Limey (Milk of Calcium) Bile• Precipitated calcium due to secretion

of sufficient concentration of calcium salts in the gallbladder lumen

• Roentgenography: diffuse, hazy opacification of bile or a layering effect

Porcelain Gallbladder• Calcium salt deposition within the

wall of a chronically inflamed gallbladder

• Associated with the development of gallbladder carcinoma

Treatment: Acute Cholecystitis

• Medical TherapyAnalgesia: NSAIDs / MeperidineIntravenous antibiotic therapy – ureidopenicillin:

piperacillin/mezlocillin, ampicillin sulbactam, ciprofloxacin, moxifloxacin, and third-generation cephalosporins.MetronidazoleImipenem/meroponem

• Surgical TherapyCholecystectomy or Cholecystotomy

Treatment: Acute Cholecystitis

Postcholecystectomy Complications

• Cystic Duct Stump Syndrome Disease in Cystic duct remnant (>1 cm) that

presents with symptoms resembling biliary pain or cholecystitis in the absence of cholangiographically demonstrable retained stones on a postchlecystectomy patient