Difference between revisions of "Gallbladder"

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Revision as of 15:28, 27 September 2013

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→‎Acute cholecystitis: split-out
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==Acute cholecystitis==
==Acute cholecystitis==
===General===
{{Main|Acute cholecystitis}}
*Less common than ''chronic cholecystitis''.
*Usually due to gallstones.<ref name=Ref_Sternberg5_1606>{{Ref Sternberg5|1606}}</ref>
*Classically older individuals (50s and 60s) with a slight female predominance.<ref name=Ref_Sternberg5_1606>{{Sternberg5|1606}}</ref>
 
Notes:
*Pathologic diagnosis very often discordant with clinical impression.<ref name=pmid8939838>{{Cite journal  | last1 = Fitzgibbons | first1 = RJ. | last2 = Tseng | first2 = A. | last3 = Wang | first3 = H. | last4 = Ryberg | first4 = A. | last5 = Nguyen | first5 = N. | last6 = Sims | first6 = KL. | title = Acute cholecystitis. Does the clinical diagnosis correlate with the pathological diagnosis? | journal = Surg Endosc | volume = 10 | issue = 12 | pages = 1180-4 | month = Dec | year = 1996 | doi =  | PMID = 8939838 }}</ref>
 
===Gross===
Features:<ref name=Ref_Sternberg5_1606>{{Ref Sternberg5|1606}}</ref>
*Wall thickening - due to edema and hemorrhage.†
*Gallstone(s) - classically obstructing the gallbladder neck.
 
Note:
*† The sonographic criterium for "thick" is greater than 3 mm.<ref name=pmid20223393>{{Cite journal  | last1 = Tsung | first1 = JW. | last2 = Raio | first2 = CC. | last3 = Ramirez-Schrempp | first3 = D. | last4 = Blaivas | first4 = M. | title = Point-of-care ultrasound diagnosis of pediatric cholecystitis in the ED. | journal = Am J Emerg Med | volume = 28 | issue = 3 | pages = 338-42 | month = Mar | year = 2010 | doi = 10.1016/j.ajem.2008.12.003 | PMID = 20223393 }}</ref><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>
 
===Microscopic===
Features:<ref name=Ref_Sternberg5_1606>{{Ref Sternberg5|1606}}</ref>
*Edema.
*Hemorrhage.
*+/-Fibrin thrombi in small veins.
*+/-Mucosal erosions.
*+/-[[Neutrophils]] - '''useful'''
**Not essential for the Dx of ''acute cholecystitis''.
**Neutrophils usually secondary to [[necrosis]]/ulceration or infection.<ref name=Ref_DCHH174>{{Ref DCHH|174}}</ref>
*+/-Reactive epithelial changes.<ref name=Ref_GLP439>{{Ref GLP|439}}</ref>
 
Notes:
*May see activated fibroblasts.
 
DDx:
*[[Chronic cholecystitis]] - has less inflammation, fibrotic wall thickening/muscular hypertrophy, may have RK sinuses.
*[[Gallbladder adenocarcinoma]].
 
====Special types====
=====Gangrenous cholecystitis=====
General:<ref name=pmid21762298>{{Cite journal  | last1 = Nikfarjam | first1 = M. | last2 = Niumsawatt | first2 = V. | last3 = Sethu | first3 = A. | last4 = Fink | first4 = MA. | last5 = Muralidharan | first5 = V. | last6 = Starkey | first6 = G. | last7 = Jones | first7 = RM. | last8 = Christophi | first8 = C. | title = Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis. | journal = HPB (Oxford) | volume = 13 | issue = 8 | pages = 551-8 | month = Aug | year = 2011 | doi = 10.1111/j.1477-2574.2011.00327.x | PMID = 21762298 }}</ref>
*Older.
*Clinically "sicker".
*Worse outcome than (acute) non-gangrenous cholecystitis.
 
Microscopic:
*[[Necrosis]] of gallbladder wall (muscularis propria).<ref>STC. 25 February 2009.</ref>
 
===Sign out===
<pre>
GALLBLADDER, CHOLECYSTECTOMY:
- ACUTE CHOLECYSTITIS.
- CHOLELITHIASIS.
</pre>
 
<pre>
GALLBLADDER, CHOLECYSTECTOMY:
- ACUTE AND CHRONIC CHOLECYSTITIS WITH MULTIPLE MUCOSAL EROSIONS AND FOCAL NECROSIS OF THE GALLBLADDER WALL.
</pre>
 
<pre>
GALLBLADDER, CHOLECYSTECTOMY:
- GANGRENOUS CHOLECYSTITIS.
- CHOLELITHIASIS.
</pre>
 
====Micro====
The sections show gallbladder wall with hemorrhage, and activated fibroblasts.  The superficial mucosa has clusters of neutrophils.


==Gallbladder cholesterolosis==
==Gallbladder cholesterolosis==
Michael
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