Gallbladder In Pregnancy Research Articles

The Hepatobiliary System: An Overview of Normal Function and Diagnostic Testing in Pregnancy.

Pregnancy is associated with physiological adaptions that affect every organ system. Changes in liver function in pregnancy have important effects on nutrient metabolism, protein synthesis, and the biotransformation of substances in preparation for excretion. A clear understanding of the anatomic and functional changes of the hepatobiliary system is necessary for the diagnosis and evaluation of disease, as well as understanding how these changes predispose women to pregnancy-specific hepatic conditions. In this review, the effect of gestational changes in hepatobiliary function on laboratory tests and the role of diagnostic imaging of the liver and gallbladder in pregnancy will be discussed.

Torsion of the gallbladder in pregnancy

Torsion of the gallbladder is a rare condition that is difficult to diagnose preoperatively, but prompt surgical intervention is necessary to avoid possible sepsis and death. A 36-year-old pregnant woman presented to Emergency Department with a constant epigastric pain at 17 weeks of gestation. Abdominal ultrasonography and magnetic resonance imaging demonstrated a distended gallbladder that contained no stones but had mild wall thickening. Laparoscopic cholecystectomy using three ports was performed under the impression of an acalculous cholecystitis. The gallbladder was found to be rotated 180 degrees clockwise on gallbladder mesentery and to be gangrenous. The postoperative course was uneventful and the patient was discharged on the 4th day after surgery. It is important to keep in mind gallbladder torsion in the differential diagnosis from acute cholecystitis when the patient has an acute onset of abdominal pain and a severely distended gallbldder. Prompt cholecystectomy via a laparoscopic approach should be performed.

Retraction notice. Emergency laparoscopic cholecystectomy for acute empyema of the gallbladder in pregnancy.

Retraction notice. Emergency laparoscopic cholecystectomy for acute empyema of the gallbladder in pregnancy.

Emergency laparoscopic cholecystectomy for acute empyema of the gallbladder in pregnancy.

Laparoscopic surgery in pregnant patients have been reported in the literature, laparoscopic cholecystectomy being the most common. A pregnant patient in her second trimester of pregnancy underwent emergency laparoscopic cholecystectomy for empyema of gallbladder. The distended gallbladder was decompressed before dissection was commenced. There was no morbidity conversion, or complications for either mother or child related to general anaesthesia. The major advantages of the minimally invasive therapy can be utilized in the surgical disorders of the pregnant patient.

Rupture of the gall-bladder in pregnancy

Rupture of the gall-bladder in pregnancy

Cholecystokinin secretion in pregnancy.

The gallbladder volume is increased in pregnancy, and its contraction during a meal is impaired. This is of importance for the increased risk of gallstones in pregnancy, since it may cause retention of cholesterol crystals in the gallbladder lumen. Cholecystokinin (CCK) is responsible for the food-induced gallbladder contraction. We have consequently measured the plasma concentrations of CCK in the fasting and the stimulated state in pregnant women and in age-matched non-pregnant controls. In a subset of pregnant women and controls the gallbladder volume was measured with ultrasound. The results show that whereas basal CCK concentrations were normal, the response to an oral preparation that contracts the gallbladder was increased in pregnancy. Moreover, the secretion of CCK correlated well with gallbladder emptying. We conclude that the behaviour of the gallbladder in pregnancy is not due to impaired secretion of CCK.

Ultrasonography of the gallbladder in pregnancy

The appearance of the gallbladder was monitored by serial ultrasound examinations in 36 women at various times during their normal pregnancy and postpartum. The gallbladder remained within normal limits in size, but there was a progressive increase in its longitudinal and transverse diameters. The contractibility of the gallbladder was also assessed and found to be satisfactory in most cases. However, the formation of sludge was demonstrated in several instances beyond the 20-25th weeks of pregnancy. Gallstones were detected in 2 patients, 1 of whom had initially normal findings on cholecystosonography during her first trimester.

The rate of emptying of the human gall bladder in pregnancy: Gerdes and Boyden: Surg. Gynec. Obst. 66: 145, 1938

The rate of emptying of the human gall bladder in pregnancy: Gerdes and Boyden: Surg. Gynec. Obst. 66: 145, 1938

Retardation of the Gall Bladder in Pregnancy

Following Mann and Higgins' pioneer study of the effect of pregnancy upon the emptying of the gall bladder in gophers, several attempts have been made to appraise the efficiency of this organ in gravid women, but with contradictory results. The latter may be attributed to difficulties inherent in visualizing the gall bladder of pregnancy, to lack of quantitative methods of measuring the flow of bile and to absence of post-partum examination of individuals selected for study. The present analysis is based upon intravenous cholecystography and upon computation of the changing volumes of the gall bladder after a standard meal. During the last 2 years 21 gravid women have been subjected to this test. Curiously enough, in view of some of the reports in the literature, the gall bladder of only one of these failed to visualize. Three other series were discarded because of gall stones, vomiting or unsatisfactory shadows. Of the remaining 17 patients, 4 had been gravid 2 to 3 months, and thirteen 5 to 8 months. Five of the latter were also visualized post-partum. Inspection of the mean curves of evacuation of the gall bladder in these groups shows that in the 13 women 5 to 8 months gravid (most of them primigravidae) only half the contents of the gall bladder had been discharged 40 minutes post-cibum, whereas in 12 nulligravidae of comparable age nearly three-fourths of the contents had been emptied (Fig. 1). This retardation is even more striking when the gravid and post-partum curves of 5 of these individuals are compared, During pregnancy these 5 gall bladders discharged only 8% of their volume in the first 20 minutes post-cibum, whereas 6 to 9 weeks post-partum the same organs discharged 48%.