CHOLECYSTITIS

GALLBLADDER

• Major Function : Concentrate, Store Bile

• Supplied by Cystic Artery
• Many Arterial Variations
 GALLSTONES
• Autopsy Prevalence 11-36%
• Female:Male Ratio is 3:1
• First Degree Relatives Have Twice the
Rate
• Cholecystectomy One of Commonest
Operations
Small’s Triangle
 PREDISPOSING FACTORS
• Obesity
• Pregnancy
• Dietary Factors
• Crohn’s Disease, Ileal Resection
• Hemolytic Diseases
• Gastric Surgery
 CHOLESTEROL STONES
• Most Common Type
• Rarely Pure, >70% Cholesterol
• Precipitation from Supersaturated Bile
• Usually Multiple, Variable Sizes
• Hard and Facetted to Irregular and Soft
• Color White/Yellow to Brown/Black
• Only 10% are Radio-opaque
 PIGMENT STONES
• <20% Cholesterol
• Dark Because of Calcium Bilirubinate
• Usually Tiny to Small
• Invariably Multiple
• Two Types- Black Stones
• Brown Stones
 BLACK STONES
• Form ONLY in Gall Bladder
• Secondary to Hematologic Diseases
• Spherocytosis
• Sickle Cell Disease
• Thalassemia
• Common in Cirrhosis
• More Common in Asia
 BROWN STONES
• Form in Gall Bladder AND Bile Ducts
• Small, Soft, Often Mushy
• Secondary to Bacterial Infection
Caused by Bile Stasis
• Bacterial Cell Walls Prominent in
Stones
• More Common in Asia
 NATURAL HISTORY
• Most Are Asymptomatic
• Asymptomatic Stones Detected On
Evaluation For Other Illnesses
• Ultrasound
• CT
• Plain Abdominal X-Ray
• Laparotomy
• 2/3 Stay Asymptomatic >20 Years
•
 COMPLICATIONS
• Biliary Colic- Initial Symptom
• Acute Cholecystitis
• Choledocholithasis
• Cholangitis
• Biliary Pancreatitis
• Cholecysto-Duodenal Fistula
• Gall Bladder Carcinoma
 CHOLECYSTECTOMY
• Indicated for Symptomatic Patients
• Rare Indications in Asymptomatic Ones
• Elderly Diabetics
• Before Transplantation
• Isolation From Medical Care
• Gallbladder Polyp (Controversial)
• Porcelain Gall Bladder Absolute
Indication