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with Gallbladder
Disease
Anatomy of Gallbladder
Anatomy of the
Gallbladder
Pear-shaped
hollow sac-like
organ;
lies in a shallow
depression on the
inferior surface of
the liver
Normal capacity is
30-50ml
Bile Flow
In the fasting state, the Sphincter of
Oddi offers a high pressure zone:
- to prevent reflux of duodenal
contents into the bile ducts
- to promote bile filling of the
gallbladder
Cholecystokinin
- is released in the duodenal
mucosa in response to the ingestion
of fats and amino acids.
Contraction of gallbladder
Decreased resistance of the Sphincter of
Oddi
Increased hepatic secretion of bile
Enhanced flow of biliary contents into the
duodenum
Enterohepatic Circulation
Diseases of the
Gallbladder
Acute Cholecystitis
Types: calculous (90%) stone
obstructs bile
outflow
acalculous absence of
obstruction by
stones
Cholelithiasis (Gallstones)
Formation of stones in the cystic duct
Types of Stones:
- cholesterol
- pigment
- stones
Risk Factors:
Obesity
Women,especially those who had
multiple pregnancies
Frequent changes in weight
Rapid weight loss
Treatment with high dose estrogen
Ileal resection/ disease
Diabetes Mellitus
Pathophysiology
Clinical Manifestations
Pain and Biliary Colic
Jaundice
Changes in urine and stool color
Vitamin Deficiency
Diagnostic Procedures
A. Plain Abdominal X-ray - to rule out
other possible diseases
B. US – detects gallstones with 95%
accuracy
C. Cholescintigraphy – biliary tract is
scanned after
administration of a
radioactive agent
D. Cholecystography – to visualize
biliary tract; x-ray is
obtained after an oral
contrast is administered
Surgical Management
Laparoscopic Cholecystectomy
Open Cholecystectomy
Nutritional and Supportive
Therapy
80% of patients with acute
cholecystitis achieve remission with
rest, IV fluids, analgesia and
antibiotics
Low-fat liquid diet; should avoid hihg
fat diet
Pharmacologic Management
Dissolving agents
Ursodeoxycholic acid
Chenodeoxycholic acid