Diseases of the Gall Bladder

Karen Chojnacki, M.D., F.A.C.S.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Karen A. Chojnacki, MD, is clinical professor of surgery at Thomas Jefferson University. Her clinical and academic interests include laparoscopic management of esophageal diseases and the surgical treatment of pancreatic malignancy. Here, she discusses biliary anatomy and physiology, and treatment options for biliary tract disease.

The first US cholecystectomy was performed in 1886, and the surgical technique remained virtually unchanged for about a century, when laparoscopic cholecystectomy was introduced.

Dr. Chojnacki describes the anatomy and physiology of the biliary tract, including the common bile duct that courses through the pancreas to form the papilla of Vater, and the sphincter of Oddi that regulates the flow of bile, especially into the gallbladder. Cholesterol-soaked bile contributes to crystals that can aggregate and become the nidus for gallstone formation.

Imaging of the biliary tract

Using lapanoic acid or tyropanoate in oral cholecystography produces a diagnostic accuracy rate of 95% for gallstones; however, the author notes that abdominal ultrasonography of the biliary tract creates no radiation exposure and is independent of patient compliance. She discusses hepatobiliary scintigraphy, CT scans and MRIs in detecting biliary disease.

Causes of gallbladder disease include stone impacted in the cystic duct or in the infundibulum (Hartman's pouch) of the gallbladder, and biliary colic. The author describes laparoscopic cholecystectomy which accounts for 85-90% of cholecystectomies and has a mortality rate close to zero ... and touches upon such alternative treatments as contact dissolution therapy and extracorporeal shock wave therapy in biliary disease.

The lecture concludes with a discussion of acute cholecystitis, asymptomatic gallstones often associated with cirrhosis, biliary diskinesia associated with dysfunction of the sphincter of Oddi, and gallstone disease in pregnancy, and gallbladder carcinoma. Future advances, says Dr. Chojnacki, are most likely to come from prevention of gallstones.