Gallbladder shrinkage

Introduction The gallbladder volume is reduced in the cystic duct syndrome. The clinical auxiliary examination of the gallbladder volume after intravenous injection of CCK does not exceed 45%. Biliar Cystic Duct Syndrome refers to a mechanical non-calculus partial obstruction of the cystic duct, which causes a poor discharge of bile and a group of clinical syndromes characterized by biliary colic as a result of elevated gallbladder pressure. Intrinsic is also known as cystic duct partial obstruction syndrome, gallbladder dyskinesia syndrome, primary chronic cysticulitis, Cozzolino cystic duct syndrome.

Cause

The causes are congenital and acquired factors, such as chronic inflammation, fibrosis, cystic duct distortion, cystic duct band narrowing, etc. An acute angle can also be caused. Due to partial obstruction of the cystic duct, bile outflow is blocked, and bile retention in the gallbladder causes an increase in internal pressure of the gallbladder, resulting in a series of clinical symptoms.

an examination

Related inspection

Gallbladder ultrasonography T-tube cholangiography venous cholangiography oral cholangiography

1. Blood routine white blood cell count, classification and liver function tests are basically normal.

2, duodenal bile drainage, B bile is delayed, after stimulation with cholecystokinin, B bile does not flow until 6 to 20 minutes, and the amount is small and lasts for a long time.

3, oral gallbladder contrast agent or radionuclide biliary scanning, visible gallbladder filling is good, but there are delays in emptying and cystic duct changes, 36 hours after the gallbladder is still developing, while showing cystic duct stricture, distortion, slender and other changes, total The bile duct shadow is light or not developed, and the gallbladder volume is reduced by no more than 45% after intravenous injection of CCK. 99mTc-HIDA radionuclide biliary scanning, gallbladder emptying delayed more than 4 hours.

4, there is post-meal biliary colic or right upper quadrant discomfort, but no chills, high fever, jaundice and white blood cells.

5, B-mode ultrasound, CT, X-ray cholecystography and other examinations did not find gallstones and space-occupying lesions.

Differential diagnosis

Differential diagnosis of gallbladder volume reduction:

1, gallbladder enlargement: patients with acute cholecystitis with gallbladder ultrasound examination often found gallbladder enlargement, wall thickening, gallstones inside the stone. Acute cholecystitis is inflammation of the gallbladder caused by cystic duct obstruction and bacterial invasion; its typical clinical features are paroxysmal cramps in the upper right abdomen, with obvious tenderness and abdominal stiffness. About 95% of patients have gallstones, called calculous cholecystitis; 5% of patients have no gallstones, called acalculous cholecystitis.

2, gallbladder wall thinning: papillary adenocarcinoma may be caused by malignant papillary or polyps, tumors grow into the gallbladder cavity, affecting gallbladder emptying, tumor surface ulcers, easy to cause infection. If the tumor blocks the gallbladder neck, it can enlarge the gallbladder and thin the gallbladder wall, similar to gallbladder abscess or effusion.

3, gallbladder water: the blood vessels that supply gallbladder nutrition is the terminal artery. When the outlet of the gallbladder is blocked, the gallbladder mucosa continues to secrete mucus, causing the pressure in the gallbladder to increase, causing the gallbladder to swell and accumulate water. Compression and ischemia, necrosis. When the gallbladder is ischemia, the gallbladder resistance is reduced, the bacteria are easy to grow and multiply, and the cholecystitis occurs when the machine is activated. Cholecystitis is a cholecystitis caused by bacterial infection or chemical stimulation (change of bile composition) and is a common disease of the gallbladder. In abdominal surgery, the incidence rate is second only to appendicitis. This disease is more common in middle-aged people aged 35-55 years. The incidence of females is more than that of males, especially in obese women with multiple pregnancies.

4, gallbladder wall fibrosis: When the gallbladder wall inflammation and fibrosis, the gallbladder is in a state of contraction, the so-called chronic acalculous cholecystitis.

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