurrent) c. Rare
before age 20 -incidence increasing
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Cholecystitis, cont d. Population at
highest risk called 4F or 5F 1.
Fat 2. Female 3. Fertile 4.
Forty 5. Fair
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Gall Bladder Diseases, cont C. Thickened
GB wall 1. Should measure ONLY when GB
is distended with bile 2. Ascites may
mimic 3. Adipose tissue may mimic
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Gall Bladder Diseases, cont D. Fish scale
GB d/t multiple small mucosal cysts E.
Sandpaper GB roughened mucous membrane
caused by cholesterin crystals.
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Gall Bladder Diseases, cont F.
Strawberry GB (cholesterosis) 1.
cholesterin fat embedded into
mucosal lining 2. Looks like strawberry
seeds G. Porcelain GB D/t extensive calcium
deposits in the mucosal lining of GB.
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Porcelain Gallbladder
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• Gall bladder diseases, cont
• H. Choledocholithiasis (stone in bile duct)
• 1. D/t extra-hepatic biliary obstruction
• 2. usually in CBD
• 3. GB is contracted
• 4. Extremely painful

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• Gall bladder diseases, cont
• I. Failure to Delineate GB
• 1. Contracted GB
• a. Non-compliant patient
• b. Smoking, ingestion of water
• 2. Secondary to cholecystectomy

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Gall bladder diseases, cont J.
Intraluminal Defects 1. Polyps of GB 2.
Viscid Bile or Sludge a. Produces linear,
echogenic interface within GB
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Sludge in Gallbladder
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• Gall bladder diseases, cont
• b. Differentiate from layered stones
• 1. Stones move rapidly
• 2. Sludge may take 20 min. to move
• 3. sludge does not cause shadowing

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• Gall bladder diseases, cont
• K. Carcinoma of the Gallbladder
• 1. U/S is a useful diagnostic tool
• 2. Characteristics
• a. Thick, irregular wall
• b. Calculi frequently found

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Gall bladder cancer, Cont c.
Enlarged lymph nodes in liver hilus d. Echo
level usually complex 3. Incidence MOST
COMMON biliary cancer 4. Female
Male 4 1 5. Age over 70
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Gall bladder cancer, Cont 6.
Distinguishing Characteristics a.
Adenocarcinomas b. Two forms 1.
Infiltrating 2. Exophytic c. GB is
palpable in 65 of cases
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Gall bladder cancer, Cont d. Symptoms
depend on location e. Metastasis 1.
Direct liver, bile ducts 2. Porta hepatic
lymph nodes f. Prognosis 3 after 5 years
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Gall bladder diseases, cont L. Carcinoma
of Extrahepatic Bile Ducts and Ampulla of
Vater 1. Incidence a. Less common than
GB cancers b. Female Male 2 1 2.
Statistical Correlation a. Age 60 70
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Biliary duct cancer, Cont b.
Sites 1. CBD (Most common) 2. Hepatic
ducts 3. Cystic duct 4. Ampulla of Vater
(Least common) c. Stones accompany one-third
of the cases
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Biliary duct cancer, Cont 3.
Distinguishing Characteristics a. Small b.
Obstruction leads to jaundice,
pruritis c. Conjugated bilirubin elevated
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Biliary duct cancer, Cont d. May
infiltrate wall or become
exophytic e. One-third have enlarged GB f.
Spread portal nodes, liver 4. Prognosis
33 gt 5 years
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Biliary duct cancer, Cont 5.
Cholangiosarcomas a. Neoplasms of bile duct
origin b. Especially common within the
liver c. aka Cholangioma d. Dilated
biliary ducts proximal to
the involved areas.
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Gallbladder Diseases, cont M.
Diagnostic Terminology q1. Murphys Sign
a. Inspiration/pressure causes pain
(rebound effect) b. d/t downward
distention of an enlarged GB c.
Seen in any condition that distends GB
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Diagnostic Terminology, cont 2.
Courvasiers Sign (Law) a. Obstruction of
CBD by stone 1. dilation of the GB is
rare 2. D/t rapid obstruction b.
Obstruction of CBD by tumor 1. dilation is
common 2. D/t slow obstruction