This document discusses the approach to patients presenting with a gallbladder lump. It defines a gallbladder lump and its characteristics including location, tenderness, shape, size and consistency. Potential causes are outlined including mucocele, empyema, periampullary carcinoma and gallbladder carcinoma. The workup and differential diagnosis are described. Management options are provided for each potential diagnosis, including cholecystectomy, antibiotics, drainage procedures, and resection depending on the underlying cause and resectability.

1. Approach to a patient with Gall
Bladder Lump
Dr. Kamal Kataria
Assistance Professor
Dr. Ankita Singh
Senior Resident
Department Of Surgical Disciplines

2. What Is Gall Bladder (GB) Lump?
• GB is pear shaped reservoir of bile (5-12cm)
• Usually not palpable
• May be palpable & even visible as abdominal
“lump”
• Can be both sign & symptom

3. Characteristics Of GB Lump
• Site:
– Right upper quadrant (RT hypochondrium +
Epigastrium)
– May be found in right lower quadrant
(Umbilical/RT lumbar/ iliac fossa region); if large
or associated with hepatomegaly
Right iliac fossa
Right lumbar
Right hypochondrium Epigastrium
umbilical
Right upper quadrant
Right lower quadrant

4. Characteristics Of GB Lump…
• Tenderness: may or may not be present over
lump, Murphy’s Sign may be present
• Shape: globular (irregular in carcinoma GB)
• Margins: superior margin usually not defined
• Size: variable
• Surface: smooth (irregular in CA GB)
• Consistency: soft or ?? Cystic (hard in CA GB)

5. Characteristics Of GB Lump…
• Mobility: side to side (horizontally), if not too
large
• Movement with respiration: present
(vertically)
• Percussion: dull

6. GB lump may be associated with??
• Painless or Pain over lump
• Yellowish discoloration of urine & eyes
• Passage of clay colored or black tarry stools
• Itching all over body
• Fever, malaise
• Decreased appetite
• Weight loss
• Other systemic symptoms

7. Differential diagnosis
• Soft, non tender GB:
– Mucocele/ hydrops of GB
– Periampullary Carcinoma (head of pancreas,
ampulla duodenum, Common bile duct)
• Tenderness, guarding over GB lump:
– Empyema GB
• Hard, irregular GB:
– Carcinoma GB

8. Mucocele/hydrops of GB

9. Differential diagnosis
• Soft, non tender GB:
– Mucocele/ hydrops of GB
– Periampullary Carcinoma (head of pancreas,
ampulla duodenum, Common bile duct)
• Tenderness, guarding over GB lump:
– Empyema GB
• Hard, irregular GB:
– Carcinoma GB

10. Periampullary carcinoma

11. Differential diagnosis
• Soft, non tender GB:
– Mucocele/ hydrops of GB
– Periampullary Carcinoma (head of pancreas,
ampulla duodenum, Common bile duct)
• Tenderness, guarding over GB lump:
– Empyema GB
• Hard, irregular GB:
– Carcinoma GB

12. Empyema GB

13. Differential diagnosis
• Soft, non tender GB:
– Mucocele/ hydrops of GB
– Periampullary Carcinoma (head of pancreas,
ampulla duodenum, Common bile duct)
• Tenderness, guarding over GB lump:
– Empyema GB
• Hard, irregular GB:
– Carcinoma GB

14. Carcinoma GB

15. Workup
• To confirm diagnosis:
–Transabdominal ultrasonography
–CECT/ MRI abdomen (if indicated)
–Endoscopic ultrasound
–Guided biopsy for suspected malignancy
??controversial

16. Workup…
• To support findings & fitness for surgery (if
operable):
–Hemogram for anemia
–LFT for obstructive jaundice
–RFT to rule out hepatorenal syndrome
–PT/INR
–BGCM
–CXR

17. Management
• Mucocele GB:
– Laparoscopic/open cholecystectomy ( if hydrops is
due to obstruction of cystic duct by stone in
hartmann;s pouch of GB)
– Bile duct resection with margin, nodal clearance,
caudate lobe/hemihepatectomy, cholecystectomy
with hepatobiliary reconstruction required if
obstruction is due to rare cholangiocarcinoma
occluding cystic duct.

18. Management…
• Empyema GB:
– Antibiotics
– Cholecystectomy as emergency procedure
– Tube cholecystostomy often required for drainage
followed by elective cholecystectomy (3-6 weeks)

19. Management…
• Periampullary carcinoma:
– Includes carcinoma of head of pancreas, ampulla
duodenum, distal common bile duct
– Whipple’s procedure –pancreaticoduodenectomy
and reconstruction if resectable

20. Management…
• Carcinoma GB:
– Arising from neck, hartmann’s pouch & proximal
body – palpable GB lump usually feels soft and
smooth
– Arising from fundus & body feels hard & irregular
– Treatment: if resectable is radical cholecystectomy

21. THANK YOU
Any queries??