71 T_h e gallbladder and bile ducts

Absence of the cystic duct This ‘anomaly’ is usually pathological, indicating the recent passage ...

Absence of the gallbladder Rarely , the gallbladder is absent; failure to visualise it should not...

Accessory cholecystohepatic duct Ducts passing directly into the gallbladder from the liver are n...

BILIARY TRACT Biliary ascariasis The roundworm Ascaris lumbricoides commonly infests the intestin...

Bile duct injuries About 15% of injuries to the bile ducts are recognised at the time of operat...

Blood supply to the bile ducts The supraduodenal CBD is supplied by the left and right choledocha...

CHOLECYSTECTOMY Preparation for operation After appropriate history taking and assessment of th...

CHOLECYSTOSES (CHOLESTEROLOSIS, POL YPOSIS, ADENOMYOMATOSIS AND CHOLECYSTITIS GLANDULARIS PROLIFE...

CHOLEDOCHAL CYST Choledochal cysts are congenital dilatations of the intra- and/ or extrahepatic...

CONGENITAL ABNORMALITIES OF THE GALLBLADDER AND BILE DUCTS Embryology The hepatic diverticulum ar...

CONGENITAL DILATATION OF INTRAHEPATIC DUCTS (CAROLI’S DISEASE) This rare congenital condition is ...

Cancer of the gallbladder Incidence Gallbladder cancer is extremely variable by geographical regi...

Causal factors Gallstones can be divided into three main types: cholesterol, pigment (brown/black...

Cholecystitis glandularis proliferans (adenomyomatosis) Adenomyomatosis is an abnormality of the...

Cholecystography Oral and intravenous cholecystography have been replaced by more accurate imagin...

Choledochotomy When faced with a patient with cholangitis due to stones in the CBD, and minimally...

Cholescintigraphy 99m Technetium-99m ( Tc)-labelled derivatives of iminodiacetic acid (hepatobil...

Cholesterol polyposis of the gallbladder USG may show a non-mobile defect in the gallbladder lume...

Cholesterolosis (‘strawberry gallbladder’) Cholesterolosis (cholesterosis) is characterised by th...

Clinical features About one-third of patients are jaundiced at birth; in all a ff ected babies, j...

Clinical presentation Gallstones are being increasingly detected incidentally during imaging for ...

Clonorchiasis (Asiatic cholangiohepatis) This disease is endemic in the Far East. The fluke inhabi...

Complications of cholecystectomy Recovery after laparoscopic cholecystectomy is associated with l...

Computed tomography Unlike USG, computed tomography (CT) is less a ff ected by body habitus and is...

Diagnosis A clinical diagnosis of acute cholecystitis must be confirmed with radiological and lab...

Differential diagnosis This includes all causes of cholestatic jaundice in a neonate; namely , α...

Diverticulosis of the gallbladder Diverticulosis of the gallbladder is usually manifest as black...

EXTRAHEPATIC BILIARY ATRESIA Aetiology and physiology Biliary atresia is present in approximately...

Endoscopic retrograde cholangiopancreatography This technique is now used only as a therapeutic m...

Endoscopic ultrasonography Endoscopic ultrasonography (EUS) utilises an endoscope with an ultraso...

FURTHER READING Carter DC, Russell RCG, Pitt HA, Bismuth H (eds). Rob and Smith’s operative surge...

Floating gallbladder The gallbladder may hang on a mesentery , which makes it liable to undergo t...

Functions of the gallbladder The gallbladder is a reservoir for bile. During fasting, the resista...

GALLSTONES (CHOLELITHIASIS) Gallstones are the most common biliary pathology . It is estimated th...

Gallbladder polyps Polyps of the gallbladder are incidental findings during radiological imaging ...

Gallstone ileus Gallstone ileus is an infrequent complication (0.4%) of cholelithiasis, occurring...

Gallstones in pregnancy Acute cholecystitis is the second most common non-obstetric indication fo...

Hydatid disease A large hydatid cyst may obstruct the hepatic ducts. Sometimes, - a cyst will rup...

IMAGING Plain radiographs A plain radiograph of the gallbladder will show radio-opaque stones in...

Imaging studies and biopsy Fasting USG is the gold standard when biliary atresia is suspected. A ...

Immunoglobulin G4-related cholangitis This recently recognised entity presents with di ff use or s...

Introduction No content extracted automatically.

Laparoscopic cholecystectomy Laparoscopic cholecystectomy is the procedure of choice for the maj...

Late symptoms after cholecystectomy In up to 15% of patients, cholecystectomy fails to relieve t...

Learning objectives To understand the surgical anatomy and physiology of the • gallbladder and bi...

Low insertion of the cystic duct The operating surgeon must identify variations in the anatomy ( ...

Lymphatics The subserosal and submucosal lymphatic vessels of the gall bladder drain into the cy...

Magnetic resonance cholangiopancreatography Magnetic resonance cholangiopancreatography (MRCP) is...

Malignant tumours of the bile duct Summary box 71.7 Bile duct cancer (cholangiocarcinoma) /uni25C...

Open cholecystectomy For patients in whom a laparoscopic approach is not indicated or in whom con...

PRIMARY SCLEROSING CHOLANGITIS PSC is a rare idiopathic and progressive biliary tract disease cha...

Percutaneous transhepatic cholangiography This is an invasive technique in which the bile ducts a...

Postcholecystectomy choledocholithiasis Any obstruction to the flow of bile can give rise to stas...

SURGICAL ANATOMY AND PHYSIOLOGY The gallbladder is a pear-shaped structure, 7.5–12 /uni00A0 cm lo...

Stricture of the bile duct The causes of benign biliary stricture are given in Summary box 71.5 ...

Surgical physiology Bile is produced by the liver and stored in the gallbladder before being rele...

TORSION OF THE GALLBLADDER This is a very rare complication, requires a long mesentery and theref...

TRAUMA Injury to the gallbladder and extrahepatic biliary tree is rare and may occur as a result...

TUMOURS OF THE BILE DUCT Benign tumours of the bile duct Benign neoplasms such as papilloma, aden...

Tenets for safe cholecystectomy ( Table 71.5 ) Safe zone of dissection The safe zone of dissecti...

Treatment For breast-fed infants, introducing supplemental formula feeds using a medium-chain tri...

Typhoid infection of the gallbladder Salmonella Typhi or Salmonella Typhimurium can infect the ga...

Ultrasonography Transabdominal ultrasonography (USG) ( Figure 71.7 initial imaging modality of c...

Xanthogranulomatous cholecystitis Xanthogranulomatous cholecystitis ( Figure 71.30 ) is an uncomm...