Gallbladder Imaging

Excerpt

There are several variations and etiologies of gallbladder disease. Chronic and acute cholecystitis are the 2 ways this condition can present. Calculous and acalculous (with or without gallstones or cholelithiasis) are variants of this disease. The most common form of gallbladder disease is chronic cholecystitis with cholelithiasis. Up to 15% of the United States population has asymptomatic gallstones. On the other hand, 15% of all cases of cholecystitis are acalculous or without stones.

Twenty to 25 million Americans have gallstones. Annually, more than 750,000 individuals undergo cholecystectomy in the United States. Many factors have been linked to gallbladder disease. Female gender, obesity, hormone exposure, diabetes, liver disease, age older than 40 years, and drastic weight loss are just a few factors that are associated with a higher incidence of gallbladder disease and gallstones. Symptoms of cholecystitis must be distinguished from other conditions, such as irritable bowel, peptic ulcer disease, gastroesophageal reflux disease, and cardiac issues.

Cases of chronic cholecystitis present as progressing right upper abdominal pain with bloating, food intolerances (especially greasy and spicy foods), increased gas, nausea, and vomiting. Pain in the mid back or shoulder may also occur. This pain could be present for years until correctly diagnosed. Cases of acute cholecystitis have similar symptoms, only more severe. Often, symptoms are mistaken for cardiac issues. The finding of right upper abdominal pain with deep palpation, Murphy's sign, is usually classic for this disease. Often, there is a specific dietary event leading to the acute attack, "I ate pork chops and gravy last night." The most important and useful test when diagnosing acute or chronic cholecystitis is a thorough history and physical exam performed by an experienced practitioner familiar with gallbladder disease.

Gallbladder cancer is somewhat rare, annually affecting 3 out of 100,000 individuals in the United States. It may present with symptoms similar to cholecystitis or asymptomatic until it becomes advanced.[NIH. Imaging and Screening of Cancer of the Gallbladder]