💛 Chapter 414: Diseases of the Gallbladder

Nelson Textbook of Pediatrics 22nd Edition — Gallbladder disease in children is increasingly common due to obesity. Cholelithiasis (gallstones) risk factors: hemolytic anemia (sickle cell, spherocytosis), obesity, TPN, ceftriaxone, cystic fibrosis. Choledocholithiasis (CBD stones) → ERCP. Acute hydrops (distended GB without stones) associated with Kawasaki disease, strep. Biliary dyskinesia → low GB ejection fraction on CCK-HIDA. Treatment: laparoscopic cholecystectomy.

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📋 30 Clinical Scenarios — Gallbladder Diseases

📇 High‑Yield Review Cards (Gallbladder Diseases)

🩺 Clinical Presentations: Gallbladder Disease

Select a presentation for diagnostic clues and management.

📋 Stepwise Evaluation & Management of Gallbladder Disease

🔑 Key Principles — Gallbladder Diseases (Nelson Ch.414)
• Cholelithiasis: Risk factors: hemolytic anemia (sickle cell, spherocytosis), obesity, prolonged TPN, ceftriaxone (pseudolithiasis), cystic fibrosis, ileal disease. Cholesterol stones now most common.
• Acute hydrops: Distended gallbladder without stones, often with Kawasaki disease or streptococcal infection. Supportive care, cholecystectomy rarely needed.
• Biliary dyskinesia: Biliary colic with normal ultrasound, low GB ejection fraction (<35%) on CCK-HIDA. Laparoscopic cholecystectomy often improves symptoms.
• Choledocholithiasis: Common bile duct stone → ERCP with sphincterotomy prior to cholecystectomy.
• Treatment: Laparoscopic cholecystectomy for symptomatic cholelithiasis, biliary dyskinesia. Asymptomatic stones in hemolytic anemia may be observed.

    ⚡ Reflex Prompts — Gallbladder Disease Decisions

    📖 Diseases of the Gallbladder — Core Summary (Nelson Ch.414)