Christopher P. Coppola, Alfred P. Kennedy, Jr. and Ronald J. Scorpio (eds.)Pediatric Surgery2014Diagnosis and Treatment10.1007/978-3-319-04340-1_65
© Springer International Publishing Switzerland 2014
Gallbladder Disease
(1)
Department of Pediatric Surgery, Janet Weis Children’s Hospital, 100 N. Academy Av. MC 21-70, Danville, PA 17822, USA
Abstract
Laparoscopic cholecystectomy for pediatric patients is increasing in incidence. A major reason for this is detection of biliary dyskinesia through use of HIDA scan. Children have gallstones less frequently than adults, but when they do, pigment stones, rather than cholesterol stones, are more common.
Laparoscopic cholecystectomy for pediatric patients is increasing in incidence. A major reason for this is detection of biliary dyskinesia through use of HIDA scan. Children have gallstones less frequently than adults, but when they do, pigment stones, rather than cholesterol stones, are more common.
1.
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Pathophysiology:
(a)
Epidemiology: pediatric biliary disease in increasing in incidence [1]. Approximately 2 % of children have gallstones, and a greater number have biliary disease without stones. After puberty females have quadruple the incidence of gallstones, compared to males.
(b)
Cholelithiasis: presence of gallstones can be asymptomatic or associated with abdominal pain. Bile is usually liquid, but unbalanced proportions of cholesterol, bile salts, and lecithin lead to precipitation of gallstones. Stress, shock, and dehydration can lead to concentration of bile and gallstones.
(c)
Types of gallstones: the color reflects content, and usually there will be one type of stone present. Cholesterol stones are most common in adults, but children have greater incidence of pigment stones.
(i)
Black (48 %): pigment stones (calcium bilirubinate) present in hemolysis and parenteral nutrition.
(ii)
Yellow (21 %): from supersaturation of bile with cholesterol.
(iii)
Protein stones (5 %).
(iv)
Calcium carbonate (4 %).
(v)
Brown (3 %): associated with cholangitis and bile stasis, made of bilirubin, fatty acids, and calcium.
(d)
Cholecystitis (inflammation of the gallbladder): occurs when gallstone (or other process) obstructs the cystic duct, creating pressure, stasis, distention, vascular congestion, edema, and ischemia of gallbladder.
(e)
Gallstone pancreatitis: occurs when stones from gallbladder pass through common bile duct and obstruct pancreatic duct.
(f)
Biliary dyskinesia: occurs when there is impaired or painful emptying of the gallbladder after a meal without the presence of gallstones. The etiology of this process is not known, but may be due to a long cystic duct, tortuous valves in duct, low junction of the cystic duct and common bile duct, or a visceral hypersensitivity of the gallbladder.
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