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Gall-bladder wall thickening in patients with liver cirrhosis
1Department of Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China.
Insights
Gall-bladder wall thickening in cirrhosis patients is linked to ascites and lower systemic vascular resistance (SVR). These findings suggest multifactorial causes for this common ultrasound finding in liver disease.
Area of Science:
- Hepatology
- Gastroenterology
- Medical Imaging
Background:
- Gall-bladder wall thickening is a frequent observation in patients with cirrhosis.
- The underlying causes for this finding remain incompletely understood.
Purpose of the Study:
- To investigate the clinical, biochemical, and hemodynamic factors associated with gall-bladder wall thickening in patients with cirrhosis.
Main Methods:
- Seventy-seven patients with cirrhosis (excluding those with gallstones, cholecystitis, heart failure, or severe renal/hepatic dysfunction) were studied.
- Data collected included clinical parameters, laboratory values, ultrasound findings, and hemodynamic measurements.
- Multivariate analysis was used to identify independent predictors of gall-bladder wall thickening.
Main Results:
- 53% of patients with cirrhosis exhibited gall-bladder wall thickening (> 4 mm).
- Thickened gall-bladder walls correlated with lower serum albumin, prolonged prothrombin time, higher Child-Pugh class C, and increased prevalence of ascites.
- Patients with thickening also showed higher hepatic venous pressure gradient and lower systemic vascular resistance (SVR).
- Ascites and SVR < 900 dyn.s/cm5 were independently associated with gall-bladder wall thickening.
Conclusions:
- Gall-bladder wall thickening in cirrhosis is multifactorial.
- Ascites, decreased SVR, and portal hypertension are key contributors to its development.
Abstract:
Gall-bladder wall thickening is commonly seen in patients with cirrhosis, but its exact causes have not been well established. We evaluated clinical, biochemical and haemodynamic data of patients with cirrhosis with respect to the presence of thickening of the gall-bladder wall. After excluding patients who presented with gallstones, acute or chronic cholecystitis, heart failure, a serum creatinine level greater than 2 mg/dL and/or a serum alanine aminotransferase level greater than 400 U/L, 77 patients with cirrhosis (75 male, two female; mean age 58 +/- 8 years) were enrolled in the study. Clinical, biochemical, ultrasound and haemodynamic data were obtained in every patient. Forty-one (53%) of 77 patients with cirrhosis had gall-bladder wall thickening (> 4 mm). Compared with patients with a normal gall-bladder wall, patients with gall-bladder wall thickening had significantly lower serum albumin levels (3.6 +/- 0.6 vs 2.9 +/- 0.7 gm/dL, respectively; P < 0.05), a longer prothrombin time (13 +/- 6 vs 16 +/- 6 s, respectively; P < 0.05), more patients with Child-Pugh class C (6 vs 37%, respectively; P < 0.05) and more patients with ascites (8 vs 50%, respectively; P < 0.05). In addition, compared with patients with a normal gall-bladder wall, those patients with gall-bladder wall thickening had a higher hepatic venous pressure gradient (13.9 +/- 4.5 vs 17.1 +/- 4.1 mmHg, respectively; P < 0.01) and a lower systemic vascular resistance (SVR; 1144 +/- 332 vs 1010 +/- 318 dyn.s/cm5, respectively; P < 0.05). Using a multivariate analysis, the presence of ascites and SVR lower than 900 dyn.s/cm5 were independently correlated with the presence of gall-bladder wall thickening, while a hepatic vein pressure gradient greater than 10 mmHg had only a marginally significant association. The presence of ascites, decreased SVR and portal hypertension are related to the occurrence of gall-bladder wall thickening in patients with cirrhosis, indicating that the development of gall-bladder wall thickening may be multifactorial.