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Differential diagnosis This includes all causes of cholestatic jaundice in a neonate; namely , α -antitrypsin deficiency , cholestasis associated with 1 intravenous feeding, choledochal cyst and inspissated bile syndrome. The most common di ff erential diagnose...

Diverticulosis of the gallbladder Diverticulosis of the gallbladder is usually manifest as black pigment stones impacted in the outpouchings of the lacunae of Luschka. This may be demonstrated by cholecystography , Mary E Charlson , contemporary , Clinical ...

EXTRAHEPATIC BILIARY ATRESIA Aetiology and physiology Biliary atresia is present in approximately 1 in 12 /uni00A0 000 live births and a ff ects males and females equally . The aetiology is unclear; the extrahepatic bile ducts are progressively destroyed by an ...

Endoscopic retrograde cholangiopancreatography This technique is now used only as a therapeutic modality in patients with obstructive jaundice; USG and MRCP have taken over the diagnostic aspect. Using a side-viewing endoscope the ampulla of Vater is identifie...

Endoscopic ultrasonography Endoscopic ultrasonography (EUS) utilises an endoscope with an ultrasound transducer at its tip, which allows the endoscopist to visualise the liver and biliary tree from within the stomach and duodenum ( Figure 71.8 ). It is accurat...

FURTHER READING Carter DC, Russell RCG, Pitt HA, Bismuth H (eds). Rob and Smith’s operative surgery: hepatobiliary and pancreatic surgery. London: Chapman & Hall, 1996. Dooley JS, Lok A, Burroughs A, Heathcoate J (eds). Sherlock’s diseases of the liver and bil...

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

Functions of the gallbladder The gallbladder is a reservoir for bile. During fasting, the resistance to flow through the sphincter of Oddi is high, and bile excreted by the liver is diverted to the gallbladder. After feeding, the resistance to flow through the ...

GALLSTONES (CHOLELITHIASIS) Gallstones are the most common biliary pathology . It is estimated that gallstones a ff ect 10–15% of the population in western societies. In the UK, the prevalence of gallstones at the time of death is estimated to be 17%. Gallst...

Gallbladder polyps Polyps of the gallbladder are incidental findings during radiological imaging of the abdomen. The polyps are more often benign (cholesterol polyps, adenomyomas, inflammatory , adenomas or miscellaneous) but may be malignant (adenocar cinoma ...

Gallstone ileus Gallstone ileus is an infrequent complication (0.4%) of cholelithiasis, occurring as a result of impaction of one or more gallstones within the gastrointestinal tract. It is seen more Leon Bouveret , 1850–1929, physician, Lyon, France. a Thes...

Gallstones in pregnancy Acute cholecystitis is the second most common non-obstetric indication for surgery in pregnant women. Hormonal (oestro gen) changes during pregnancy increase cholesterol secretion and progesterone reduces bile acid secretion, reducing t...

Hydatid disease A large hydatid cyst may obstruct the hepatic ducts. Sometimes, - a cyst will rupture into the biliary tree and its contents cause obstructive jaundice or cholangitis, requiring appropriate surgery (see Chapter 6 ).

IMAGING Plain radiographs A plain radiograph of the gallbladder will show radio-opaque stones in 10% ( Figure 71.4 ). It may also show calcification of the gallbladder – the rare ‘porcelain’ gallbladder ( Figure 71.5 ). Paolo Mascagni , 1752–1815, Figure 71.5 ...

Imaging studies and biopsy Fasting USG is the gold standard when biliary atresia is suspected. A shrunken gallbladder, a hyperechogenic liver hilum (‘triangular cord sign‘) or a cyst at the liver hilum with out bile duct dilatation with associated anomalies su...

Immunoglobulin G4-related cholangitis This recently recognised entity presents with di ff use or segmental narrowing of the intra- or extrahepatic bile ducts. Its features may make di ff erentiation from PSC, cholangiocarci noma and pancreatic cancer di ffi cult....

Introduction No content extracted automatically.

Laparoscopic cholecystectomy Laparoscopic cholecystectomy is the procedure of choice for the majority of patients. The indications and preparation for cholecystectomy are the same whether it is performed by laparoscopy or by open technique. The patient is pl...