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Hydrops of the Gallbladder

Hydrops Gallbladder

Hydrops of the gallbladder is a condition where the gallbladder is significantly enlarged due to excess mucus or watery fluid accumulating in its lumen. It is often associated with a gallstone-related disease but can also be the consequence of excessive fasting. Surgical treatment is required to alleviate symptoms.


Presentation

Hydrops of the gallbladder can show a variety of symptoms. Epigastric pain and discomfort in the right-upper-quadrant are common with frequent episodes of nausea and vomiting. It often develops as a secondary condition masking a more serious ailment, for example, tumors in the bile duct, enlarged surrounding organs (e.g. hepatomegaly) or lymph nodes in the vicinity of the gallbladder. It can also form as a consequence of cholelithiasis. All these possible causes lead to a reduced capability of the bile duct to evacuate the gallbladder [1]. A hydrops of the gallbladder has also been reported after long periods of total parenteral nutrition and extended use of ceftriaxone. The condition presents as a large, palpable and somewhat tender mass in the epigastric region with minimal inflammatory signs. In extreme cases, the gallbladder can extend down to the pelvis [2].

If the above mentioned key symptoms are accompanied by fever, the bile is likely to be infected and suggests acute gallbladder empyema. If a patient exhibits jaundice, it is a strong indication of a common bile duct obstruction [3].

While hydrops of the gallbladder is quite common in children, in adults, it occurs concomitantly with acute toxic hepatitis [4]. Occasionally, an enlarged gallbladder could also be a congenital anomaly [5].

Plethora
  • Consequently, it is necessary to utilize a plethora of imaging techniques in combination with laboratory studies to confirm the diagnosis.[symptoma.com]
Abdominal Mass
  • The symptoms and signs of AHGB include abdominal pain, vomiting, abdominal mass and/or tenderness.[ncbi.nlm.nih.gov]
Abdominal Tenderness
  • He was resistant to intravenous immunoglobulin treatment and in the follow up resulting abdominal tenderness was explained by gallbladder hydrops.[turkiyeklinikleri.com]
Biliary Colic
  • If the gallbladder hydrops was formed after the first attack of biliary colic, bile admission process in the bladder and emptied his broken.[medicalformat.com]
  • Dropsy of the bladder often begins with biliary colic (pain intense character in the right upper quadrant radiating to the right shoulder or scapula, often after intake of fatty and spicy foods or bumpy drive, calming after injection of morphine, pantopoda[lecheniebolezni.com]
  • Treatment of biliary colic : aims to relieve pain, nausea, vomiting and anxiety. Bed rest is recommended during the painful phase. Medical treatment is addressed to uncomplicated biliary colic.[bendomd.com]
  • The following features may help to distinguish an attack of biliary colic from acute cholecystitis.[sites.ualberta.ca]
Gallbladder Enlargement
  • Fig. 6. 18 Determining the dimensions of the gallbladder Enlargement of the gallbladder Large gallbladders can occur as morphologic variants ( Figs. 6.19 , 6.20 ), especially in older patients and diabetics.[radiologykey.com]
Arthritis
  • Abstract Henoch-Schönlein Syndrome (HSS) is characterized by the presence of purpuric skin lesions, colicky abdominal pain, renal manifestations, and arthritis.[ncbi.nlm.nih.gov]
  • In brief, we describe an unusual presentation of WD, with gallbladder hydrops and talocrural arthritis in a patient with complete clinical manifestations of the disease. Actions (login required) View Item[eprints.ugd.edu.mk]
Skin Lesion
  • Abstract Henoch-Schönlein Syndrome (HSS) is characterized by the presence of purpuric skin lesions, colicky abdominal pain, renal manifestations, and arthritis.[ncbi.nlm.nih.gov]
Suggestibility
  • We suggest that the incidence of hydrops of the gallbladder in mucocutaneous lymph node syndrome is higher than commonly appreciated, since diagnosis may be missed unless ultrasound is performed.[ncbi.nlm.nih.gov]
  • The diagnosis is suggested by abdominal symptoms and abnormal results of liver function tests. The diagnosis is confirmed by ultrasonography, which shows the gallbladder to be twice the normal size. Cardiac complications may be increased.[ncbi.nlm.nih.gov]
  • We suggest that the preferred treatment of abdominal symptoms in Kawasaki disease is medical, and surgical intervention is deserved only for the complications of the hydrops. Simple cholecystostomy seems to be safe and sufficient for such occasion.[ncbi.nlm.nih.gov]
  • If the above mentioned key symptoms are accompanied by fever, the bile is likely to be infected and suggests acute gallbladder empyema. If a patient exhibits jaundice, it is a strong indication of a common bile duct obstruction.[symptoma.com]
  • It is suggested that the mucosal inflammation following the obstruction to bile flow leads to disturbances in reabsorptive processes, secretion of mucous and a subsequent increase in intraluminal pressure.[ncbi.nlm.nih.gov]

Workup

There is no direct laboratory test to probe for a hydrops of the gallbladder. Consequently, it is necessary to utilize a plethora of imaging techniques in combination with laboratory studies to confirm the diagnosis.

Standard laboratory tests to consider are bilirubin levels and alkaline phosphatase levels, which can be mildly elevated as a consequence of an obstructed common bile duct. Serum amylase levels can be significantly raised as a consequence of acute pancreatitis, which may impair bile duct function. A mild leukocytosis is frequently observed in patients with a hydrops of the gallbladder [6].

An abdominal X-ray procedure typically reveals a hydrops of the gallbladder as a large globular shadow in the subhepatic region. This finding is nonspecific but should only be used as a backup check. An ultrasonographic image of the right upper quadrant can show a slightly thickened gallbladder wall and pinpoint the location of possible gallstones [7]. Computed tomography is well suited to check for possible hepatic or pancreatic conditions affecting the gallbladder. Both the extended gallbladder and the thickened wall are clearly visible, while it may be difficult to localize gallstones with this method [2].

Surgically opened hydropic gallbladders exhibit clear and watery or mucoid content, a white and slightly thickened wall and sometimes accumulated gallstones near the neck of the bile duct [8]. An extraordinarily thick gallbladder wall in combination with a viscous and opaque intraluminal fluid are indicative of gallbladder empyema or pyocele [9].

Thrombocytosis
  • We report a case complicated by several unusual manifestations, including hydrops of the gallbladder and extreme thrombocytosis.[ncbi.nlm.nih.gov]
  • Blood tests demonstrated non-specific inflammation with thrombocytosis, elevated aminotransferases (2-3xULN) and alkaline phosphatase (ALP), normal Gamma-glutamyltransferase (GGT) and bilirubin levels. Infectious workup was negative.[ard.bmj.com]

Treatment

  • Review of diagnosis and treatment of 41 reported cases of hydrops of the gallbladder in Kawasaki syndrome from the English language literature is also presented.[ncbi.nlm.nih.gov]
  • Clinical features of the disease and treatment regimens, including early administration of intravenous gamma globulin (IVGG), which prevents cardiac complications, are discussed.[ncbi.nlm.nih.gov]
  • The hydrops in our patient resolved spontaneously without specific medical or surgical treatment.[ncbi.nlm.nih.gov]
  • If the positive dynamics of conservative treatment is missing, the patient performs the operation-cholecystectomy (removal of the gallbladder). At a dropsy gallbladder large size is always surgical treatment.[omedicine.info]
  • Treatment is largely supportive, but cholecystostomy is the procedure of choice in cases requiring operative intervention.[ncbi.nlm.nih.gov]

Prognosis

  • Causes include: impacted stone tumors or polyps extrinsic compression by tumor, lymph node, or fibrosis Kawasaki disease parasites e.g. ascariasis 4 cm transverse measurement 9 cm longitudinal measurement straight or convex borders Treatment and prognosis[radiopaedia.org]
  • Prognosis favorable with early diagnosis and surgical treatment. Prevention of dropsy of the gall bladder is in the treatment of inflammatory diseases of the biliary tract and bladder, which are the root cause of this disease.[medicalformat.com]
  • […] hydrops of the gallbladder (mucocele) chronic obstruction -- resorption of normal gallbladder contents and enlargement of the gallbladder by the production of large amounts of clear fluid (hydrops) or mucous secretions (mucocele) gallbladder cancer prognosis[quizlet.com]
  • […] arise from cholangiocytes lining the intrahepatic and extrahepatic biliary ducts • Extrahepatic cholangiocarcinomas (2/3) of the tumours • Site : hilum (Klatskin tumour) or distal biliary tree • 50-70 years old • Asymptomatic until late stage • Poor prognosis[slideshare.net]

Etiology

  • Abstract Kawasaki disease is an acute, febrile, systemic syndrome of unknown etiology which principally affects young children.[ncbi.nlm.nih.gov]
  • The etiology of hydrops is not known, but bile stasis and mesenteric lymphadenitis seem to be important factors. Treatment has varied from supportive observation to operative aspiration or cholecystectomy.[ncbi.nlm.nih.gov]
  • […] answers 0 Etiology and pathogenesis HYDROPS OF THE GALLBLADDER (HYDROPS VESICAE FELLEAE) The blockage of the cystic duct by a stone or his scar narrowing to a complete obliteration of the lumen.[lecheniebolezni.com]
  • Core Learning Issues Definition of mucocele or hydrops of the gall bladder; Etiology of hydrops of the gallbladder; Pathophysiology and morphology; Symptomatology of hydrops of the gall bladder; Criteria considered when diagnosing hydrops of the gallbladder[pathology.jcu.edu.au]
  • Common etiologies of persistent cystic duct blockage in adults include, stone impaction, cystic duct stenosis, tumors/polyps, and parasites (eg, ascariasis).[pearls4peers.com]

Epidemiology

  • Rauch AM (1986) Kawasaki Syndrome: critical review of US epidemiology. In: Shulman ST (ed) Kawasaki disease. Proceedings of the Second International Kawasaki Disease Symposium. Alan R Liss Inc, New York, pp33–44 Google Scholar 9.[link.springer.com]
  • Kawasaki syndrome: critical review of US epidemiology. In: Shulman ST, editor. Kawasaki disease. Proceedings of the 2nd International Kawasaki Disease Symposium. New York: Alan R. Liss Inc, 1986:33-44. 5. Chamberlain JW, Hight DW.[annsaudimed.net]
  • Epidemiology Milk of Calcium gall bladder (AKA limy bile) is a rare finding (prevalence less than 1%) in patients that have undergone biliary lithiasis surgery.[proxraymanagement.com]
  • A meta-analysis of epidemiologic studies of biliary pain, dyspeptic symptoms, and food intolerance. Scand J Gastroenterol 1995; 30:411. 18. Adedeji, OA, McAdam, WA. Murphy's sign, acute cholecystitis and elderly people.[sites.ualberta.ca]
Sex distribution
Age distribution

Pathophysiology

  • Core Learning Issues Definition of mucocele or hydrops of the gall bladder; Etiology of hydrops of the gallbladder; Pathophysiology and morphology; Symptomatology of hydrops of the gall bladder; Criteria considered when diagnosing hydrops of the gallbladder[pathology.jcu.edu.au]
  • Pathogenesis The pathophysiological mechanism is unknown, however it is suggested to develop from stasis of bile content in the gallbladder such as a Phrygian cap or porcelain gallbladder, or due to bile duct (CBD) obstruction or pancreatic tumour.[proxraymanagement.com]
  • The exact pathophysiologic mechanism leading to oedema of the gallbladder wall in these diverse conditions is uncertain, but it is likely due to elevated portal venous pressure, elevated systemic venous pressure, decreased intravascular osmotic pressure[radiologyassistant.nl]
  • Pathophysiology of acute obstructive cholecystitis: Implications for nonoperative management. Br J Surg 1987; 74:1084. 11. Myers, SI, Bartula, L. Human cholecystitis is associated with increased prostaglandin I2 and prostaglandin E2 synthesis.[sites.ualberta.ca]

Prevention

  • Clinical features of the disease and treatment regimens, including early administration of intravenous gamma globulin (IVGG), which prevents cardiac complications, are discussed.[ncbi.nlm.nih.gov]
  • Special attention is given to the prevention and treatment of these diseases found in developing countries as well as the latest findings about new antimicrobial agents, gram-negative infections and their management, and recommendations for immunization[books.google.com]
  • Prevention Is it possible to avoid the development of such a dangerous state prevention of the disease provided that certain conditions, which can generally be attributed to the list of rules for a healthy life: need periodic checkups; do not postpone[hairmask3.org]
  • Prevention of dropsy of the gall bladder is in the treatment of inflammatory diseases of the biliary tract and bladder, which are the root cause of this disease.[medicalformat.com]

References

Article

  1. Aldagi M, Haghighat M, Dehghani SM. Gallbladder Hydrops Due to Viral Hepatitis A Infection: A Case Report. Jundishapur J Microbiol. 2015;8(1): e15779.
  2. Feldman M, ed. Sleisenger and Fordtran's Gastrointestinal and Liver disease. 6th ed. Philadelphia, PA: WB Saunders Company; 1998.
  3. Agrawal S, Jonnalagadda S. Gallstones, from gallbladder to gut. Management options for diverse complications. Postgrad Med. 2000;108(3):143-153.
  4. Albu S, Voidazan S, Popa D. Gallbladder Hydrops Associated with an Episode of Acute Liver Toxicity in the Adult: May It Be Considered a Surgical Emergency or Not? Journal of Interdisciplinary Medicine. 2016;1(2):180-182.
  5. Zong L, Chen P, Wang L, et al. A case of congenital giant gallbladder with massive hydrops mimicking celiac cyst. Oncol Lett. 2013;5(1): 226-228.
  6. Rosen P, Barkin R. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, MO: Mosby-Year Book Inc; 1998.
  7. Maurer K, Unsinn KM, Waltner-Romen M, et al. Segmental bowel-wall thickening on abdominal ultrasonography: an additional diagnostic sign in Kawasaki disease. Pediatr Radiol. 2008;38(9):1013-1016.
  8. Mofti AB, Al-Momen A, Suleiman SI, et al. The single gallbladder stone - is it innocent?. Ann Saudi Med. 1994;14(6):471-473.
  9. Vijayaraghavan R, Belagavi CS. Double gallbladder with different disease entities: a case report. J Min Access Surg. 2006;2:23-26.

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Last updated: 2018-06-21 21:08