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1. Clarinda clare linus
Diploma in Medical Science
Intake January 2011
Lecturer : DR. Angelo

2.  The gallbladder is a hollow system that sits
just beneath the liver.
In adults, the gallbladder measures

approximately 8 centimetres (3.1 in) in length
and 4 centimetres (1.6 in) in diameter when
fully distended.
 It is divided into three sections: fundus, body
and neck.

3. The neck tapers and connects to
the biliary tree via the cystic duct,
which then joins the common
hepatic duct to become the
common bile duct.
At the neck of the gallbladder is a mucosal fold
called Hartmann's pouch, where gallstones commonly
get stuck.

4.  Cholecystitis is the  It may become thick
inflammation of the walled, scarred and
gallbladder, usually small. The
resulting from a gallbladder usually
gallbladder stone contains sludge (a
blocking the cystic microscopic particles
duct. or materials similar
 It lasts for a long to gallstones)
time and  It block its opening
characterized by into the cystic duct
repeated attacks of or reside in cystic
pain (biliary colic). duct itself.

5. Notice thickness of galldladder wall, abundant polyhedric stones
and small papillary tumor in the cystic duct.

7. Enlarged mucosal folds of the gallbladder can be seen, and
in many there will be an infiltrate of foamy histiocytes.
There is very little inflammation of the acute or chronic
type here, and if there is any at all, it will be found in the
muscular wall and serosal fat. This is a very common and
benign process, and very likely is the starting point for
some types of gall stones.

8.  The physical examination may reveal fever,
tachycardia, and tenderness in the RUQ( right
upper quadrant) or epigastric region, often with
guarding or rebound.
 The Murphy sign, which is specific but not
sensitive for cholecystitis, is described as
tenderness and an inspiratory pause elicited
during palpation of the RUQ. A palpable
gallbladder or fullness of the RUQ is present in
30-40% of cases. Jaundice may be noted in
approximately 15% of patients.

9.  Many patients present with diffuse epigastric
pain without localization to the RUQ. Patients
with chronic cholecystitis frequently do not
have a palpable RUQ mass secondary to
fibrosis involving the gallbladder.

10.  The main symptoms is pain in the upper right
side or upper middle of the abdomen. The
pain may :
 Be sharp, cramping, steady
 Spread to the back or below the right
shoulder blade
 Other symptoms : clay-colored stools, fever,
nausea or vomitting, yellowing of
skin(jaundice)

11.  Cholecystitis is diagnosed by doctors mainly
based on symptoms and results of imaging
tests.
 Ultrasonography is the best way to detect
gallstones in the gallbladder or the thickening
of its wall.

12.  Ultrasound of the Abdomen. Ultrasound is a
simple, rapid, and noninvasive imaging
technique. It is the diagnostic method most
frequently used to detect gallstones and is
the method of choice for detecting
cholecystitis.
 If possible, the patient should not eat for 6 or
more hours before the test, which takes only
about 15 minutes. During the procedure, the
doctor can check the liver, bile ducts, and
pancreas, and quickly scan the gallbladder
wall for thickening (characteristic of
cholecystitis.

13.  Cholescintigraphy, another imaging test, is
useful when acute cholecystitis is difficult to
diagnose.

14.  For this test, a radioactive substance
(radionuclide) is injected intravenously. A gamma
camera detects the radioactivity given off and a
computer is used to produced an image. Thus
the movement of the radionuclide from the liver
through the biliary tract can be followed.
 Images of the liver, bile ducts, gallbladder and
upper part of small intestines are taken. If the
radionuclide does not fill the gallbladder, the
cystic duct is probably blocked by a gallstones.

15.  Liver blood test are often normal unless the
person has an obstructed bile duct. Other
blood test can detect some complications
such as high level of a pancreatic enxyme
(lipase or amylase) in pancratitis.
 A high count of WBC suggest inflammation,
an abscess, gangrene or a perforated
gallbladder.

16.  Surgical – removal of the gallbladder
(cholecystectomy) is usually done by using a
flexible tube called a laproscope.

17.  This surgery uses a smaller surgical cuts,
which results in a faster recovery. Patients are
often sent home from the hospital on the
same day as surgery or the next morning.
Open cholecystectomy requires larger cut in
the upper-right part of the abdomen.
 Gall stones may also be dissolved with
medication taken by mouth. But may take 2
years or longer to work.

18.  Pain after surgery : a few people have new or recurring
episodes of pain that felt on gallbladder even thought the
gallbladder and the stones have been removed.
 It may be the malfunction of the sphincter of Oddi, the
muscle that control the released of bile and pancreatic
secretion.

19.  Cancer of gallbladder (rarely)
 Jaundice
 Pancreatitis
 Worsening of the condition
 + info jaundice :
 The pancreas and liver drain into the same duct
into the gut. When the pancrease becomes
inflamed and swollen the outflow from the liver
does not drain into the gut.
The bile salts do not get into the gut and stay in
the body leading to jaundice.

20.  The condition is not always preventable.
 Eating less fatty food may relieve symptoms
who have not had their gallbladder removed.

21.  www.nlm.nig.gov/medlineplus/ency/article/0
00217.htm
 www.webmd.com/digestive-
disorders/tc/cholecystitis-overview
 Medical-
dictionary.thefreedictionary.com/cholecystitis
 en.wikipedia.org/wiki/cholecystitis
 en.wikipedia.org/wiki/Gallbladder
 http://www.umm.edu/patiented/articles/how
_gallstones_gallbladder_disease_diagnosed_0
00010_6.htm#ixzz21kbeCKm7