Debnath Jyotindu, George Raju A, Satija Lovleen, Mathur Ankit, Banerjee Debabrata, Mishra Siddhartha
Associate Professor, Department of Radiodiagnosis, AFMC, Pune 40, India.
Senior Adviser, Radiology, Military Hospital Mhow, India.
Med J Armed Forces India. 2012 Oct;68(4):346-9. doi: 10.1016/j.mjafi.2012.04.021. Epub 2012 Jul 20.
A minority of patients of acute hepatitis may exhibit edematous GB walls with no visible lumen despite fasting and may also exhibit paradoxical GB response in the post-prandial state.
Patients of acute hepatitis underwent routine upper abdominal sonography after overnight fasting. Patients who demonstrated contracted GB with edematous and coapted walls without any visible lumen despite overnight fasting were studied in the post-prandial phase after having breakfast. Serial ultrasonography was carried out at 10-15 min interval for an hour and changes in GB morphology was noted at each stage.
A total of 77 patients of acute hepatitis underwent USG of hepatobiliary system between Sept 2008 and Aug 2009. Contracted gall bladder with edematous and coapted walls without any visible lumen despite overnight fasting was noted in 11 patients and were studied in the post-prandial phase. Post-prandial paradoxical filling of GB was observed in all such cases. Serial post-prandial ultrasonography demonstrated onset of filling of GB as early as 10-15 min post-prandial. Maximal GB distension was observed between 30 and 60 min. USG at 60 min post-prandial showed slight reduction in GB volume. As the GB distended in the post-prandial state, the lumen became increasingly visible with marginal reduction in wall thickening.
We have observed transient paradoxical filling of GB on serial USG in early post-prandial state, in a subset of patients of acute viral hepatitis who had contracted GB with coapted walls in the initial USG after overnight fasting.
少数急性肝炎患者可能出现胆囊壁水肿，即使禁食也无可见的胆囊腔，并且在餐后状态下可能出现矛盾的胆囊反应。
急性肝炎患者在禁食过夜后接受常规上腹部超声检查。对于那些尽管禁食过夜但胆囊收缩、胆囊壁水肿且贴合在一起而无可见胆囊腔的患者，在早餐后的餐后阶段进行研究。每隔10 - 15分钟进行一次系列超声检查，持续一小时，并记录每个阶段胆囊形态的变化。
2008年9月至2009年8月期间，共有77例急性肝炎患者接受了肝胆系统超声检查。11例患者被发现尽管禁食过夜，但胆囊收缩、胆囊壁水肿且贴合在一起而无可见胆囊腔，并在餐后阶段进行了研究。所有这些病例均观察到餐后胆囊的矛盾性充盈。系列餐后超声检查显示，餐后最早10 - 15分钟胆囊开始充盈。在30至60分钟之间观察到胆囊最大程度的扩张。餐后60分钟的超声检查显示胆囊体积略有减小。随着餐后胆囊扩张，胆囊腔变得越来越明显，胆囊壁增厚略有减轻。
我们观察到，在一部分急性病毒性肝炎患者中，这些患者在禁食过夜后的初始超声检查中胆囊收缩且胆囊壁贴合，在餐后早期系列超声检查中出现胆囊短暂的矛盾性充盈。
