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PubMed1986

An experimental study on the role of gallbladder mucosal fluid secretion and intraluminal pressure in cholecystitis.

The cystic duct was ligated and gallstones were implanted into the gallbladder in cats. Five to eighteen weeks later the hydrostatic pressure in the gallbladder lumen was measured after laparotomy, and fluid transport across the gallbladder epithelium was studied and compared to the microscopic gallbladder morphology. Instead of the normal absorption many of these gallbladders continuously secreted fluid to the lumen and had raised intraluminal hydrostatic pressure (61 +/- 8 SEM, mmHg). Morphological signs of acute gallbladder inflammation were common (47%) in gallbladders with mucosal fluid secretion, but were never seen in those that absorbed fluid (p less than 0.05). Gallbladder mucosal fluid transport correlated with a histological score of the inflammation (r = +0.68, p less than 0.01). Gallbladder fluid secretion decreased when the intraluminal pressure was experimentally raised to the initially observed level, demonstrating mechanisms counteracting the secretion in this situation. An increased intraluminal pressure is suggested to be involved in the pathophysiology of acute cholecystitis.

Animals↗

PubMed1984

The influence of somatostatin on gallbladder response to intraduodenal acid and autonomic nerve stimulation in the cat.

The influence of somatostatin on the concentrating function and motility of the feline gallbladder has been studied with perfusion techniques in vivo. Somatostatin did not cause any change in the basal volume or concentrating function of the gallbladder. Duodenal acidification and also efferent electrical stimulation of the vagus nerves after atropinization reduced the net water absorption from the gallbladder, and these effects were blocked by intravenous somatostatin. The enhanced rate of net water absorption in response to electrical stimulation of the splanchnic nerves, however, was not influenced by somatostatin. Both the gastrointestinal peptides vasoactive intestinal peptide (VIP) and secretin reduce the net water absorption in the gallbladder. The blocking effect of the gallbladder's response to duodenal acid might be explained by an inhibition by somatostatin of secretin release from the duodenum. The inhibition of the gallbladder's reaction to vagal stimulation can be explained by a suppression of VIP release from noncholinergic, nonadrenergic nerve fibres in the gallbladder wall. Apart from the earlier described interference with gallbladder emptying, somatostatin seems to affect the regulation of the gallbladder's concentrating function. The results are discussed in view of the recent observation that patients with somatostatinoma characterized by high levels of circulating somatostatin usually have gallstone disease.

Animals↗

PubMed1983

The non-visualized gallbladder by ultrasonography implications and differential diagnosis.

The findings in 42 consecutive patients in whom the gallbladder or its lumen were not visualized ultrasonographically were reviewed retrospectively for evidence of gallbladder disease. The series contains two groups of patients--the larger comprised 32 patients in whom the gallbladder was represented only by a dense echogenic focus, with acoustic shadowing, in the right upper quadrant, thought to be due to cholelithiasis in a small contracted gallbladder. The accuracy of this finding in predicting gallbladder disease was 96%. The smaller group consisted of eight patients in whom the gallbladder was not visualized. In seven patients with follow-up, the accuracy of this finding in predicting gallbladder disease was only 71%. Dense echoes in the right upper quadrant were not always due to cholelithiasis but to emphysematous cholecystitis in one patient, porcelain gallbladder in a second, and agenesis of the gallbladder in a third.

Calcinosis↗

PubMed1982

Lipid composition of bile and gallbladder mucosa in patients with acalculous cholesterolosis.

To investigate pathogenetic factors of cholesterolosis of the gallbladder, the lipid composition of both the hepatic and gallbladder bile and gallbladder mucosa were compared with each other in 6 patients with and 5 patients without acalculous cholesterolosis. The molar percentage of biliary cholesterol and total bile acid pattern were similar in the two groups. Of the biliary cholesterol precursors, methyl sterols, but not squalene, correlated closely with cholesterol both in the hepatic (r = 0.901) and gallbladder bile (r = 0.747). Methyl sterols, expressed either per cholesterol or bile acids, were higher and squalene was lower in the gallbladder bile than in the hepatic bile. In addition, methyl sterols were increased in the hepatic and gallbladder bile of the patients with cholesterolosis, as if the hepatic production of these precursors had been enhanced--probably as a consequence of altered hepatic cholesterol synthesis. In cholesterolosis the gallbladder mucosa was characterized by a marked increase in triglycerides and significant elevations of the esterified sterols and free methyl sterols. The esterification degrees of sterols, which were consistently higher for methyl sterols than for cholesterol, were closely correlated with the respective mucosal sterol concentrations. The methyl sterols/cholesterol ratio in the bile correlated significantly with mucosal free and esterified methyl sterols, esterified cholesterol, and the methyl sterols/cholesterol ratio. The data suggest that free sterols can be transferred from the bile to the gallbladder mucosa, and that altered hepatic cholesterol synthesis is associated with the development of the cholesterolosis of human gallbladder.

Adult↗

PubMed1995

Cholesterol metabolism in liver and gallbladder mucosa of patients with cholesterolosis.

The objective of this study was to investigate possible pathogenetic factors for cholesterolosis. Liver tissue, gallbladder mucosa, and gallbladder bile were collected in patients with cholesterol gallstones (GS) (14 patients with and 14 patients without cholesterolosis) and gallstone-free (GSF) subjects (11 with and 21 without cholesterolosis) undergoing cholecystectomy. In cholesterolosis, the gallbladder mucosa was characterized by a fivefold increase in esterified cholesterol and normal content of free cholesterol. The hepatic levels of 3-hydroxy-3-methylglutaryl coenzyme A reductase activity, governing cholesterol synthesis, and acyl coenzyme A: acyltransferase activity, catalyzing the esterification of cholesterol, were similar in patients with and without cholesterolosis. Also in the gallbladder mucosa, the 3-hydroxy-3-methylglutaryl coenzyme A reductase activity was similar in patients with and without cholesterolosis. The acyl coenzyme A: acyltransferase activity of the gallbladder mucosa was increased in the GSF subjects with cholesterolosis. The nucleation time of gallbladder bile was shorter in the GSF subjects with cholesterolosis compared with the time of those without cholesterolosis. Occurrence of cholesterol crystals, lipid composition, and cholesterol saturation of gallbladder bile were not significantly influenced by the absence or presence of cholesterolosis. The study has confirmed that cholesterolosis is associated with a several-fold increased level of esterified cholesterol. The data suggest that patients with cholesterolosis have normal hepatic cholesterol formation and esterification. The local synthesis of cholesterol in the gallbladder mucosa seems to be normal. A positive correlation was obtained between the cholesterol saturation of bile and the content of esterified cholesterol in the gallbladder mucosa in the whole series of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Bile↗

PubMedDate not supplied

[Ultrasonography aspects of primary gallbladder neoplasms].

Sixty six patients with primary gallbladder cancer were seen at the Hospital A. C. Camargo, São Paulo, Brazil, from January 1980 to December 1988 and who represent 0.14% of the total of 46,519 patients registered in the same period. Out of the 66 cases, 41 were submitted to an ultrasonographic exam. As to the other 25 patients, 20 had been submitted to a cholecystectomy at another hospital. This exam was not done in the other 5 patients for several reasons. The gallbladder cancer diagnosis was based on data obtained from surgery and confirmed by anatomopathological exam. Regarding the 20 cases operated on at another hospital there was a slide review performed at the Department of Pathologic Anatomy at the Hospital A. C. Camargo. The main ultrasonographic aspects in the 30 cases in which there was a correct diagnosis, were the following: solid mass in the gallbladder lumen in 13 cases (43.33%); solid tumour in the gallbladder area in 7 cases (23.33%); a tumour contiguous to the gallbladder reaching other organs in 6 cases (20.00%); an alteration of the gallbladder shape in 3 cases (10.00%) and an accentuated thickening of the gallbladder wall with inaccurate limits in one case (3.33%). In the sub-group in which the ultrasonographic exam was performed, cholelithiasis was observed in 31 (75.60%) of the 41 cases. There was a correct diagnosis in 18 (58.06%) of the 31 cases with cholelithiasis and in 8 (80.00%) of the 10 without cholelithiasis; not a significant difference. As to the ultrasonographic aspects of the false negative cases, in 9 (81.81%) of the 11 cases the images suggested cholelithiasis. Among these 9 cases there were 2 with an enlarged gallbladder, one case of escleroatrophic gallbladder and one case with thickened walls. The diagnosis of the other 2 cases were biliary mud in one and a probable cholelithiasis in another.

Age Factors↗

PubMed1996

Gallbladder nonvisualization with pericholecystic rim sign: morphine-augmentation optimizes diagnosis of acute cholecystitis.

UNLABELLED: This study investigated the value of morphine-augmentation in patients who demonstrated gallbladder nonvisualization with a pericholecystic rim sign at 1 hr, a cholescintigraphic pattern considered highly predictive of acute cholecystitis. METHODS: Retrospectively, 170 consecutive morphine-augmented cholescintigrams were analyzed for the presence of a pericholecystic rim sign, marked or mild, associated with gallbladder nonvisualization at 1 hr (before morphine); those with a pericholecystic rim sign were further evaluated for persistent gallbladder nonvisualization versus gallbladder visualization after morphine. Scintigraphic interpretations were correlated with surgical pathology or clinical diagnosis. RESULTS: Before morphine, 43/170 (25%) patients demonstrated gallbladder nonvisualization with a pericholecystic rim sign. Since only 31 had acute cholecystitis, a diagnosis based solely on that scintigraphic pattern would have resulted in 12 false-positives. After morphine, gallbladder visualization correctly excluded acute cholecystitis in seven; a single false-negative was encountered; five false-positives remained. Morphine-augmentation improved the positive predictive value from 72% (gallbladder nonvisualization with pericholecystic rim sign before morphine) to 86% (gallbladder nonvisualization after morphine). Of 24 patients with marked pericholecystic rim signs, 21 had acute cholecystitis. Of 31 with acute cholecystitis, however, 10 (32%) had a mild pericholecystic rim sign. CONCLUSION: Morphine-augmented cholescintigraphy optimizes the diagnosis of acute cholecystitis in patients with the suggestive, but not pathognomonic, cholescintigraphic pattern at 1 hr of gallbladder nonvisualization with a pericholecystic rim sign, regardless of its intensity.

Acute Disease↗

PubMed1998

The inflammatory effects of crystalline cholesterol monohydrate in the guinea pig gallbladder in vivo.

BACKGROUND: The etiologic role of crystalline material in inflammatory arthritis is well established. The role of crystals in cholecystitis is unclear. We hypothesized that crystalline cholesterol monohydrate stimulates guinea pig gallbladder inflammation in vivo. METHODS: Crystalline cholesterol monohydrate, lipopolysaccharide (LPS), lysolecithin, polystyrene latex spheres (noninflammatory particles), and saline were instilled into guinea pig gallbladders for 24 to 72 hours after cystic duct ligation. Water transport across gallbladder mucosa was measured. Gallbladder tissue was analyzed for mucus layer thickness, myeloperoxidase, prostaglandin E2 (PGE2) prostaglandin F-1 alpha (PGF-1 alpha), and interleukin-1. Luminal fluid was also examined for PGE2 and PGF-1 alpha. Values for each test were compared with saline controls by using Student's test (p < 0.05). RESULTS: Crystalline cholesterol, LPS, and lysolecithin caused significant reduction in mucus layer thickness, reversed water absorption to secretion across the gallbladder mucosa, caused significant increases in myeloperoxidase and interleukin-1 in gallbladder tissue, and caused significant increases in PGE2 and PGF-1 alpha in luminal fluid. These effects were generally dose- but not time-dependent. Polystyrene latex particles caused no difference in outcomes compared with saline controls. CONCLUSIONS: Crystalline cholesterol monohydrate has dose-dependent inflammatory effects in the guinea pig gallbladder in vivo that are not simply-due to mechanical irritation of the gallbladder wall by crystalline particles. Crystals in the gallbladder may have an etiologic role in cholecystitis.

Animals↗

PubMed1998

Erythromycin, a motilin agonist, increases postprandial gallbladder emptying during therapy with ursodeoxycholic acid.

Sufficient gallbladder emptying accelerates early gallstone clearance after extracorporeal shock wave lithotripsy (ESWL). Litholytic therapy with ursodeoxycholic acid (UDC) subsequent to ESWL increases fasting volume (FV) and postprandial residual volume (RV) of the gallbladder. This may lead to retention of cholesterol crystals and small fragments within the gallbladder. In order to find out whether erythromycin, a motilin agonist, improves gallbladder emptying, we tested gallbladder motility after administration of ursodeoxycholic acid with and without oral application of erythromycin. Ten healthy males (age 26-35 years) obtained 10 mg/kg/d of UDCA as a single bedtime dose for three weeks. Prior and after UDCA administration, gallbladder FV was determined sonographically after overnight fasting. After a test meal (490 kcal), gallbladder volume was measured every 5 min until the gallbladder had reached its minimal RV. The next day the same procedure was repeated with 500 mg erythromycin p.o. 45 min prior to test meal application. FV, RV, ejection volume (EV = FV-RV) and ejection fraction (EF = EV/FV x 100) were calculated and differences were compared by the student's t-test. FV (29 ml +/- 8 ml vs. 38 ml +/- 10 ml), RV (12 ml +/- 6 ml vs. 17 ml +/- 6 ml) and EV (17 ml +/- 5 ml vs. 21 ml +/- 6 ml) increased significantly during therapy with UDCA (p < 0.05). EF did not change significantly. After erythromycin application RV decreased to its original values (13 ml +/- 6 ml), whereas EV (24 ml +/- 6 ml) and EF (58% +/- 9% vs. 66% +/- 11%) increased significantly (p < 0.05). Thus, administration of a motilin agonist blunts unwanted effects on gallbladder motility during litholytic therapy with UDC.

Administration, Oral↗

PubMedDate not supplied

Concurrent primary carcinoma of the gallbladder and acute cholecystitis.

BACKGROUND/AIMS: Primary carcinoma of the gallbladder is rare and associated with a late diagnosis and poor prognosis. Concurrent acute cholecystitis frequently obscures the presence of carcinoma. The information regarding gallbladder carcinoma with acute cholecystitis is limited. In order to better understand the presentation of gallbladder carcinoma with acute cholecystitis, we retrospectively reviewed the data of patients with primary carcinoma of the gallbladder. METHODOLOGY: The data of 86 patients with primary carcinoma of the gallbladder treated between 1979 and 1994 were compiled and reviewed. The patients were divided into 2 groups: Group 1 (with acute cholecystitis, 21 patients) and Group 2 (without cholecystitis, 65 patients). Clinicopathological comparisons were made and evaluated between these two groups RESULTS: The average age of Group 1 patients was older than that of Group 2 patients (75+/-2 years vs. 63+/-2 years; p<0.05). Three Group 1 patients presented with sepsis. The interval between the onset of symptoms and hospital admission in Group 2 patients was significantly (p<0.05) longer than that in Group 1 patients (243+/-95 days vs. 20+/-11 days). Leukocytosis (>11,000/mm3) was more common in Group 1 patients than in Group 2 patients (47.6% vs. 15.4%). Jaundice was more common in Group 2, and fever was common in Group 1. The majority of Group 2 gallbladder cancers were stage V (75.4%). In contrast, 52.4% of Group 1 gallbladder cancers were stage III and 38.1% were stage V. The 30-day postoperative mortality rate in Group 1 and Group 2 patients was 9.5% and 7.7%, respectively. The cumulative survival of Group 1 patients was not different from that of Group 2 patients (log-rank test, p>0.05). CONCLUSIONS: Age, the interval of symptoms prior to admission, the location of abdominal pain, fever, leukocytosis, and the absence of jaundice suggested the presence of acute cholecystitis in gallbladder carcinoma. A high index of suspicion of the disease, intraoperative examination of gallbladder specimens, and more aggressive surgical treatment may improve patient survival.

Acute Disease↗

PubMedDate not supplied

Anomalous pancreaticobiliary ductal union--an etiologic association of gallbladder cancer and adenomyomatosis.

BACKGROUND/AIMS: Anomalous pancreaticobiliary ductal union (APBDU) has been proposed as a risk factor of gallbladder cancer. To clarify the frequency and the subtype distribution of APBDU in patients with gallbladder cancer and adenomyomatosis, a retrospective study was performed. METHODOLOGY: The radiograms of endoscopic retrograde cholangiopancreaticography of 680 patients with well-documented biliary and pancreatic ducts from April 1992 to November 1996 were reviewed. The length of the common channel and insertion of the pancreatic duct and the bile duct were identified and recorded. RESULTS: Gallbladder cancer and adenomyomatosis were identified in 8 and 12 patients, respectively. Patients with gallbladder cancer were significantly older (mean age: 66.5 years, p<0.01) than those with gallbladder adenomyomatosis (mean age: 42.7 years). APBDU was noted in 59 (8.7%) of 680 cases with complete pancreaticobiliary radiograms. Among them, 5 of 8 patients with gallbladder cancer coexisted with APBDU. Four (80%) belonged to the P-B type. Six of 12 patients with gallbladder adenomyomatosis had APBDU. Five (83.3%) belonged to P-B type. CONCLUSIONS: Patients with gallbladder cancer and adenomyomatosis were frequently associated with APBDU. The close relationship and similar distribution of the P-B type of APBDU in both diseases suggest an etiologic association in various gallbladder diseases.

Adenomyoma↗

PubMed2004

Smooth muscle function and dysfunction in gallbladder disease.

The gallbladder epithelium and smooth muscle layer are exposed to concentrated biliary solutes, including cholesterol and potentially toxic hydrophobic bile salts, which are able to influence muscle contraction. Physiologically, gallbladder tone is regulated by spontaneous muscle activity, hormones, and neurotransmitters released into the muscle from intrinsic neurons and extrinsic sympathetic nerves. Methods to explore gallbladder smooth muscle function in vitro include cholecystokinin (CCK) receptor-binding studies and contractility studies. In human and animal models, studies have focused on cellular and molecular events in health and disease, and in vitro findings mirror in vivo events. The interplay between contraction and relaxation of the gallbladder muscularis leads in vivo to appropriate gallbladder emptying and refilling during fasting and postprandially. Defective smooth muscle contractility and/or relaxation are found in cholesterol stone-containing gallbladders, featuring a type of gallbladder leiomyopathy; defects of CCKA receptors and signal transduction may coexist with abnormal responses to oxidative stress and inflammatory mediators. Abnormal smooth musculature contractility, impaired gallbladder motility, and increased stasis are key factors in the pathogenesis of cholesterol gallstones.

Animals↗

PubMed1999

Hypokinetic gallbladder disease: a cause of chronic abdominal pain in children and adolescents.

BACKGROUND/PURPOSE: Impaired gallbladder emptying has been identified as a cause of chronic abdominal pain in adults. This study aims to define a pediatric population with functional abnormalities of gallbladder contractility and to assess clinical outcome after cholecystectomy. METHODS: Children and adolescents (n = 42) with abdominal complaints underwent gallbladder emptying studies, measured by either ultrasonography or scintigraphy with intravenous cholecystokinin (CCK). On ultrasound studies, gallbladder volume was measured before injection and 15 minutes after injection. Measures of gallbladder emptying by scintigraphy were taken at least 30 minutes after CCK injection. A study was classified as abnormal for contractility less than 50%. Cholecystectomy was performed and outcomes were evaluated during office visits and by telephone interview. RESULTS: Abdominal pain and fatty food intolerance were the predominant symptoms. Patients were treated by open (n = 2) or laparoscopic (n = 40) cholecystectomy. In 20 cases the gallbladder showed chronic inflammation on pathology. Response to surgical therapy was excellent in 41 patients (mean follow-up, 20.4 months). CONCLUSIONS: Children and adolescents with persistent abdominal pain should undergo functional assessment of gallbladder contractility. Patients with abnormal gallbladder contractility benefit from cholecystectomy.

Abdominal Pain↗

PubMed2004

Percutaneous cholecystostomy versus gallbladder aspiration for acute cholecystitis: a prospective randomized controlled trial.

OBJECTIVE: This study was performed to determine and compare the effectiveness and incidence of complications of percutaneous cholecystostomy and gallbladder aspiration in cases of severe acute cholecystitis. SUBJECTS AND METHODS. Fifty-eight patients with severe acute cholecystitis who did not improve after antibiotic treatment were included in this study. The patients were randomized into either the percutaneous cholecystostomy group (n = 30) or the gallbladder aspiration group (n = 28). Under sonographic guidance, percutaneous cholecystostomy was performed in the usual manner using a 6.5- or 7-French catheter. Gallbladder aspiration was carried out with a 21-gauge needle under sonographic guidance. The technical success, clinical response, and complications in each group were evaluated. RESULTS: Percutaneous cholecystostomy and gallbladder aspiration were technically successful in 30 patients (100%) and 23 patients (82%), respectively (not statistically significant). In five patients (18%) of the gallbladder aspiration group, aspiration was unsuccessful because of replacement of bile with dense biliary sludge or pus. Good clinical response was obtained in 27 patients (90%) of the percutaneous cholecystostomy group and in 14 patients (61%) of the gallbladder aspiration group (p < 0.05). As for complications, dislodgment of the catheter occurred in one patient of the percutaneous cholecystostomy group and minor bleeding in one patient after gallbladder aspiration. No major complications or procedure-related deaths occurred in either group. CONCLUSION: For severe acute cholecystitis, percutaneous cholecystostomy was superior to gallbladder aspiration in terms of clinical effectiveness and had the same complication rate as gallbladder aspiration.

Acute Disease↗

PubMed2002

Two cases of acute cholecystitis in which percutaneous transhepatic gallbladder aspiration (PTGBA) was useful.

We report 2 patients with acute cholecystitis for which percutaneous transhepatic gallbladder aspiration (PTGBA) was useful. In Case 1, the patient was a 75-year-old woman who experienced a sudden onset of back pain and upper abdominal pain at night. Abdominal ultrasound (US) showed enlargement of the gallbladder with thickening of the wall, a sonolucent layer, and a stone in the neck of the gallbladder, which led to a diagnosis of acute cholecystitis. Magnetic resonance imaging (MRI) demonstrated thickening of the gallbladder wall and 2 areas of low-intensity signal. The pain and fever persisted, for which we performed PTGBA, aspirating about 113 ml of infected bile. Subsequently, the pain and fever subsided, and abdominal US revealed a reduction in the enlargement of the gallbladder with the persistence of thickening of the wall. On the eighth day after PTGBA, open abdominal cholecystectomy was performed. In Case 2, the patient was a 56-year-old woman who had right hypochondriac pain after supper. The pain gradually increased in severity. Abdominal US showed enlargement of the gallbladder with a thickened wall, a sonolucent layer, and a gallstone in the neck of the gallbladder, which led to a diagnosis of acute cholecystitis. Magnetic resonance cholangiopancreatography (MRCP) showed enlargement of the gallbladder with no abnormalities in the common bile duct. After admission to hospital, the pain and fever persisted, for which we performed PTGBA, aspirating about 50 ml of infected bile. Subsequently, the pain and fever vanished. Abdominal US revealed a reduction in the enlargement of the gallbladder with the persistence of thickening of the wall. On the seventh day after PTGBA, laparoscopic cholecystectomy was performed. PTGBA seems useful for early alleviation of the symptoms of acute cholecystitis because of low invasiveness and ease of performance.

Acute Disease↗

PubMed1997

Proliferating cell nuclear antigen expression in the gallbladder with pancreaticobiliary maljunction.

BACKGROUND AND OBJECTIVE: To clarify the histogenesis of cancer of the gallbladder of the patients with pancreaticobiliary maljunction (PBMJ), the proliferating cell activity of the epithelium of gallbladder was examined. METHODS: A total of 21 patients with pancreaticobiliary maljunction [8 with gallbladder cancer (MCA group) and 13 without cancer (M group)] were studied using immunohistochemical staining with a monoclonal antibody to the proliferating cell nuclear antigen (PCNA). The 23 gallbladder cancer patients without PBMJ (CA group) and 10 patients with normal gallbladders (N group) were also examined as controls. RESULTS: The PCNA-positive rates of non-cancerous epithelium of the gallbladder in patients with PBMJ (14.2% in MCA group and 11.6% in M group) were significantly higher than those without PBMJ (3.9% in CA group and 1.5% in N group). CONCLUSION: The high proliferating cell activity of epithelium of the gallbladder may be an explantation for the high incidence of gallbladder cancer in patients with pancreaticobiliary maljunction.

Aged↗

PubMed2003

Sonographic evaluation of gallbladder volume and ejection fraction in obese women without gallstones.

PURPOSE: Obese people have an increased incidence of gallstones. Although the exact pathogenic mechanisms of gallstone development are unknown, impaired gallbladder emptying has been suggested as a possible underlying mechanism. Our aim was to investigate this possibility by evaluating gallbladder motility and related factors in obese and nonobese women without gallstones. METHODS: This study included 79 obese women and 25 nonobese healthy women. Using real-time sonography, we evaluated fasting and postprandial (15th-, 30th-, 45th-, 60th-, 75th-, 90th-, 120th-, and 150th-minute) gallbladder volumes and ejection fractions. The smallest postprandial volume was considered the residual volume. RESULTS: Mean (+/- standard deviation) fasting and residual gallbladder volumes were 43.2 +/- 18.3 cm(3) and 21.4 +/- 11.2 cm(3), respectively, in the obese women and 28.1 +/- 12.3 cm(3) and 7.9 +/- 3.4 cm(3), respectively, in the nonobese women. Maximal ejection fraction was 49 +/- 19% in obese women and 63 +/- 29% in nonobese women (p = 0.001). The fasting and residual volumes and the postprandial volumes at all time points were higher in obese women than in nonobese women (p < 0.001). In addition, 15th-, 30th-, 45th-, 60th-, 75th-, and 90th-minute postprandial ejection fractions were lower in obese women than in nonobese women (p < 0.001). Positive correlations were found between fasting gallbladder volume and body mass index and body fat weight and between residual volume and body mass index, waist circumference, body fat percentage, and body fat weight (p < 0.05 for all comparisons). CONCLUSIONS: Our results show that fasting and postprandial gallbladder volumes are higher and that postprandial gallbladder motility is lower in obese than in nonobese women. There are positive correlations between fasting gallbladder volume and body weight, body mass index, and body fat weight.

Adult↗

PubMed1988

Unusual causes of sonographic nonvisualization or nonrecognition of the gallbladder: a review.

Nonvisualization of the gallbladder by ultrasound in a fasting patient usually indicates calculous gallbladder disease. However, a number of other less common conditions can prevent gallbladder visualization or recognition. The latter occurs when the location or the morphology of the gallbladder is so altered that the gallbladder is difficult to identify. These conditions can be classified as: (1) congenital anomalies, (2) gallbladder contraction not due to stones, (3) conditions that cause shadowing or reverberation from the near wall of the gallbladder, and (4) the solid gallbladder pattern. Their distinction is important to proper patient management.

Gallbladder↗