Topic 44 of 74 in the MU Sofia syllabus for Surgery (Medicine, Year 5). The free AceMed note covers it in 2 sections, about 267 words (2 min of reading), with 14 flashcards.
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TOPIC 44
Gallbladder mucocele (hydrops), empyema and biliary peritonitis
Gallbladder mucocele (hydrops), empyema and biliary peritonitis
HYDROPS / MUCOCELE
Gallbladder hydrops occurs when the cystic duct remains obstructed, commonly by an impacted stone, and the gallbladder fills with clear mucus rather than bile.
Patients may have RUQ discomfort or a palpable distended gallbladder; fever and systemic toxicity are usually absent unless infection develops.
Ultrasound shows a distended gallbladder, often with an obstructing stone and no major inflammatory change. Management is usually cholecystectomy in symptomatic patients or when complications are likely.
GALLBLADDER EMPYEMA
Empyema is accumulation of pus within the gallbladder, usually a complication of acute calculous cholecystitis.
Features include persistent RUQ pain, fever, toxicity, marked tenderness, leukocytosis and sepsis. It may occur in older, diabetic or immunocompromised patients.
Ultrasound/CT may show a distended thick-walled gallbladder, internal debris, pericholecystic fluid or gas. Blood cultures are useful in systemic infection.
Management requires resuscitation, IV antibiotics and urgent source control—usually early cholecystectomy in fit patients. Percutaneous cholecystostomy is considered in patients at high operative risk.
BILIARY PERITONITIS
Biliary peritonitis is inflammation of the peritoneal cavity due to leakage of bile, following gallbladder perforation, bile duct injury, trauma or postoperative leak.
Presentation includes severe abdominal pain, guarding, rebound tenderness, fever, ileus and sepsis. Early signs may be subtle, particularly in frail patients.
Ultrasound or CT may identify free fluid, collections or biliary pathology. HIDA scan or MRCP can help identify a leak; ERCP may diagnose and treat selected duct leaks.
Management: ABC resuscitation, IV fluids, broad-spectrum antibiotics, urgent surgical/hepatobiliary consultation and source control. Drain collections and repair or decompress the biliary leak depending on anatomy.
Complications include intra-abdominal abscess, bile duct stricture, sepsis, multi-organ failure and death.
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