Gall Bladder( Introduction, Investigation)

The gall bladder

  • The gall bladder is a reservoir for bile, a pear-shaped structure, 7-12cm long, with a capacity of 50 ml and capable of concentration of bile 5-10 times.
  • The cystic duct is variable  about 3 cm long, lumen of  1-3 mm and join the common hepatic duct (3 cm) to form the common bile duct (7 cm).
  • Common bile duct has a supra-, retro-, infra- and intra-duodenal parts.
  • The cystic artery a branch of right hepatic artery (80%) cross behind the common hepatic duct.
  • The lymph drains to cystic lymph node which is at level of cystic duct.

Investigations of the biliary tract.

  • Laboratory test
    • Blood cp, LFTs, hepatitis B & C, APT, PT, urine RE, bile salts, serum amylase, etc.
  • Ultrasonography
    • Initial modality of choice as it is accurate, readily available, inexpensive and quick to perform.
  • Plain radiograph
    • 10% of gallstones are radio-opaque.
    • Porcelain gall bladder (calcification of GB) is commonly (25%) associated with carcinoma of GB and strong indication for cholecystectomy.
    • Gas may be seen in GB or its wall (emphysematous cholicystitis).
  • In evaluation of difficult cases further investigations are.
    • Computerised tomography
      • Anatomy of liver, gall bladder and pancreas, especially of cancer.
    • Magnetic resonance cholangiopancreatography (MRCP)
      • Anatomy of biliary system.
    • Endoscopic retrograde cholangiopancreatography (ERCP)
      • These days more therapeutic role than diagnostic e.g.; extraction of stone, stenting, etc.
    • Percutaneous transhepatic cholangiography (PTC)
      • Anatomy of biliary system.
    • Peroperative cholangiography
    • Operative biliary endoscopy (choledochoscopy)
    • Radioisotope scanning (HIDA, IODIDA)
      • Helpful in diagnosing of function of liver, post operative bile leaks and iatrogenic biliary obstruction.

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