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THE GALLBLADDER

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Carcinoma of Extrahepatic Bile Ducts and Ampulla of Vater. 1. Incidence: ... 4. Ampulla of Vater (Least common) c. Stones accompany one-third of the cases. 35 ... – PowerPoint PPT presentation

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Title: THE GALLBLADDER


1
THE GALLBLADDER
2
I. General Information A. Function to
store concentrate bile. 1. 35 50 ml of
bile stored 2. 90 of water removed
3
  • 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.

4
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
5
Anatomy, cont 2. Cystic duct a.
Takes bile to/ from GB b. Two way duct
3. Common bile duct a. Takes bile to
duodenum
6
  • Gallbladder Diseases
  • A. Cholelithiasis (stones, calculi)
  • 1. Most calculi will cause shadows
  • 2. Easily recognized
  • 3. Layered stones cast more
    prominent shadows

7
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
8
Cholelithiasis, cont b. Pure Bilirubin
1. less than 10 of stones 2. Small
3. Multiple 4. Associated with
hemolytic disorders (why??)
9
Cholelithiasis, cont c. Mixed stones
Most Common 1. Large up to 3 cm 2.
Multiple 3. Associated with
cholecystitis
10
Cholelithiasis, cont 4. Greater
cholesterol amount greater
echogenicity 5. Cholesterol stones a.
more echogenic b. float more easily
(why??)
11
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
12
Cholelithiasis
  • Note layered stones in the gall bladder
  • Note single stones in the neck, cystic duct, and
    CBD

13
Cholelithiasis, cont 8. Complications
of cholelithiasis a. Cholecystitis b. Bilary
tract obstruction c. Peritonitis
14
  • 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

15
  • Cholecystitis, cont
  • b. Signs/Symptoms
  • 1. Acute pain
  • 2. Sweating
  • 3. Nausea, vomiting
  • 4. Tender GB

16
Cholecystitis, cont c. Treatment 1.
Cholecystectomy 2. More than 50 will rupture
GB without surgery
17
Cholecystitis, cont 2. Chronic
Cholecystitis a. Signs/symptoms 1. Less
severe pain 2. History of indigestion, fat
intolerance 3. GB usually
contracted
18
Cholecystitis, cont b. With cholelithiasis
-(90 cases are concurrent) c. Rare
before age 20 -incidence increasing
19
Cholecystitis, cont d. Population at
highest risk called 4F or 5F 1.
Fat 2. Female 3. Fertile 4.
Forty 5. Fair
20
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
21
Gall Bladder Diseases, cont D. Fish scale
GB d/t multiple small mucosal cysts E.
Sandpaper GB roughened mucous membrane
caused by cholesterin crystals.
22
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.
23
Porcelain Gallbladder
24
  • 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

25
  • 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

26
Gall bladder diseases, cont J.
Intraluminal Defects 1. Polyps of GB 2.
Viscid Bile or Sludge a. Produces linear,
echogenic interface within GB
27
Sludge in Gallbladder
28
  • 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

29
  • 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

30
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
31
Gall bladder cancer, Cont 6.
Distinguishing Characteristics a.
Adenocarcinomas b. Two forms 1.
Infiltrating 2. Exophytic c. GB is
palpable in 65 of cases
32
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
33
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
34
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
35
Biliary duct cancer, Cont 3.
Distinguishing Characteristics a. Small b.
Obstruction leads to jaundice,
pruritis c. Conjugated bilirubin elevated
36
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
37
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.
38
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
39
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
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