Ceramic gallbladder

Introduction to ceramic gallbladder The ceramic gallbladder (porcelaingallbladder) is the extensive calcification of the gallbladder wall, also known as calcified gallbladder, porcelain-like gallbladder, porcelain gallbladder, ceramic-like gallbladder disease. The clinical symptoms of patients with ceramic gallbladder are not specific, most of them are symptoms of biliary colic and cholecystitis, and about one third of patients can have no clinical symptoms. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: gallstones

Ceramic gallbladder cause

Causes:

Brinzeu's observations revealed that there may be three local pathogenic factors in the ceramic gallbladder: a chronic tendency to form stones in the neck and block the cystic duct, chronic inflammation of the gallbladder wall, obstruction of the gallbladder artery leading to complete gallbladder ischemia, and other ceramic-like gallbladder Possible causes include intracranial hemorrhage in chronic cholecystitis, abnormal calcium metabolism, etc. The above various speculations can only explain the possibility of ceramic gallbladder formation in some aspects.

Ceramic gallbladder prevention

1. Do some physical activities to make the whole body metabolically active, especially mental work and middle-aged people who are always sitting still, and more consciously do manual labor to prevent excessive obesity, because obesity is cholecystitis or An important cause of gallstones.

2, pay attention to food hygiene, avoid overeating, appropriate diet fat food. Because eating fatty foods will reflexively contract the gallbladder, and once the contraction is too strong, it will lead to an acute attack of biliary colic.

3, pay attention to keep warm after the autumn cool, especially when sleeping, cover the quilt, prevent the abdomen from being cold, because the stomach will stimulate the vagus nerve after the cold, so that the gallbladder strongly contracts.

4, when there are intestinal insects (mainly aphids), timely application of deworming drugs, the amount should be sufficient, in order to prevent the lack of medication, aphids active and easy to drill into the biliary tract, causing obstruction, causing cholecystitis.

Ceramic gallbladder complications Complications gallstones

Patients with ceramic-like gallbladder have no specificity due to clinical symptoms, so when the disease occurs, the clinical complications are the same as those of cholecystitis and gallstone disease.

Ceramic gallbladder symptoms common symptoms calcium deposition calcified biliary colic

The clinical symptoms of patients with ceramic gallbladder are non-specific, most of which are symptoms of biliary colic and cholecystitis. About one-third of patients can have no clinical symptoms, but they are accidentally discovered by taking X-ray films or doing B-timeout, 50~ 60-year-olds are common, female patients are five times as many as male patients. Clinical symptoms are highly overlapping with cholecystitis and gallstones. The diagnosis depends on B-ultrasound, CT, X-ray and pathology.

Ceramic gallbladder examination

See "Cholecystitis", "Cholelithiasis".

1. There is relatively little chance of gallbladder calcification in the abdominal plain film. Some patients have large patchy dense shadows in the right upper abdomen, or flaky arcs, uneven density, or elliptical or spherical high density. Shadow, sometimes it can be seen in the gallstone containing calcium salt, the lateral film sees the dense shadow in front of the spine.

2. Abdominal B-ultrasound and CT examination are the main methods for finding asymptomatic ceramic-like gallbladder. B-stained gallbladder wall has strong echo, rear with sound shadow, gallbladder wall can be thickened, B-mode ceramic gallbladder is divided into 3 Type: Type I, also known as the hardening and shrinking period, is an echo-enhanced half-moon structure with posterior sound shadow, similar to a stone-filled bile-free systolic gallbladder, type II, which is a biconvex curve with variable sound shadow, but The sound wave attenuation is lighter than that of the I type, so the anterior and posterior walls of the gallbladder can be observed. This type can often see stones in the gallbladder, type III, which is an irregular block echo with posterior acoustic shadow, and type I is complete calcification in pathological type. Type, the incidence of cancer is low or no, type II and type III are incomplete calcification, easy to concomitant stones and gallbladder cancer.

3. Abdominal CT can be seen in the gallbladder wall edge arc calcification, gallbladder shrinkage, such as in the gallbladder neck or cystic duct obstruction, gallbladder can also expand, CT can still observe the mass around the gallbladder, and metastatic cancer of the abdominal viscera.

4. Contrast-enhanced angiography can determine the function and morphology of the gallbladder, which is helpful for further examination of the gallbladder disease and guiding the surgical plan.

(1) Oral cholecystography: After preparing for angiography, take 6 tablets (3g) of the contrast agent iodoic acid (Telepaque) and take the first slice at 12~14h. If the gallbladder is well developed. You can eat fat meal, 30min and 1h after meal, observe the emptying of bile duct and gallbladder. If the first photo of gallbladder is unsatisfactory or not developed, you can wait for 2~3h, if you still don't develop, don't eat Fat meal, end the check.

Oral angiography is a commonly used method for the examination of gallbladder disorders. It is of great value in the diagnosis of chronic cholecystitis, gallbladder proliferative disorders and cholelithiasis. Patients with ceramic gallbladder, especially type I patients, have oral gallbladder angiography due to loss of gallbladder wall function. Can not be developed.

(2) intravenous cholecystograpy and cholangiography: After preparing for the test (including fasting, allergy test, etc.), the vein is slowly injected with 20% of iodipamide (methylglucanine Biligrafin) 20ml, according to the development situation 20, 40, 60 and 120min photos of each photo, 60min bile duct development, 120min gallbladder development, such as gallbladder development, can eat fat meal, 30min and lh after meals, observe bile duct and gallbladder emptying, such as development Lightness can delay the photo time; if the gallbladder is not developed, the examination can be ended. The intravenous method is not affected by the gastrointestinal absorption factor, and is suitable for patients who have not developed the cholangiectasis by oral angiography. Similarly, the venous angiography of patients with ceramic gallbladder may not be used. development.

(3) Percutaneous transhepatic cholangiography (PTC): suitable for patients with obstructive jaundice, especially suitable for patients with intrahepatic bile duct dilatation. This method can show the location, extent, extent and nature of bile duct obstruction. Decompression and drainage can be performed, but complications such as bleeding, bile leakage, and biliary peritonitis should be noted. It is meaningful for the examination of ceramic gallbladder suspected of having tumors.

(4) endoscopic retrograde cholangio pancreatogr aphy (ERCP): the duodenum is sent to the duodenal descending segment, after finding the nipple, insert a thin plastic catheter through the nipple, then inject 60% In the case of diatrizoate, the pancreatic duct is first developed and photographed; then the bile duct is developed. After the bile duct is fully developed, the endoscopic re-photograph is removed, which is mainly used to check the biliary and pancreatic diseases. Symptoms of recurrence after cholecystectomy and jaundice Patients to be examined can also be used for endoscopic papillectomy and lower common bile duct stone removal and bile duct drainage. Complications include injection pancreatitis, suppurative cholangitis, suspected gallbladder cancer, chronic cholecystitis, chronic pancreas This check can be considered during inflammation.

5. Endoscopic ultrasonography (EUS) EUS and fine-needle aspiration (FNA) guided by EUS have a diagnostic significance for the diagnosis of gallbladder gallbladder with gallbladder carcinoma. EUS uses a high frequency probe only for stomach or ten. Scanning the gallbladder in the wall of the duodenum greatly improves the detection rate of gallbladder carcinoma, and can further determine the extent to which the layers of the gallbladder wall are infiltrated by the tumor.

6. Magnetic resonance cholangiopancreatography (MRCP) MRCP uses magnetic resonance pulse sequence imaging. On MRCP images, static liquids are arranged in high signals, contrasting with low signals or black backgrounds. After image post-processing technology, it can produce pancreaticobiliary images similar to those obtained by ERCP. MRCP examination is easy to operate, non-invasive, no need to inject contrast agent, no ionizing radiation. For patients with ERCP contraindications, ERCP failure and ERCP incomplete development are feasible. At present, MRCP has gradually replaced the role of diagnostic ERCP.

In short, the above examinations for the gallbladder are not necessarily suitable for a specific ceramic-like gallbladder patient, B-ultrasound, abdominal plain film is a routine examination, CT can exclude certain tumors, oral gallbladder angiography is simple and easy to operate, can display stones and Gallbladder function, but only 60% of patients can achieve satisfactory results with single angiography. Intravenous cholangiography can overcome the influence of gastrointestinal tract. In the case of oral double-dose contrast agent still not developed, intravenous method can be used, in the presence of jaundice, tumors are not excluded. When using ERCP or PTC, the examination time can be shortened. The EUS and FNA examinations have small trauma. It can be considered for patients who are suspected of having tumors. MRCP examination is feasible for those who have ERCP indications and cannot perform ERCP or EPCP failure.

Diagnosis and identification of ceramic gallbladder

The diagnosis of ceramic gallbladder is mainly pathological diagnosis. According to the calcification of gallbladder wall, it can be divided into complete calcification and incomplete calcification. Complete calcification is manifested as the muscular layer of the gallbladder wall, or even the entire capsule wall. There is extensive, continuous calcium carbonate. Sedimentary zone, incomplete calcification into multiple mucosal layers, punctate calcification.

Imaging studies have found that the massive upper isolated calcification of the right upper abdomen should consider the ceramic gallbladder, but at the same time should be distinguished from the adrenal, kidney, pancreas, lung and chest wall calcification lesions, such as cystic echinococcosis, calcified renal cysts, Chest wall mass, pancreatic lesions, adrenal lesions, etc., because ceramic gallbladder often combined with cholecystitis, gallstones and gallbladder cancer, must be considered in the diagnosis, to provide an accurate basis for the choice of treatment options.

Earlier literature showed that ceramic gallbladder is closely related to gallbladder cancer. In recent years, many authors have classified the ceramic gallbladder and found that the "true" ceramic gallbladder is completely calcified gallbladder, and the mucosal cells of the gallbladder wall are completely degraded. Dense connective tissue and calcium substitution, manifested as transmural full-thickness calcification, no residual mucosal epithelium, and thus no cancer, but not completely calcified gallbladder, that is, non-"true" ceramic gallbladder wall, still left Mucosal epithelial cells, under the long-term stimulation of chronic inflammation, may have cancerous changes, and Towfigh's observations show that even in the incomplete calcified ceramic-like gallbladder, no malignant changes are observed, which they believe may be related to environmental factors. (such as diet, food processing, etc.) and cholecystectomy are generally carried out, so that some patients' ceramic gallbladder has been removed before it has been cancerated.

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