Forces in the Gall Bladder

  • Structural Design – To Prevent Gravity to Rule

    Gallbladder Bile Ducts and Pancreatic Duct
    tags gallbladder bile duct pancreatic duct sphincter of Oddi papilla ampulla normal anatomy Davidoff art Ashley Davidoff MD
    11921.8b05b014b09.8s
  •  Physiology
    • How Fluid  Layers in the Upright Position   – Normal

      20yr old  male showing normal gallbladder in normal position function storage concentration layering of bile fresh new old specific gravity SG fundus inferior shape anatomy USscan ultrasound Ashley Davidoff MD 82257c06b03.8s

      88F p/w abdominal pain no known prior study gallbladder shape character sinusoidal shape to “s” shape fluid fluid level milk of contrast bile vicarious excretion anatomy CTscan
      82453c01.8s
      88F p/w abdominal pain no known prior study gallbladder shape character sinusoidal shape to “s” shape fluid fluid level milk of contrast bile vicarious excretion anatomy CTscan
      Ashley Davidoff MD
      82450.8

      88F p/w abdominal pain no known prior study gallbladder shape character sinusoidal shape to “s” shape fluid fluid level milk of contrast bile vicarious excretion anatomy CTscan
      Ashley Davidoff MD
      82450.8b
    • Valves of Heister
    • Archimedes Screw
      Archimedes water screw elevation gravity screw delivery cystic duct spiral valves of Heister anatomy physiology function uploading Davidoff art copyright
      Ashley Davidoff MD
      82656b15.8
      82656b20.8s gallbladder Archimedes water screw cystic duct gravity upright spiral valves of Heister filling ampulla of VAter closed neck body fundus distended sympathetic bile duct Davidoff art Ashley Davidoff MD 82656b20.8s
      Archimedes water screw cystic duct gravity upright spiral valves of Heister filling ampulla of VAter closed neck body fundus distended parasympathetic bile duct CCK cholecystokinin contraction relaxation of ampulla juice gates open delivery of bile and pancreatic juices to duodenum pancreatic duct Davidoff art Ashley Davidoff MD 82656b23.8s
      gallbladder sphincter of Oddi sympathetic system parasympathetic system juice gates fatty food closed open storage delivery contracted relaxed fat protein carbohydrates CCK cholecystokinin normal physiology function delivery Davidoff art Ashley Davidoff MD 82656b23c02.8s
      gallbladder Archimedes water screw cystic duct gravity upright spiral valves of Heister filling ampulla of VAter closed neck body fundus distended parasympahtetic bile duct CCK cholecystokinin contraction relaxation of ampulla juice gates open delivery of bile and pancreatic juices to duodenum pancreatic duct Davidoff art Ashley Davidoff MD 82656b23.8s

      gallbladder Archimedes water screw cystic duct gravity upright spiral valves of Heister filling ampulla of VAter closed neck body fundus distended parasympahtetic bile duct CCK cholecystokinin contraction relaxation of ampulla juice gates open delivery of bile and pancreatic juices to duodenum pancreatic duct Davidoff art Ashley Davidoff MD 82656b23b03

  • Air

    • In the Lumen and Wall
    • Air in the lumen dx emphysematous cholecystitis gallbladder wall lumen plain X-ray lateral abdominal projection Ashley Davidoff MD 04537c02s
      air in the gallbladder wall air in the lumen air fluid level dx emphysematous cholecystitis gallbladder wall lumen plain X-ray decubitus right side up lateral abdominal projection Ashley Davidoff MD 04541c01s
      GSW Acalculous Cholecystitis
      gunshot wound to the abdomen gallbladder air in wall emphysematous cholecystitis fragments of bullet plain X-ray Ashley Davidoff MD 04641c01.8s
      Elderly patient with heart disease and significant atherosclerotic disease gallbladder lumen is filled with air wall linear air collection bubbles of air air fluid level dx emphysematous cholecystitis CTscan Ashley Davidoff MD
      16195c02.8s

      61 year old male patient with acute pancreatitis and emphysematous cholecystitis characterised by air fluid level in the gallbladder and and air in the wall of the gallbladder
      Ashley Davidoff MD 31095c.8
    • In the Bile Ducts
      • Ischemic Bowel Pneumatosis Coli
        Ashley Davidoff MD
        16302

         

 

  • Stones
  • Cholelithiasis
    tags gallbladder cystic duct gallstones cholelithiasis Davidoff Art c
    Ashley Davidoff MD
    11921.8b05b018.8s
    Acute Cholecystitis and Sludge
    tags
    gallbladder cystic duct gallstones cholelithiasis stone impacted in the cystic duct distended enlarged hyperemic wall complex fluid in the gallbladder fossa tumefactive bile cholestasis sludge acute
    Ashley Davidoff MD
    11921.8b05b031.8s
    Acute Cholecystitis Complicated by Abscess
    tags
    gallbladder cystic duct gallstones cholelithiasis stone impacted in the cystic duct distended enlarged hyperemic wall complex fluid in the gallbladder fossa tumefactive bile cholestasis sludge acute cholecystitis abscess formation Davidoff Art copyright
    Ashley Davidoff MD
    11921.8b05b037.8s

     

        • In the Body
          • Supine
          • Prone
        • In the neck
    • Cholecystitis
  • Calcification
    • In the Lumen
    • In the Wall
      • Round
      • Linear
  • Fluid – Fluid Levels
88F p/w abdominal pain no known prior study gallbladder shape character sinusoidal shape to “s” shape fluid fluid level milk of contrast bile vicarious excretion anatomy CTscan
Ashley Davidoff MD
82450.8b

An Air Fluid Level

 

    • Not perfectly straight
      • Sludge
      • Fluid Like Sludge
        tags gallbladder distended enlarged dilated fluid fluid level gravity specific gravity sediment sludge cholestasis stasis Davidoff art copyright 2020
        Ashley Davidoff MD
        11921.8b05b039.8sb01
        • tags gallbladder cholestasis fluid fluid level cholelithiasis, acute cholecystitis shadowing stone thickening of gallbladder fossa GBF USscan Ultrasound Ashley Davidoff MD
          04740.8s
          • Tippable – Mobile
            Acalculous Cholecystitis
            tags 88f gallbladder distended, sludge, fluid- fluid level irregular, floater, acalculous cholecystitis
            88f gb acalculous 01
            Acalculous Cholecystitis Right Side Up
            tags 88f gallbladder distended, sludge, fluid- fluid level irregular, floater, acalculous cholecystitis
            Ashley Davidoff MD
            88f gb acalculous 02
        • Fluid
        • Tumefactive

          • Cholestasis Tumefactive Bile
            tags gallbladder distended tumefactive bile crank case oil thick sludge enlarged dilated fluid fluid level gravity specific gravity sediment sludge black cholestasis stasis Davidoff art Ashley Davidoff MD
            11921.8b05b043..8sb01
          • Acalculous Cholecystitis
            tags gallbladder prolonged ICU stay right upper quadrant pain right upper quadrant tenderness cholestasis enlarged tumefactive bile sludge thick walled acalculous cholecystitis ultrasound USscan Ashley Davidoff MD
            16136c03
            Acalculous Cholecystitis
            Cholestasis Tumefactive Bile
            tags gallbladder distended tumefactive bile crank case oil thick sludge enlarged dilated fluid fluid level gravity specific gravity sediment sludge black cholestasis stasis Davidoff art Ashley Davidoff MD
            11921.8b05b043.16kb02.8s
            Acalculous Cholecystitis
            tags right upper quadrant pain ICU setting RUQ pain gallbladder distended thick walled hyperemic enhancing wall pericholecystic induration dirty fat stranding sludge cholestasis tumefactive bile fluid in gallbladder fossa small shadowing stones acalculous cholecystitis shape of bile in the gallbladder has fetus like formation CTscan USscan ultrasound Ashley Davidoff MD
            77717cs

            Acalculous Cholecystitis
            tags right upper quadrant pain ICU setting RUQ pain gallbladder distended thick walled sludge cholestasis tumefactive bile fluid in gallbladder fossa small shadowing stones acalculous cholecystitis shape of tumefactive bile in the gallbladder has fetus like formation USscan ultrasound
            Ashley Davidoff MD
            77717c01
    • Fluid Blood level
      • Acute hemorrhagic Cholecystitis

      • Acute Hemorrhagic Cholecystitis
        tags gallbladder distended enlarged containing hyperdense material sludge differential diagnosis tumefactive bile cholestasis dx acute hemorrhagic cholecystitis CT scan USscan
        Ashley Davidoff MD
        16214c.8s
      • Hemobilia Trauma
        • Traumatic Arterial Injury and Hemobilia
          tags liver traumatic biloma fluid fluid level hepatic artery laceration trauma disruption occlusion hemobilia hematemesis gallbladder blood hemorrhage imaging radiology CTscan
          Ashley Davidoff MD
          00118
          Traumatic Arterial Injury and Hemobilia
          tags liver traumatic biloma fluid fluid level hepatic artery laceration trauma disruption occlusion hemobilia hematemesis gallbladder blood hemorrhage imaging radiology CTscan
          Ashley Davidoff MD
          00118b

           

  • Air Fluid Levels
Air Fluid Level – Hemorrhagic Emphysematous Cholecystitis Elderly patient with heart disease and significant atherosclerotic disease gallbladder lumen is filled with air wall linear air collection bubbles of air air fluid level dx emphysematous cholecystitis CTscan Ashley Davidoff MD
16195c02.8s
air in the gallbladder wall air in the lumen air fluid level dx emphysematous cholecystitis gallbladder wall lumen plain X-ray decubitus right side up lateral abdominal projection Ashley Davidoff MD 04541c01s
  • Pushing and Pulling on the Gallbladder
  • Cholangiogram
    • How the Gallbladder and Cystic Duct Fill
    • Cholangiogram via percutaneous catheter requires the gallbladder to be filled and the pressure to rise before the contrast fills the cystic duct
      Ashley Davidoff MD
      gallbladder cholangiogram 001

      Cholangiogram via percutaneous catheter requires the gallbladder to be filled and the pressure to rise before the contrast fills the cystic duct
      Ashley Davidoff MD
      gallbladder bile duct stones