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Chapter 3
41
Pathology of the gallbladder
and biliary tree
CHAPTER CONTENTS
Cholelithiasis 41
Ultrasound appearances 42
Choledocholithiasis 45
Biliary reflux and gallstone pancreatitis 47
Further management of gallstones 47
Enlargement of the gallbladder 48
Mucocoele of the gallbladder 48
Mirizzi syndrome 48
The contracted or small gallbladder 50
Porcelain gallbladder 50
Hyperplastic conditions of the gallbladder wall 51
Adenomyomatosis 51
Polyps 53
Cholesterolosis 53
Inflammatory gallbladder disease 54
Acute cholecystitis 54
Chronic cholecystitis 56
Acalculous cholecystitis 56
Complications of cholecystitis 57
Obstructive jaundice and biliary duct
dilatation 58
Assessment of the level of obstruction 58
Assessment of the cause of obstruction 61
Management of biliary obstruction 64
Intrahepatic tumours causing biliary
obstruction 64
Choledochal cysts 64
Cholangitis 66
Biliary dilatation without jaundice 66
Postsurgical CBD dilatation 66
Focal obstruction 67
Pitfalls 67
Obstruction without biliary dilatation 67
Early obstruction 67
Fibrosis of the duct walls 67
Other biliary diseases 67
Primary sclerosing cholangitis 67
Caroli’s disease 68
Parasites 70
Echogenic bile 71
Biliary stasis 71
Haemobilia 72
Pneumobilia 72
Malignant biliary disease 73
Primary gallbladder carcinoma 73
Cholangiocarcinoma 74
Gallbladder metastases 76
Ultrasound is an essential first-line investigation in
suspected gallbladder and biliary duct disease. It is
highly sensitive, accurate and comparatively cheap
and is the imaging modality of choice. 1 Gallbladder
pathology is common and is asymptomatic in over
13% of the population. 2
CHOLELITHIASIS
The most commonly and reliably identified gallbladder
pathology is that of gallstones (see Table
3.1). More than 10% of the population of the UK
have gallstones. Many of these are asymptomatic,
which is an important point to remember. When