Overdistension of the gallbladder occasionally the

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overdistension of the gallbladder; occasionally, the gallbladder assumes massive proportions, and the volume may be as much as 1,5 liters. The bile or bile pigment is slowly resorbed, and continuing secretion from the mucosa of the gallbladder results in clear and watery or mucoid content (white bile). The gallbladder wall may be of normal thickness, although in long-standing cases, the mucosa atrophies and the wall becomes thin, sometimes even transparent. Wall thickening can occur with recurrent attacks of cholecystitis. The contents are usually sterile, and any bacterial contamination ends in empyema of the gallbladder. Gross overdistension may result in gangrene and/or perforation of the gallbladder, with ensuing pericholecystic collection or peritonitis. Microscopic examination reveals a flattened mucosa lined by low columnar or cuboidal cells; the increased intraluminal pressure results in plentiful Rokitansky-Aschoff sinuses. Inflammatory cells may be present either in small numbers or in abundance. Presentation Symptomatology of a gallbladder mucocele includes right upper quadrant (RUQ) pain or epigastric pain and discomfort, nausea, and vomiting. Continuance of pain or persistence of tenderness longer than 6 hours indicates possible acute cholecystitis. Fever and chills suggest infected bile, with a possible empyema of the gallbladder. Jaundice is unusual. A palpable, somewhat tender mass is usual in the RUQ; the gallbladder at times may even be felt down in the pelvis. 7
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Diagnostic criteria The diagnosis of a mucocele should be considered in the following: Minimal acute inflammatory signs are present. A large, palpable, minimally tender gallbladder is found on clinical examination. Laboratory test results are normal or just within the upper limit of reference range values. Plain radiograph of the abdomen shows a soft-tissue–density, globular shadow in the subhepatic region. Ultrasonography of the RUQ shows evidence of minimal wall thickening, an impacted stone in the neck, or infundibulum of an enlarged gallbladder and clear content. Intraoperatively, the aspirate from the gallbladder is clear and watery or mucoid (white bile). The gallbladder on opening shows a white wall, clear and watery or mucoid content, a stone or stones impacted in the neck or cystic duct, a narrowed cystic duct, or a tumor and/or polyp causing obstruction of the neck of the gallbladder. Laboratory Studies No single laboratory test is diagnostic of a mucocele. However, laboratory workup should include all tests performed for acute cholecystitis. Higher counts of WBC indicate the possibility of infected bile (empyema). Imaging Studies Ultrasonography is extremely sensitive in detecting stones in the gallbladder. A grossly distended, thin-walled gallbladder measuring over 5 cm across anteroposteriorly, an impacted stone in the infundibulum or neck of the gallbladder or in the cystic duct, and clear fluid content indicate a possible mucocele. Ultrasonographic Murphy sign may be positive.
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  • Winter '18
  • Jane doe
  • Digestive System, bile duct, Hepatology, Gallstone

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