The document discusses various topics related to biliary anatomy and gallbladder disease: 1) It describes common gallbladder conditions like cholecystitis, gallstones, porcelain gallbladder, and Mirizzi syndrome. 2) Imaging findings for evaluating these conditions are provided, including ultrasound, CT, and ERCP findings. 3) Treatment options are summarized for various gallbladder diseases and complications.

1. Biliary Anatomy

2. Biliary Calculi Milk of calcium bile Porcelain gallbladder Cholecystitis Mirizzi Syndrome, Gall stone ileus

3. Biliary lithiasis

4. Biliary lithiasis 最佳影像診斷線索 : Echogenic foci with posterior acoustic shadowing (10% stones: No acoustic shadow) in US Discrete & (movable) lower signal (density) filling defects within bile ducts in MRC and ERCP Opaque stones (20%) in plain radiography

7. Gallbladder completely filled with calculi ~ Calculi are molded ( 鑄造 ) by the wall of the gall bladder : the acoustic shadow posterior to the Calculi that do not change with positional change

9. Floating stone

13. Crescent (meniscus) lucent sign Bull’s eye sign

15. Milk of calcium bile Calcium carbonate precipitate within gall bladder lumen (calcium milk) 最佳影像診斷線索 : Identification of calcified liquid within gallbladder (echogenic fluid similar to sludges but with acoustic shadowing) Incidental finding: asymptom or RUQ pain Etiology: GB stasis ~ Ca++ carbonate in bile, thickness of GB wall

16. GB sludges (thick bile)

17. GB sludges ~ cholecystitis ~ stone

18. Milk of calcium bile (vs. sandy gall stone)

20. Porcelain GB Calcification of gallbladder wall 最佳影像診斷線索 : Rim of calcification in RUQ conforming to GB shape Usually asymptomatic ; old age Rish factor for gallbladder carcinoma Prophylactic cholecystectomy is current consensus recommendation

23. Gallstones --> cystic duct obstruction Bile secretion  GB distention Wall edema / hypervascularity Intraluminal pressure  Compression on vessels --> Thrombosis/ ischemia --> GB wall necrosis --> Perforation / abscess Pathophysiology Gallstones (+) : 96 %

24. Color Doppler sonogram: marked Hyperemia & wall thickness of GB

25. Tc-HIDA scan: Acute cholecystitis without isotope filling of GB

30. Acaculous cholecystitis ?

32. Non-inflammatory GB wall thickness: Congestive heart failure with dilated IVC

33. Non-inflammatory GB wall thickness: Acute hepatitis Acute hepatitis s/p treatment

35. Intraluminal membranes Empyema of gall bladder

36. Emphysematous cholecystitis

37. Intraluminal membranes Sloughed ( 蛻腐 ) mucosae (Asymmetrical wall thickness) Gangrene of gall bladder

38. Perforated GB with abscess localized peri-cholecystic complicated fluid collections

39. Perforated GB with abscess

41. Chronic Cholecystitis Two appearance Small, contracted, sclerosed GB with/without stones (fasting state) Same imaging appearance as acute cholecystitis but without Murphy sign (terderness)

42. Small, contracted, sclerosed GB; even non-visualization of GB (during fasting state)

43. Mirizzi syndrome Partial or complete obstruction of common hepatic duct (CHD) due to gallstone impacted in cystic duct or gall bladder neck 最佳影像診斷線索 : Impacted cystic duct stone on US with proximal dilatation of intraheptic ducts

47. Porta hepatis nodes Klatskin tumor

64. Pathological No.: 962230 Date of Arrival: 2007/8/7 Date of Report: 2007/8/8 Pathological diagnosis: Gall bladder, cholecystectomy ----- ----- Chronic cholecystitis with acute exacerbation and cholelithiasis Gross: The specimen consists of an opened gall bladder, measuring 9.2 x 4.5 x 3 cm in size. It is enlarged. The wall is thickened and measuring up to 0.5 cm in thickness. The mucosal folds are absent. There are several pieces of black stone in the lumen. Representative parts are embedded in one block. Microscopy: The sections show a picture of edema, neutrophilic infiltration, congestion, hemorrhage, abscess formation, fibrosis and focal chronic inflammatory cell infiltration in the lamina propria, muscular layer and perimuscular layer. Rokitansky-Aschoff sinuses are present.

70. Spigelian hernia Lap. Port hernia