Disease of the Gallbladder and Biliary Tree

Abstract

Choledochal cyst involves congenital cystic dilatation of any portion of the extrahepatic bile ducts, and most choledochal cysts are diagnosed in childhood; however, up to 20% of cysts manifest in adults. It is classified based on the spectrum of morphologic changes in the bile ducts. The most common classification scheme is the Todani modification of the Alonso-Lej classification. Todani type I-single cystic dilatation of the extrahepatic bile duct (EBD). Todani Type II-true diverticula of the EBD. Todani Type III-choledochocele or ectasia of an intramural EBD segment. Todani Type IV-multiple and can have both intrahepatic and extrahepatic components. Todani Type V (Caroli disease)-cystic dilatation of the intrahepatic bile ducts (IBDs). Complications of choledochal cysts in adults include rupture with bile peritonitis, stone formation, cholangitis, liver abscess, and cholangiocarcinoma (CC). CC arising in a choledochal cysts appears as an intracystic soft tissue density mass or irregular thickening of the cyst wall [1]. 5.1.2 Choledocholithiasis Regardless of whether bile duct dilatation is present, the visible ducts should be scrutinized to identify and characterize filling defects, the vast majority of which represent stones [2]. Detectability of a bile duct stone on CT depends on the calcium content and requires precontrast CT. Depending on the composition, stones may show soft tissue attenuation, near-water attenuation, or fat attenuation with peripheral calcification. Stones are manifested as a signal void on T2-weighted imaging or MRCP (Fig. 5.1). On T1-weighted imaging, cholesterol stones are generally iso-or hypointense, while pigment stones are hyperintense due to the presence of metal ions. ERCP is highly accurate for the detection of small choledocholithiasis and also provides access for therapeutic intervention.

Território E Atenção Primária Em Saúde: Experiência De Estudantes De Medicina Da Cidade De Manaus- Am

“…As obstruções extra-luminais ocorrem nos adenocarcinomas pancreáticos, colangiocarcinomas, entre outros. 6…”

Imaging-based algorithmic approach to gallbladder wall thickening

“…Focal wall thickening most commonly occurs due to the intrinsic causes. The malignant causes include GBC, GB lymphoma, and metastasis (most commonly from melanoma), while the most common benign causes include focal XGC, focal ADM, and localized chronic cholecystitis[ 9 ].…”

C-reactive protein in gallbladder diseases: diagnostic and therapeutic insights

“…The delay of elective cholecystectomy from the time of diagnosis has not been shown to increase risk of complications from either surgery or acute cholecystitis. Cholecystectomies are relatively safe procedures and provide symptom relief in 75%-90% of patients (Elwood 2008;Greenberger and Paumgartner 2018;Lee and Boll 2018;Okamoto et al 2018).…”

“…Chronic cholecystitis can be complicated by many concomitant issues, such as empyema, hydrops, gangrene, fistulas, or limey bile. Calcium may also deposit and harden in the walls of the gallbladder, causing extensive scarring (Elwood 2008;Greenberger and Paumgartner 2018;Lee and Boll 2018).…”