Pathology of Gallbladder

Gallbladder Concentrates bile (stronger emulsifying effect) Concentrates bile (stronger emulsifying effect) After a fatty meal, gallbladder contracts to secrete bile After a fatty meal, gallbladder contracts to secrete bile

Formation of Gallstones: If bile contains an imbalance of cholesterol, salts or bilirubin = gallstones If bile contains an imbalance of cholesterol, salts or bilirubin = gallstones 1 st - precipitate like snowflakes, then: 1 st - precipitate like snowflakes, then: A. combines to form “gravel”  stones A. combines to form “gravel”  stonesOR - B. forms “sludge”

Ducts that Transport Bile: hepatic ducts: carry bile out of liver hepatic ducts: carry bile out of liver cystic duct: takes bile to & from gallbladder cystic duct: takes bile to & from gallbladder common bile duct: takes bile from the cystic & hepatic ducts to small intestine common bile duct: takes bile from the cystic & hepatic ducts to small intestine

Effects of Gallstones: Blocked ducts can cause inflammation of gallbladder, liver and pancreas Blocked ducts can cause inflammation of gallbladder, liver and pancreas Symptoms: pain, fever, jaundice Symptoms: pain, fever, jaundice

3 pathologies related to gallstones: 1. biliary colic: 1. biliary colic: Stone blocks cystic duct Stone blocks cystic duct Causes RUQ & back pain Causes RUQ & back pain

2. Acute cholecystitis 2. Acute cholecystitis If stone remains in wall of gallbladder, causes inflammation If stone remains in wall of gallbladder, causes inflammation Needs to be removed immediately Needs to be removed immediately

3. Jaundice: 3. Jaundice: Small stone travels and blocks common duct Small stone travels and blocks common duct Bile goes back to gallbladder and liver Bile goes back to gallbladder and liver Bile enters blood  skin and sclera turn yellowish Bile enters blood  skin and sclera turn yellowish

Cholecystectomy Removal of gallbladder Removal of gallbladder 1. clip cystic artery and cystic duct 1. clip cystic artery and cystic duct 2. burn the separation between gallbladder and liver 2. burn the separation between gallbladder and liver

Laparoscopy 1. make incision in umbillical region 1. make incision in umbillical region 2. instruments enter through ports 2. instruments enter through ports

Subcostal Incision Open patient and remove gallbladder from top Open patient and remove gallbladder from top Still done if dr. cannot see during laparoscopy Still done if dr. cannot see during laparoscopy MUST get “consent to open” from patient prior to surgery MUST get “consent to open” from patient prior to surgery

m/DOWNLOADS.HTM Title: Full video of laparoscopic cholecystectomy (2) Title: Full video of laparoscopic cholecystectomy (2) (4 th link) (4 th link)