Clinical Presentation

There is considerable overlap in the clinical features of gall bladder and extrahepatic bile duct disease. Gallstones are often asymptomatic. However, if there is gall bladder outlet obstruction by a stone then progressively severe right-upper-quadrant "colicky" pain (biliary colic), associated with nausea and vomiting, may be felt. If the stone remains impacted the gall bladder may become infected and acutely inflamed (acute cholecystitis) - this leads to severe constant right-upper-quadrant pain, pyrexia and signs of localised peritonitis. This can progress to an empyema

The regional lymph nodes are the cystic duct node and the pericholedochal, hilar, peripancreatic (head only), periduodenal, periportal, coeliac and superior mesenteric nodes

The regional lymph nodes are the cystic duct node and the pericholedochal, hilar, peripancreatic (head only), periduodenal, periportal, coeliac and superior mesenteric nodes

Peripancreatic Lymph Node
Figure 8.1. Gall bladder: regional lymph nodes. Reproduced from Hermanek P, Hutter RVP, Sobin LH, Wagner G, Wittekind Ch (eds.). TNM Atlas: illustrated guide to the TNM/pTNM classification of malignant tumours, 4th edition. Springer-Verlag: Berlin and Heidelberg, 1997.

(pus-filled gall bladder). Stone impactation may also lead to a mucocoele, i.e., a dilated gall bladder in which the bile has been resorbed but mucus secretion continues. A mucocoele is heralded by a palpable gall bladder and dull right-upper-quadrant pain. Occasionally in the elderly the gall bladder may perforate leading to generalised peritonitis. Gallstones localised to the cystic duct will occasionally cause obstructive jaundice, especially if the duct is short as the inflammation and oedema around the cystic duct impedes the flow of bile through the adjacent common bile duct (Mirizzi syndrome). Gallstone ileus (small-bowel obstruction due to impactation of a stone at the ileocaecal valve after the formation of a fistula between the gall bladder and duodenum) is a rare complication of cholecystitis.

Gall bladder carcinoma may present in a similar manner to gallstone disease, although weight loss and jaundice are additional features, obstructive jaundice being caused by metastatic spread to nodes which compress the bile ducts.

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    WHERE IS A PERICYSTIC DUCT LYMPH NODE?
    6 years ago

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