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CHOLECYSTOSES (CHOLESTEROLOSIS, POL YPOSIS, ADENOMYOMATOSIS AND CHOLECYSTITIS GLANDULARIS PROLIFERANS) This is a relatively uncommon group of conditions a ff ecting the gallbladder, in which there are chronic inflammatory changes with hyperplasia of all tissue...

CHOLEDOCHAL CYST Choledochal cysts are congenital dilatations of the intra- and/ or extrahepatic biliary system. The pathogenesis is unclear. Anomalous insertions of the biliary–pancreatic junction are frequently observed, but whether or not these play a rol...

CONGENITAL ABNORMALITIES OF THE GALLBLADDER AND BILE DUCTS Embryology The hepatic diverticulum arises from the ventral wall of the foregut and elongates into a stalk to form the choledochus. A lateral bud is given o ff , which is destined to become the gallblad...

CONGENITAL DILATATION OF INTRAHEPATIC DUCTS (CAROLI’S DISEASE) This rare congenital condition is characterised by multiple irregular saccular dilatations of the intrahepatic ducts, sepa - rated by segments of normal or stenotic ducts, with a normal extrahepa...

Cancer of the gallbladder Incidence Gallbladder cancer is extremely variable by geographical region and racial–ethnic groups; the highest incidence is among Chileans, Native Americans and residents in parts of northern India, where it accounts for as much as 9...

Causal factors Gallstones can be divided into three main types: cholesterol, pigment (brown/black) and mixed stones. In the USA and Europe, 80% of gallstones are cholesterol or mixed stones, whereas in parts of Asia 80% are pigment stones. Choles terol or mi...

Cholecystitis glandularis proliferans (adenomyomatosis) Adenomyomatosis is an abnormality of the gallbladder char - acterised by overgrowth of the mucosa and thickening of the muscle wall, leading to cyst-like structures in the gallbladder wall or polypoid ...

Cholecystography Oral and intravenous cholecystography have been replaced by more accurate imaging modalities.

Choledochotomy When faced with a patient with cholangitis due to stones in the CBD, and minimally invasive techniques for stone extraction are not possible, the surgeon must undertake laparotomy , drain the CBD and remove the stones through a longitudinal inci...

Cholescintigraphy 99m Technetium-99m ( Tc)-labelled derivatives of iminodiacetic acid (hepatobiliary iminodiacetic acid [HIDA]; the utility of a hepatobiliary IDA or HIDA scan is that the radiotracer follows Figure 71.8 Endoscopic ultrasonography. CBD, commo...

Cholesterol polyposis of the gallbladder USG may show a non-mobile defect in the gallbladder lumen with no acoustic shadow . The di ff erential is an adenomatous polyp, and interval follow-up is indicated to ensure stability . Surgery is advised only if there ...

Cholesterolosis (‘strawberry gallbladder’) Cholesterolosis (cholesterosis) is characterised by the accu - mulation of lipids (triglycerides, cholesterol precursors and cholesterol esters) in the mucosa of the gallbladder wall. These nodules are less than 1 /...

Clinical features About one-third of patients are jaundiced at birth; in all a ff ected babies, jaundice is present by the end of the first week and deepens progressively . The meconium may be a little bile-stained, but later the stools are pale and the urine ...

Clinical presentation Gallstones are being increasingly detected incidentally during imaging for other symptoms. Prophylactic cholecystectomy is not usually indicated since the risk of developing serious complications is low . Longitudinal follow-up study of ...

Clonorchiasis (Asiatic cholangiohepatis) This disease is endemic in the Far East. The fluke inhabits the bile ducts, including the intrahepatic ducts. Fibrous thicken - ing of the duct walls occurs. Many cases are asymptomatic. Complications include biliary pa...

Complications of cholecystectomy Recovery after laparoscopic cholecystectomy is associated with less pain and faster return to normal activity than open cholecystectomy . The majority of elective patients can have this performed as a day case; however, any pa...

Computed tomography Unlike USG, computed tomography (CT) is less a ff ected by body habitus and is not operator dependent. It allows visualisation of the liver, bile ducts, gallbladder and pancreas. CT findings in acute cholecystitis include gallbladder distens...

Diagnosis A clinical diagnosis of acute cholecystitis must be confirmed with radiological and laboratory investigations. USG is the first choice for imaging; however, the sensitivity and specificity of diagnosing acute cholecystitis is increased when combined w...