In the fasting state, only 50–60% of bile goes to the gall bladder.
The rest trickles through to the intestine regardless.
Gallbladder contraction and relaxation of the sphincter of Oddi
is stimulated by cholecytokinin (CCK). The biliary tree is a low pressure system,
and the flow of bile stops at 20 cm H2O.
Severe colicky RUQ pain after fatty meals. Vomiting.
US shows gallstones in the gallbladder.
Ureteric colic, gallbladder dyskinesia.
Fever, RUQ pain.
RUQ tenderness, mass.
FBC(↑WBC), U&E(hepatorenal syndrome), amylase, blood cultures.
erect CXR, supine AXR to exclude perforation.
US gall bladder: thickened wall, stones, pericholecystic fluid.
Cefuroxime + metronidazole (most often E. coli). Diamorphine.
Abdominal discomfort, distension, flatulence, fat intolerance.
Fever not always present.
- Charcot's triad
- Altered mental state
Cefuroxime + metronidazole. Biliary drainage.