# Gallbladder * chronic cholescyctitis with cholelithiasis[![](https://www.jessepelley.ca/dokuwiki/lib/exe/fetch.php?w=400\&tok=1ca0c3\&media=gallbladder1.jpg)](https://www.jessepelley.ca/dokuwiki/lib/exe/fetch.php?media=gallbladder1.jpg) * usually received with perforations or tears and fragmented calculi Serosa * smooth and glistening (normal) * adhesions other than what's normally found at the liver bed * inflammation, dull and irregular, subserosal fibrosis, fat necrosis (very firm yellow hemorrhagic soft tissue, may indicate pancreatitis), fibrinous or purulent exudates[1)](https://www.jessepelley.ca/dokuwiki/doku.php?id=gallbladder#fn__1) * tumor implants, firm tan-white nodules * Necrosis, blue-black discolouration associated with possible perforation * Porcelain gallbladder, wall may be markedly thickened in chronic cholescyctitis. If extensive calcification it may looked “porcelain” * Intact, or with defects/tears, or opened Mucosa and wall[![](https://www.jessepelley.ca/dokuwiki/lib/exe/fetch.php?w=200\&tok=a6c73b\&media=adenomyomatosis_gallbladder.png)](https://www.jessepelley.ca/dokuwiki/lib/exe/fetch.php?media=adenomyomatosis_gallbladder.png) * tan/green and velvety with a honeycomb pattern, thin pliable wall (normal) * Cholesterolosis, speckled yellow mucosa * Inflammation, ulcerated, friable, flattened and white (atrophy), thickened wall and fibrotic or edematous. * Acute acalculus cholecystitis (without stones) is life-threatening disease of severely ill or debilitated patients. Often transmural necrosis is present which may be apparent on examining the serosa. The wall may be very thin and friable or markedly thickened by edema [2)](https://www.jessepelley.ca/dokuwiki/doku.php?id=gallbladder#fn__2) * Rokitanski sinuses * Polyps, usually small and papillary * Carconoma, usually appears as a solid white mass infiltrating wall or as an exophytic, soft, fronded intraluminal tumor Bile * viscous green/black fluid or clear watery mucin Gallstones * note if obstructing the cystic duct * Number, estimate if several or many * size in aggregate and range of sizes * color and shape, ovoid or faceted Cholesterol calculi * green/yellow/black, hard and crystalline Pigment calculi * black, soft and crumbly ### Differential * Adenocarcinoma, 6-15 per 1000 cholecystectomies and many may be grossly inapparent. Most have an infiltrating pattern and will appear as a diffuse homogeneous thickening of the wall that effaces the normal texture. About one third of tumors are exophytic and grow into the Gallbladder lumen as a mass as well as invade into the wall. In most cases, gallstones and fibrosis will also be present. Porcelain gallbladders are associated with an increased risk of carcinoma. * Metastatic Carconimas, 1-5 cases per 1000, usually to the serosa surface. Rarely the peridcutal lymph node will reveal metastatic carcinoma or lymphoma * Acute Cholecystitis (with or without stones) * Chronic Cholecystitis * Mucoceles * Infections [1)](https://www.jessepelley.ca/dokuwiki/doku.php?id=gallbladder#fnt__1) Lester, p366[2)](https://www.jessepelley.ca/dokuwiki/doku.php?id=gallbladder#fnt__2) Lester, p367