Difference between revisions of "Gallbladder"

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Gallbladder (view source)

Revision as of 15:15, 27 September 2013

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→‎Chronic cholecystitis: split-out
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=Common=
=Common=
==Chronic cholecystitis==
==Chronic cholecystitis==
*Abbreviated ''CC''.
{{Main|Chronic cholecystitis}}
===General===
====Epidemiology====
*Female, [[obese|fat]], fertile, family history, forty (though now getting younger... as people get fatter).
 
====Etiology====
*Cholelithiasis.
*Thick bile (acalculous cholecystitis).
 
====Clinical (classic)====
*Constant right upper quadrant pain after a fatty meal.
*Positive Murphy's sign (physical exam, with ultrasound).
 
===Gross===
*+/-[[Cholelithiasis]] - strongly associated pathology.
*+/-Strawberry-like appearance - common (due to [[gallbladder cholesterolosis]]).
**Small ridges (microvillus architecture) + yellow.
***Normal gallbladder mucosa = smooth, green.
*+/-Congestion/erythema.
*+/-Wall thickening - typically ~ 6-7 mm.<ref name=pmid21879282>{{Cite journal  | last1 = Kim | first1 = HJ. | last2 = Park | first2 = JH. | last3 = Park | first3 = DI. | last4 = Cho | first4 = YK. | last5 = Sohn | first5 = CI. | last6 = Jeon | first6 = WK. | last7 = Kim | first7 = BI. | last8 = Choi | first8 = SH. | title = Clinical usefulness of endoscopic ultrasonography in the differential diagnosis of gallbladder wall thickening. | journal = Dig Dis Sci | volume = 57 | issue = 2 | pages = 508-15 | month = Feb | year = 2012 | doi = 10.1007/s10620-011-1870-0 | PMID = 21879282 }}</ref>
 
Note:
*Wall thickening (due to congestion/edema) is the important gross finding in ''[[acute cholecystitis]]''.
*Wall thickenss greater than 10 mm should raise the suspicion of malignancy.<ref name=pmid21879282/>
 
===Microscopic===
Features:<ref name=Ref_GLP439>{{Ref GLP|439}}</ref>
*Thickening of the gallbladder wall - due to fibrosis/muscular hypertrophy - '''key feature'''.
*Chronic inflammatory cells - usu. "minimal".
**Lymphocytes - most common.
*Rokitansky-Aschoff sinuses - common.<ref>URL: [http://www.whonamedit.com/synd.cfm/983.html http://www.whonamedit.com/synd.cfm/983.html]. Accessed on: 29 October 2011.</ref>
**Entrapped epithelial crypts -- pockets of epithelium in the wall of the gallbladder.
*+/-Foamy macrophages in the lamina propria ([[cholesterolosis of the gallbladder]]).
 
DDx:
*[[Gallbladder adenocarcinoma]].
*[[Gallbladder adenomyoma]].
*[[Acute cholecystitis]] - more inflammation, lack Rokitansky-Aschoff sinuses, +/-mucosal erosions.
*Cholecystectomy for [[gallstone pancreatitis]] - intraepithelial [[neutrophil]] clusters common, history essential.
 
===Sign out===
<pre>
GALLBLADDER, CHOLECYSTECTOMY:
- CHRONIC CHOLECYSTITIS.
- CHOLELITHIASIS.
</pre>
 
====Liver present====
<pre>
GALLBLADDER, CHOLECYSTECTOMY:
- CHRONIC CHOLECYSTITIS.
- CHOLELITHIASIS.
- SMALL AMOUNT OF LIVER WITHOUT APPARENT PATHOLOGY.
</pre>
 
====Micro====
The sections shows gallbladder wall with Rokitansky-Aschoff sinuses and a moderate mixed
inflammatory infiltrate predominantly consisting of lymphocytes. No nuclear atypia is seen.


==Acute cholecystitis==
==Acute cholecystitis==
Michael
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