Gallbladder Hydrops
Gallbladder Hydrops
Gallbladder Hydrops
The gallbladder is a hollow sac that stores bile containing wastes and fats among other substances
that need to be evacuated from the body. Normally this bile is secreted when a person eats food
and digestion is occurring in the duodenum, the first part of the small intestine. Since bile has an
emulsifying property, it is useful for breaking down the oils and fats in a fatty meal. By doing so,
other digestive enzymes can act on the fats to break it down further and allow for the body to
absorb it from the gut.
Bile is produced throughout the day. The gallbladder can store as much as 1.5 liters (about 50 fluid
ounces) of bile by drawing water out of the bile in the gallbladder. This concentrates the bile but also
helps to reduce the space occupied in the gallbladder. The water can be added at a later stage just
before the bile empties out into the duodenum. The gallbladder has a fairly thick wall which can
stretch to a very large degree thereby allowing for a large quantity of bile to be stored if necessary.
Bile empties out of the gallbladder through the narrow duct that joins the common bile duct which
leads to the duodenum. When the neck of the gallbladder and its duct (cystic duct) is blocked, bile
cannot flow out. Over a prolonged period of time, the bile and its salts are gradually resorbed
through the gallbladder wall. Mucus and water are secreted from the wall and accumulates within
the gallbladder. This is a mucocele. Usually the fluid within the gallbladder is sterile meaning that
there are no microbes like bacteria and there is also no pus. Over time the gallbladder expands and
distends often close to its maximum capacity, and sometimes even beyond where it may then
rupture.
Effect on Gallbladder
The overdistension of the gallbladder has a host of effects on the organ. In long term cases, the
walls of the bladder become thinner and even slightly transparent. The enlarged gallbladder may
press against the duodenum and hamper stomach emptying. This causes gastric outlet obstruction.
Blood supply to the gallbladder is affected and an infection can set in eventually leading to gangrene
of the organ. The thinner and overdistended gallbladder is weak and can rupture with serious
implications. The gallbladder contents that empty into the abdominal cavity may lead to peritonititis.
Gallstones
External compressions of the gallbladder neck or cystic duct by swollen lymph nodes, or tumors and
enlarged organs around the gallbladder.
Fibrocystic disease
Hepatitis
Kawasaki syndrome
Leptospirosis
Mesenteric adenitis
Nephrotic syndrome
Streptococcal pharyngitis
Typhoid
Other Causes
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These other conditions are less likely to cause a gallbladder mucocele but it is still a
possible factor that needs to be considered.
Kidney mass
Parasitic cysts
Pancreatic pseudocyst
Abdominal discomfort or pain on the upper right side (RUQ) or upper middle region
(epigastric).
Symptoms of complications
Abdominal x-ray
CT scan
HIDA scan
Diagnostic findings during surgery, such as clear fluid in the gallbladder and a
blocked duct, confirms the diagnosis.
Open surgery where a large incision is made in the right upper portion of the
abdomen and the gallbladder is then removed.
Laparoscopic surgery where a tiny hole (keyhole) is made in the abdominal wall and
a flexible tube known as a laparoscope is inserted. Minute surgical instruments are
also inserted through other portals and used to locate the gallbladder and remove
it.
Although laparoscopic surgery is the procedure of choice as it is minimally invasive and has fewer
complications, it may not always be ideal for a very enlarged gallbladder. The choice of procedure is
dependent on the individual case. Removing the gallbladder usually provides total resolution of
symptoms and has an excellent outcome. However, this is dependent on whether complications had
already arisen or not prior to surgery.