Hydrops

Impacted stone at cystic duct leads to bile reabsorption and increased mucus production - thus white or clear bile

treatment - cholecystectomy

Gallbladder Polyp

Indications for surgery - symptomatic polyp, polyp with gallstones, > 1cm, age > 50

Cholesterolosis or Strawberry Gallbladder

accumulation of cholesterol in macrophages leading to deposition on surface of gallbladder

benign condition - does not need resection

Choledochal cyst

Type I: fusiform cyst (most common)
Type II: diverticulum of common bile duct
Type III: choledochocele (intraduodenal portion of CBD)
Type IVa: intra- and extrahepatic cysts
Type IVb: only extrahepatic cysts
Type V: Caroli’s Disease (only intrahepatic cysts)
Treatment: Hepaticojejunostomy (type I); diverticulectomy (type II); excision / sphincteroplasty (type III); OLT (types IV & V) to reduce malignancy risk

Gallstones

Cholesterol stones - due to cholesterol insolubilization secondary to stasis - cholecystectomy

Pigmented stones

    brown - bacteria (usually E.coli) or parasite infection, composed of calcium bilirubinate, need biliary drainage procedure (sphincteroplasty)

    black - associated with hemolytic disorder, ileal resection, chronic TPN - cholecystectomy

Chronic Cholecystitis

associated with recurrent symptomatic cholelithiasis or biliary colic

Aschoff-Rokitansky sinuses = epithelium or mucosa protrudes into muscular layer

Bile

Consists of bile salts (80%), phospholipids (15%), and cholesterol (5%)

Primary Bile salts - cholic acid and chenodeoxycholic acid

Secondary bile salts - lithocholate and deoxycholate

Sterobilin - conguated bilirubin breakdown product - gives stool brown color

Urobilin - conjugated bilirubin breakdown product - gets reabsorbed in blood and delivery to kidney, secreted in urine, gives yellow color