GALL BLADDER – ANATOMY, LOCATION, SIZE, FUNCTION & PATHOLOGY

📍 LOCATION

• Gall bladder lies on the undersurface of the liver (inferior surface).

• Present in the right upper quadrant (RUQ) of abdomen.

• Lies along the interlobar fissure / main lobar fissure of liver.

• Attached to the visceral surface of the liver between right and quadrate lobe.

📏 SIZE

• Length: 7–10 cm

• Width: 3–4 cm

• Capacity: 30–60 ml

• Wall thickness (normal): ≤ 3 mm

• Common bile duct diameter: < 6 mm (after cholecystectomy can be up to 10 mm)

🧬 ANATOMY

The gall bladder has 3 main parts:

1️⃣ Fundus

• Rounded end

• Projects beyond the liver edge

• Lies at the level of the 9th costal cartilage

2️⃣ Body

• Middle portion

• Lies in a fossa between liver lobes

3️⃣ Neck

• Narrow part

• Continuous with cystic duct

• Contains Hartmann’s pouch (common site for stone impaction)

⚪ Cystic Duct

• Length 2–4 cm

• Has spiral valves of Heister

• Joins the common hepatic duct to form Common Bile Duct (CBD)

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🧪 FUNCTION

The gallbladder mainly manages bile storage and concentration:

⭐ 1. Stores bile

• Liver continuously produces bile

• Gall bladder stores bile till food intake

⭐ 2. Concentrates bile

• Removes water → bile becomes 5–10× more concentrated

⭐ 3. Releases bile into duodenum

• When we eat fatty food:
  → CCK hormone stimulates gall bladder contraction
  → Bile flows via CBD → Ampulla → Duodenum

• Helps in fat digestion and absorption

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⚠️ COMMON GALL BLADDER PATHOLOGIES

1️⃣ Cholelithiasis (Gall Stones)

• Most common disease

• Stones: cholesterol, pigment

• Seen on USG as:
  ✓ Hyperechoic focus
  ✓ Posterior shadowing
  ✓ Mobility with position

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2️⃣ Cholecystitis

Acute cholecystitis

• Gall bladder wall thickening > 3 mm

• Distended gall bladder

• Pericholecystic fluid

• Positive sonographic Murphy sign

Chronic cholecystitis

• Thickened fibrotic wall

• Gall bladder contracted or shrunken

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3️⃣ Gall Bladder Polyps

• Non-mobile echogenic lesions

• No shadow

• 1 cm → suspicious for malignancy

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4️⃣ Adenomyomatosis

• Hyperplastic condition

• Rokitansky–Aschoff sinuses

• Comet-tail artifact on USG

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5️⃣ Gall Bladder Carcinoma

• More common in elderly females

• Associated with gall stones

• Imaging:
  ✓ Mass replacing gall bladder
  ✓ Irregular thickening
  ✓ Liver invasion
  ✓ Lymph nodes + metastasis

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6️⃣ Biliary Dyskinesia

• Gall bladder fails to contract properly

• Diagnosed on HIDA scan (GBEF ↓)

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7️⃣ Empyema of Gall Bladder

• Pus-filled gall bladder

• Large, painful, fever

• Emergency

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8️⃣ Porcelain Gallbladder

• Calcified wall

• High risk of carcinoma

Generalized prominence of ventricular system, sulci, and cisterns — suggestive of corticocerebral atrophym, dilated ventricles , enlargement ventricles.

MRI Finding Explained:

“Generalized prominence of ventricular system, sulci, and cisterns — suggestive of corticocerebral atrophy.”

Meaning in Simple Terms:

This statement means that on the MRI of the brain:

• The ventricles (fluid-filled spaces in the brain) are larger than normal

• The sulci (grooves on the brain surface) and cisterns (CSF spaces around the brain) are also widened

These changes indicate loss (shrinkage or thinning) of brain tissue (cortex and cerebrum) — called corticocerebral atrophy.

ymptoms (Depend on Severity & Cause):

• Memory loss

• Slowed thinking or confusion

• Difficulty walking or maintaining balance

• Personality or behavioral changes

• Speech difficulty

• In severe cases — dementia symptoms

How It’s Diagnosed:

• MRI Brain: shows enlarged ventricles and widened sulci (as mentioned)

• Neuropsychological tests: to assess memory and thinking

• Blood tests: Vitamin B12, thyroid, infection markers

• EEG or PET scan: sometimes used to differentiate causes

What Is Liver Cirrhosis?, Liver Cirrhosis: Causes, Symptoms, Diagnosis, Treatment & Prevention Common Causes of Cirrhosis, Symptoms of Liver Cirrhosis.

Liver Cirrhosis: Causes, Symptoms, Diagnosis, Treatment & Prevention

Liver cirrhosis, also known as liver sclerosis, is a chronic condition in which healthy liver tissue is gradually replaced by scar tissue (fibrosis). This scarring disrupts the liver’s ability to work effectively. Over time, severe cirrhosis can lead to liver failure and life-threatening complications.

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What Is Liver Cirrhosis?

Cirrhosis is the final stage of long-term liver damage. When the liver is repeatedly injured—due to alcohol, infections, or metabolic diseases—it tries to repair itself, forming scar tissue. As the scarring increases, blood flow through the liver becomes restricted, and normal liver functions such as filtering toxins, producing proteins, and regulating nutrients begin to decline.

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Common Causes of Cirrhosis

1. Chronic Alcohol Use

Long-term, heavy alcohol intake is one of the most common causes of cirrhosis. Alcohol directly damages liver cells, leading to inflammation and scarring.

2. Viral Hepatitis (Hepatitis B & C)

Chronic viral hepatitis can silently damage the liver for years until cirrhosis develops.

3. Non-Alcoholic Fatty Liver Disease (NAFLD / NASH)

Fat accumulation in the liver—especially in individuals with obesity, diabetes or high cholesterol—can progress to inflammation and fibrosis.

4. Genetic & Metabolic Disorders

Conditions like hemochromatosis, Wilson’s disease, and alpha-1 antitrypsin deficiency can cause cirrhosis.

5. Autoimmune Hepatitis

The immune system mistakenly attacks liver cells, causing chronic inflammation.

6. Bile Duct Diseases

Diseases like primary biliary cholangitis or primary sclerosing cholangitis block the bile ducts and damage the liver.

7. Medications & Toxins

Certain drugs (e.g., methotrexate, isoniazid) and toxic exposures may also lead to cirrhosis.

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Symptoms of Liver Cirrhosis

In early stages, cirrhosis may not show any symptoms. As the disease progresses, signs may include:

• Persistent fatigue and weakness

• Loss of appetite and weight loss

• Nausea and itching

• Muscle cramps

• Easy bruising or bleeding

• Jaundice (yellowing of eyes and skin)

• Fluid buildup in the abdomen (ascites)

• Confusion, memory problems (hepatic encephalopathy)

• Spider-like veins on the skin and red palms

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How Cirrhosis Is Diagnosed

Doctors may use a combination of tests:

• Blood Tests

To check liver enzymes, clotting ability, and possible causes like viral hepatitis.

• Imaging Studies

Ultrasound, CT scan, MRI, and MR elastography help assess liver scarring and complications.

• Liver Biopsy

A small tissue sample helps confirm the severity and cause of cirrhosis.

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Treatment of Cirrhosis

Although cirrhosis cannot always be reversed, early treatment can slow progression and prevent complications.

Treating the Cause

• Stop alcohol completely

• Treat hepatitis B/C

• Weight loss, diabetes control for NAFLD

• Manage autoimmune or metabolic disorders

Lifestyle & Dietary Changes

• Low-sodium diet to reduce ascites

• Balanced nutrition with adequate protein

• Avoid alcohol and harmful medications

Preventing Complications

• Vaccinations (hepatitis, flu, pneumonia)

• Medicines to prevent variceal bleeding

• Regular screening for liver cancer

Advanced Stage

A liver transplant may be required if liver failure develops.

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Complications of Cirrhosis

• Portal hypertension

• Esophageal or gastric varices

• Ascites

• Splenomegaly

• Frequent infections

• Bleeding tendency

• Hepatic encephalopathy

• Bone weakness (osteoporosis)

• Hepatocellular carcinoma (liver cancer)

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Prevention: How to Protect Your Liver

• Avoid heavy alcohol consumption

• Maintain a healthy weight

• Control diabetes and cholesterol

• Get vaccinated for hepatitis B

• Practice safe hygiene to avoid hepatitis infection

• Avoid unnecessary medications and toxins

• Regular health check-ups if you have risk factors

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Prognosis

Cirrhosis is a long-term disease, and once scarring is established, it usually cannot be fully reversed. However, with timely treatment and lifestyle changes, its progression can be slowed, and many complications can be prevented. In severe cases, liver transplantation can significantly improve survival and quality of life.

radiology, positive and negative contrasts, Quick Comparison Table.

 In radiology, positive and negative contrasts refer to the way a contrast medium appears on imaging, depending on how it alters the attenuation or signal.

1. Positive Contrast

Definition:
Contrast agents that appear white or bright on the image because they increase X-ray attenuation (in radiography/CT) or produce high signal intensity (in some MRI sequences).

Examples:

• Radiography/CT:

  • Barium sulfate (for GI tract studies)

  • Iodinated contrast (for angiography, CT scans)

• MRI:

  • Gadolinium-based contrast agents (T1-weighted images)

Uses:

• To outline hollow structures (stomach, intestines, vessels)

• To enhance lesion detection (tumors, inflammation, vascular abnormalities)

2. Negative Contrast

Definition:
Contrast agents or substances that appear black or dark on the image because they reduce X-ray attenuation (in radiography/CT) or cause signal loss (in MRI).

Examples:

• Radiography/CT:

  • Air (natural or insufflated in GI tract)

  • CO₂ (angiography in patients allergic to iodine)

• MRI:

  • Certain agents like superparamagnetic iron oxide nanoparticles (SPIO) that shorten T2/T2* relaxation, producing dark areas.

Uses:

• To distend hollow organs for better visualization

• To provide contrast against surrounding tissues when positive contrast isn’t suitable

Quick Comparison Table

Feature	Positive Contrast	Negative Contrast
Appearance	White / Bright	Black / Dark
Attenuation	High attenuation	Low attenuation
Common Agents	Barium, iodine, gadolinium	Air, CO₂, SPIO (MRI)
Uses	Outline & enhance structures	Distend & create background contrast

positive and negative contrasts, Quick Comparison

💡 In double contrast techniques (like barium enema or CT colonography), both positive and negative contrasts are used together — e.g., barium (positive) + air (negative) — to give superior mucosal detail.

Absence of flow void in left transverse and left sigmoid sinus, Large area of altered signal intensity in left parieto-temporal lobe.

• Large area of altered signal intensity in left parieto-temporal lobe → indicates hemorrhagic venous infarct (a type of stroke caused by blocked venous drainage, leading to brain tissue damage and bleeding).

• Absence of flow void in left transverse and left sigmoid sinus + no signal on MR Venography (2D TOF) → indicates Cerebral Venous Sinus Thrombosis (CVST) — a blood clot in the brain’s venous sinuses.

Cause (Etiology)

Cerebral venous sinus thrombosis (CVST) can occur due to many reasons:

1. Hypercoagulable States (Increased Clotting Tendency):

• Dehydration (common in children or hot climates)

• Pregnancy or postpartum period

• Oral contraceptive pills (OCPs)

• Thrombophilia (inherited or acquired clotting disorders)

• Malignancy (cancer)

• Infections (especially ear, mastoid, or sinus infections)

2. Local Infections:

• Otitis media (middle ear infection)

• Mastoiditis

• Sinusitis

• Meningitis

3. Systemic Conditions:

• Head trauma or brain surgery

• Autoimmune diseases (e.g., lupus, vasculitis)

• Severe anemia or polycythemia

• COVID-19 infection or vaccination-related (rare)

 Symptoms

Symptoms depend on the size and site of thrombosis, but common signs include:

System/Area	Symptoms
Headache	Severe, persistent headache (most common symptom)
Neurological deficits	Weakness or paralysis (especially opposite side of the clot)
Seizures	Common due to venous infarct and hemorrhage
Visual symptoms	Blurred vision or double vision (due to raised intracranial pressure)
Altered sensorium	Confusion, drowsiness, or even coma in severe cases
Speech issues	If parieto-temporal lobe is involved (aphasia)
Vomiting/Nausea	Due to raised intracranial pressure

Precautions / Lifestyle Modifications

• Stay well-hydrated

• Avoid smoking or alcohol

• Avoid hormonal pills (unless medically necessary)

• Regular follow-up MRI/MRV to monitor recanalization

• Maintain healthy weight and diet rich in fruits/vegetables

• Regular medical checkup for blood coagulation profile if history of thrombosis

National Epilepsy Day – November 17: Awareness, Education & Support, What is Epilepsy?, Why Do We Celebrate National Epilepsy Day?, Causes of Epilepsy, Is Epilepsy Treatable?, Important Tips for Epilepsy Patients:, How We Can Help as a Society

 

National Epilepsy Day – November 17: Awareness, Education & Support

National Epilepsy Day is observed every year on November 17 to raise awareness about epilepsy, a neurological condition that affects millions of people across the world. In India, this day is especially recognized to educate people, reduce stigma, and support those living with epilepsy and their families.

Why Do We Celebrate National Epilepsy Day?

National Epilepsy Day aims to:

• Spread awareness about epilepsy and its symptoms

• Correct myths and misconceptions

• Encourage early diagnosis and proper treatment

• Support individuals living with epilepsy

• Promote research and better healthcare facilities

• Reduce discrimination in society

Many people still consider epilepsy a social taboo. Awareness campaigns on this day help people understand that epilepsy is a medical condition and not a curse, fear, or mental illness.

What is Epilepsy?

Epilepsy is a brain disorder in which people experience repeated seizures. These seizures happen due to sudden, abnormal electrical activity in the brain.

Common Symptoms:

• Sudden shaking or convulsions

• Staring spells

• Temporary confusion

• Loss of consciousness

• Strange sensations or emotional changes

Not all seizures look the same. Some are mild and last only a few seconds, while others may be severe.

Causes of Epilepsy

Epilepsy can occur due to:

• Genetic factors

• Head injuries

• Brain infections

• Stroke

• Brain tumor

• Unknown causes (in many cases)

Is Epilepsy Treatable?

Yes!
With proper medication, lifestyle management, and sometimes surgery, many people with epilepsy can live normal, healthy lives.

Important Tips for Epilepsy Patients:

• Take medicines regularly

• Avoid sleep deprivation

• Reduce stress

• Avoid alcohol and smoking

• Follow doctor’s advice strictly

How We Can Help as a Society

• Do not panic during a seizure

• Ensure the person is safe

• Do not put anything in their mouth

• Turn them gently to one side

• Call for medical help if the seizure lasts more than 5 minutes

Cerebrovascular Diseases CVDs, Definition, Causes and Risk Factors

Cerebrovascular Diseases (CVDs) refer to a group of conditions that affect the blood vessels and blood supply to the brain. These disorders can lead to significant neurological damage and are a major cause of death and disability worldwide.

Definition

Cerebrovascular disease occurs when there's a sudden disruption of blood flow to the brain due to blockage (ischemia) or rupture (hemorrhage) of blood vessels.

Types of Cerebrovascular Diseases

1. Stroke (Cerebrovascular Accident)

   • Ischemic Stroke (≈ 85% cases): Caused by a blood clot blocking a vessel.

     • Thrombotic (from a local clot)

     • Embolic (from a clot that travels from another part of the body)

   • Hemorrhagic Stroke: Caused by bleeding into the brain.

     • Intracerebral hemorrhage

     • Subarachnoid hemorrhage

2. Transient Ischemic Attack (TIA)

   • A "mini-stroke" with temporary blockage of blood flow. Symptoms resolve within 24 hours.

   • A warning sign for future major strokes.

3. Aneurysm

   • A weakened area in a blood vessel that balloons out. May rupture, leading to hemorrhage.

4. Arteriovenous Malformations (AVMs)

   • Abnormal tangles of arteries and veins that can rupture and bleed.

5. Cerebral Venous Sinus Thrombosis (CVST)

   • Blood clot in the brain’s venous sinuses, leading to increased intracranial pressure.

Causes and Risk Factors

• Hypertension

• Diabetes mellitus

• High cholesterol

• Smoking

• Atrial fibrillation

• Sedentary lifestyle

• Obesity

• Family history of stroke or CVD

Symptoms

• Sudden numbness or weakness (especially one side of the body)

• Confusion, trouble speaking or understanding

• Visual disturbances

• Dizziness or loss of balance

• Severe headache (especially in hemorrhagic stroke)

Diagnosis

• CT Scan / MRI Brain

• CT Angiography / MR Angiography

• Carotid Doppler Ultrasound

• Blood tests (clotting profile, glucose, cholesterol)

• Echocardiogram / ECG (if embolic cause is suspected)

Treatment

• Ischemic Stroke:

  • Clot-busting drugs (e.g., tPA)

  • Mechanical thrombectomy

• Hemorrhagic Stroke:

  • Blood pressure control

  • Surgical intervention (e.g., clipping or coiling of aneurysms)

• Preventive Therapies:

  • Antiplatelets (aspirin)

  • Anticoagulants

  • Lifestyle modification

  • Statins

Prevention

• Control blood pressure and sugar

• Quit smoking and alcohol

• Healthy diet and regular exercise

• Manage heart conditions (e.g., atrial fibrillation)

• Regular health screenings