Gallbladder cancer

Cholelithiasis is the presence of gallstones in the gallbladder, most often cholesterol stones from bile supersaturation, and is asymptomatic in most patients. Symptomatic disease presents as biliary colic, self-limited postprandial right upper quadrant pain without fever, diagnosed by right upper quadrant ultrasound and treated with elective laparoscopic cholecystectomy.

Acute cholecystitis is inflammation of the gallbladder from cystic duct obstruction, most often by a gallstone, presenting with RUQ pain lasting more than 6 hours, fever, and a positive Murphy sign. Diagnosis follows the Tokyo Guidelines TG18 criteria and severity grade, and treatment combines IV antibiotics with early laparoscopic cholecystectomy, or cholecystostomy in patients too unstable for surgery.

Primary sclerosing cholangitis is an autoimmune fibroinflammatory disease of the large bile ducts, occurring mostly in young men and associated with inflammatory bowel disease, chiefly ulcerative colitis, in 80 to 90% of cases. MRCP showing multifocal strictures and dilations confirms the diagnosis, no drug alters progression, and management centers on endoscopic dilation of dominant strictures, surveillance for cholangiocarcinoma and colorectal cancer, and liver transplantation for advanced disease.

Pancreatic ductal adenocarcinoma usually presents late, with painless obstructive jaundice from a head-of-pancreas mass, weight loss, and sometimes new-onset diabetes or migratory thrombophlebitis. Pancreas-protocol CT defines resectability, endoscopic ultrasound with fine-needle aspiration confirms tissue diagnosis, and only complete surgical resection with pancreaticoduodenectomy offers a chance of cure, which most patients cannot receive.

Hepatocellular carcinoma is a primary liver cancer that arises almost exclusively in cirrhosis and can be diagnosed non-invasively when multiphase CT or MRI shows arterial-phase hyperenhancement with portal-venous washout in a lesion at least 1 cm. Treatment is stratified by tumor burden, liver function, and vascular or extrahepatic spread, ranging from resection or ablation through transplantation and transarterial chemoembolization to systemic atezolizumab-bevacizumab for advanced disease.

Choledocholithiasis is a gallstone that has migrated into the common bile duct, causing obstructive jaundice and cholestatic liver chemistries and predisposing to acute cholangitis and gallstone pancreatitis. Risk is stratified by ASGE criteria and confirmed by MRCP, endoscopic ultrasound, or therapeutic ERCP, which clears the duct before same-admission cholecystectomy.

Acute cholangitis is a bacterial infection of an obstructed biliary tree, classically presenting as Charcot triad of fever, right upper quadrant pain, and jaundice and progressing to septic shock when drainage is delayed. Diagnosis follows the Tokyo Guidelines and severity grade, and treatment combines prompt broad-spectrum antibiotics with biliary drainage, most often by ERCP.

Typhoid fever is a prolonged systemic infection caused by Salmonella enterica serotype Typhi, marked by stepwise fever, relative bradycardia, and rose spots. Diagnosis rests on blood or bone marrow culture, and first-line treatment is ceftriaxone for severe or resistant disease or azithromycin for uncomplicated illness, since fluoroquinolone resistance is now widespread.

Gallbladder empyema is a severe suppurative complication of acute cholecystitis in which persistent cystic duct obstruction lets the gallbladder fill with frank pus under pressure. Patients present with high fever, marked right upper quadrant pain, and a positive Murphy sign, often with systemic toxicity. Diagnosis is confirmed by aspiration of pus at drainage or surgery, and treatment pairs broad-spectrum antibiotics with urgent source control, cholecystectomy when feasible or percutaneous cholecystostomy in unstable patients.