Skip to content

Miscellaneous

Summary: Cholesterolosis of the Gallbladder

  • Cause and Appearance (Options A & B):
    • Cholesterolosis is caused by the accumulation of cholesterol in macrophages within the gallbladder mucosa.
    • This can manifest either locally or as polyps.
    • The classic macroscopic appearance is described as a "strawberry gallbladder."
  • Premalignant Status (Option C):
    • Cholesterolosis is not considered a premalignant condition.
  • Treatment (Option D):
    • In symptomatic patients, the treatment of choice is cholecystectomy.

(Source: Schwartz 10th edition, page 1320)

Summary: Gallbladder Injuries

  • Occurrence and Causes (Option A):
    • Gallbladder injuries are uncommon.
    • Penetrating injuries are typically caused by gunshot wounds, stab wounds, and rarely by a needle biopsy of the liver.
    • Nonpenetrating trauma to the gallbladder is extremely rare.
  • Types of Nonpenetrating Trauma (Options B & C):
    • Types include contusion, avulsion, laceration, rupture, and traumatic cholecystitis.
  • Treatment and Prognosis (Option D):
    • The treatment of choice for gallbladder injury is cholecystectomy.
    • The prognosis depends on the type and incidence of associated injuries.

(Source: Schwartz 10th edition, page 1331)

Summary: Gallbladder Wall Thickness

  • Normal Gallbladder Wall: Should be smooth and not exceed 3 mm in thickness.
  • False Thickening:
    • Can occur when the gallbladder is contracted, often seen in nonfasting patients.
  • Primary Causes of Wall Thickening:
    • Cholecystitis
    • Adenomyomatosis
    • Gallbladder cancer
  • Secondary Causes of Wall Thickening:
    • AIDS cholangiopathy
    • Sclerosing cholangitis
    • Hepatitis
    • Pancreatitis
    • Heart failure
    • Hypoalbuminemia
    • Cirrhosis
    • Portal hypertension
    • Lymphatic obstruction
  • Clinical Example:
    • Marked gallbladder wall thickening is seen in septic patients with acalculous cholecystitis, often observed via transabdominal ultrasound.

(Source: Shackelford 8th edition, page 1268, Fig 107.2)

Summary: Anatomy of the Caudate Lobe (Segment I)

  • Bile Drainage:
    • Bile drains through a variable number of ducts into the left hepatic duct, right hepatic duct, or both.
    • Segment I ducts run above the portal branch and join the corresponding bile duct on its posterior aspect near the biliary confluence.
  • Venous Drainage:
    • The caudate lobe is unique as it does not drain into one of the main hepatic veins.
    • It has one or two large short hepatic veins and several small ones that drain directly into the retrohepatic inferior vena cava (IVC), usually on its left anterior side.
  • Anatomical Borders:
    • The caudate lobe proper (Spigelian lobe) protrudes visibly from the left side of the IVC.
    • Its anterior border fuses indistinctly with segment 4, and its right border merges with segments 6 and 7.

(Source: Mastery of Surgery, 7th edition, page 3675)

APBJ:

image.png

MCQ: Type of Post-ERCP Perforation

Question: A post-ERCP patient has retroperitoneal air seen on imaging. What type of post-ERCP perforation is this?

Options: a) Type I

b) Type II

c) Type III

d) Type IV

Correct Answer: D) Type IV

Summary:

  • Type I: Free bowel wall perforation.
  • Type II: Retroperitoneal duodenal perforation secondary to periampullary injury.
  • Type III: Perforation of the pancreatic or bile duct.
  • Type IV: Retroperitoneal air alone (without evidence of bowel perforation).

MCQ: Gallbladder Not Situated in Gallbladder Fossa

Question: In which anomaly is the gallbladder not situated in the gallbladder fossa?

Options: a) Retrodisplaced Gallbladder

b) Transverse Gallbladder

c) Floating Gallbladder

d) Intrahepatic Gallbladder

Correct Answer: A) Retrodisplaced Gallbladder

Summary: Anatomical Variations of the Gallbladder

  • Retrodisplacement of the Gallbladder:
    • The gallbladder is not located in its usual fossa.
    • It may be bound to another portion of the liver or freely suspended with the fundus extending posteriorly.
    • It can be partially or completely located within the retroperitoneum.
  • Transverse Gallbladder:
    • Positioned horizontally in the transverse fissure of the liver.
    • The gallbladder is often deeply embedded within the liver parenchyma.
  • Floating Gallbladder:
    • Occurs in about 5% of individuals, typically women over 60 years old.
    • Completely surrounded by peritoneum and attached to the undersurface of the cystic fossa.
    • May be susceptible to torsion around its pedicle due to its unsupported position.
  • Intrahepatic Gallbladder:
    • Normally intrahepatic during embryologic development and later becomes extrahepatic.
    • An intrahepatic gallbladder is partially or completely embedded within the liver.
    • This condition may be associated with gallstones in approximately 60% of cases.

(Source: Shackelford 8th edition, page 1260)