Which of the following gallbladder pathology can be diagnosed on simple abdominal x-ray and patient can be considered for cholecystectomy even on the basis of x-ray finding?
Ans. B. Porcelein gall bladder. (Ref Bailey and Love 25th / pg. 1113)The plain X-ray of the gall bladder show radio-opaque gallstones in 10 % of patients. It may also show the rare cases of calcification of the gall bladder, a so-called "porcelain gall bladder" The importance of this appearance is that it is premalignant and an indication for cholecystectomy.# Limey bile is frequently related to multiple small stones.This lesion is not a premalignant lesion.# Cholecystoses (cholesterosis. polyposis. adenomvomatosis and cholecystitis glandularis proliferans) is a not un- common group of conditions affecting the gall bladder in which there are chronic inflammatory changes with hyperplasia of all tissue elements.# In Cholesterosis ("strawberry gall bladder") the interior of the gall bladder looks something like a strawberry; the yellow specks (submucous aggregations of cholesterol crystals and cholesterol esters) correspond to the seeds. It may be associated with cholesterol stones.# Cholesterol polyposis of the gall bladderCholecystography shows negative shadows in a functioning gall bladder, or on ultrasound there is a well-defined polyp present. These are either cholesterol polyposis or adenomatous change. With improving ultrasonography they are seen more frequently and surgery advised only if they change in size. A polyp of the mucous membrane is fleshy and granulomatous. All layers of the gall bladder wall may be thickened but sometimes an incomplete septum forms which separates the hyperplastic from the normal. Intraparietal emixedf calculi may be present. These can be complicated by an intramural, and later extramural, abscess. If symptomatic, the patient is treated by cholecystectomy.# Diverticulosis of the gall bladderDiverticulosis of the gall bladder is usually manifest as black pigment stones impacted in the out-pouchings of the lacunae of Luschka. Diverticulosis of the gall bladder may be demonstrated by cholecystography, especially when the gall bladder contracts after a fatty meal. There are small dots of contrast medium just outside the gall bladder.A septum may also be present (to be distinguished from the Phrygian cap) and the Rx is cholecystectomy.
Cholesterosis
Porcelein gall bladder
Limey bile
Diverticulosis of gallbladder
G.I.T.