Gall‐bladder wall thickening in patients with liver cirrhosis

Abstract

Gall-bladder wall thickening is commonly seen in patients with cirrhosis, but its exact causes have not been well established. We evaluated clinical, biochemical and haemodynamic data of patients with cirrhosis with respect to the presence of thickening of the gall-bladder wall. After excluding patients who presented with gallstones, acute or chronic cholecystitis, heart failure, a serum creatinine level greater than 2 mg/dL and/or a serum alanine aminotransferase level greater than 400 U/L, 77 patients with cirrhosis (75 male, two female; mean age 58 +/- 8 years) were enrolled in the study. Clinical, biochemical, ultrasound and haemodynamic data were obtained in every patient. Forty-one (53%) of 77 patients with cirrhosis had gall-bladder wall thickening (> 4 mm). Compared with patients with a normal gall-bladder wall, patients with gall-bladder wall thickening had significantly lower serum albumin levels (3.6 +/- 0.6 vs 2.9 +/- 0.7 gm/dL, respectively; P < 0.05), a longer prothrombin time (13 +/- 6 vs 16 +/- 6 s, respectively; P < 0.05), more patients with Child-Pugh class C (6 vs 37%, respectively; P < 0.05) and more patients with ascites (8 vs 50%, respectively; P < 0.05). In addition, compared with patients with a normal gall-bladder wall, those patients with gall-bladder wall thickening had a higher hepatic venous pressure gradient (13.9 +/- 4.5 vs 17.1 +/- 4.1 mmHg, respectively; P < 0.01) and a lower systemic vascular resistance (SVR; 1144 +/- 332 vs 1010 +/- 318 dyn.s/cm5, respectively; P < 0.05). Using a multivariate analysis, the presence of ascites and SVR lower than 900 dyn.s/cm5 were independently correlated with the presence of gall-bladder wall thickening, while a hepatic vein pressure gradient greater than 10 mmHg had only a marginally significant association. The presence of ascites, decreased SVR and portal hypertension are related to the occurrence of gall-bladder wall thickening in patients with cirrhosis, indicating that the development of gall-bladder wall thickening may be multifactorial.

Diffuse Gallbladder Wall Thickening on Computed Tomography in Patients With Liver Cirrhosis

“…9 In this study, presence of ascites, lower level of albumin, and lower platelet count were identified as independently In their study, portal hypertensionVdirectly measured by calculation of hepatic venous pressure gradient (HVPG)Vwas not, however, statistically significant albeit showing a tendency for association. 8 Although the associating factors were somewhat different among these studies, our results were overall concordant with those of previous investigations. The pathophysiologic mechanism for DGWT in the patients with liver cirrhosis has not been clearly understood.…”

“…11 Therefore, cholecystic venous outflow would be impaired in case of increased hepatic vascular resistance, resulting in venous congestion of the gallbladder manifesting as DGWT on cross-sectional imaging. However, the study by Wang et al,8 in which portal hypertension was measured by HVPG, failed to show a significant association between portal hypertension and DGWT, as mentioned above. In addition, Loreno et al 9 reported that DGWT developed in almost all Child-Pugh class A cirrhotic patients without portal hypertension.…”

“…This finding was consistent with a study using ultrasonographic examination for evaluation of DGWT in 77 cirrhotic patients, in which the prevalence rates were 31%, 57%, and 88% for Child-Pugh classes A, B, and C, respectively. 8 The apparent discrepancy in the 2 studies with regard to the prevalence of DGWT in Child-Pugh class A patients might be attributed to difference in patient population. A recent ultrasonographic study even showed that almost all patients with Child-Pugh class A had DGWT.…”

“…8,9 The prevalence of gallstones in cirrhotic patients is significantly higher than in normal population. In addition, the prevalence of gallstones increases with the progression of liver cirrhosis.…”

Hepatitis C Virus Infection Is Positively Associated with Gallstones in Liver Cirrhosis

“…This has led to a drastic increase of GD prevalence in HBsAg positive population. As for gender, our results are consistent with the generally accepted view that gallstone prevalence is higher in women than in men [32,33]. Quite a few studies revealed a positive correlation between a high serum LDL level and cholesterol gallstone development [34,35]; the results of our study displayed a relationship between a high serum LDL level and GD prevalence, though we failed to get the information of the gallstone type.…”