Chapter 18: Gallbladder & Biliary Tract Pathology

Gallbladder & Biliary Tract Pathology differentiates between the two primary types of gallstones: cholesterol stones, which are frequently associated with obesity, female gender, and specific Native American populations, and pigmented bilirubinate stones, which are linked to chronic hemolytic anemias and parasitic infections like Clonorchis sinensis. The summary details the progression of inflammatory conditions, describing acute cholecystitis caused by cystic duct obstruction and chronic cholecystitis characterized by wall thickening and lymphocytic infiltration. Key diagnostic signs are explained, including Murphy’s sign for gallbladder inflammation and Charcot’s triad—fever, jaundice, and right upper quadrant pain—which indicates ascending cholangitis. The text also covers miscellaneous conditions such as cholesterolosis, known as strawberry gallbladder, and hydrops resulting from mucous accumulation. Furthermore, the chapter outlines malignant pathologies, including gallbladder adenocarcinoma and its association with calcified porcelain gallbladders, as well as bile duct cancers like cholangiocarcinoma and Klatskin tumors. Finally, it highlights critical clinical correlates such as Courvoisier's law, which helps distinguish malignant obstruction, such as adenocarcinoma of the ampulla of Vater, from benign stone disease based on physical examination findings.