|Year : 2016 | Volume
| Issue : 4 | Page : 214-218
Ultrasound determination of gall bladder size and wall thickness in normal adults in Abuja, North Central Nigeria
Kolade-Yunusa Hadijat Oluseyi
Department of Radiology, University of Abuja/University of Abuja Teaching Hospital, Abuja, Federal Capital Territory, Nigeria
|Date of Web Publication||8-Dec-2017|
Dr. Kolade-Yunusa Hadijat Oluseyi
Department of Radiology, University of Abuja/University of Abuja Teaching Hospital, Abuja, Federal Capital Territory
Source of Support: None, Conflict of Interest: None
Background: Diseases of the gallbladder (GB) do affect its size and wall thickness. GB diseases are common pathology frequently encountered in medical practice and presents as right upper quadrant pain. Ultrasound is a relatively safe, inexpensive, and reproducible imaging modality for assessing normal or diseased GB. It is the first method of choice when GB disease is suspected.
Objective: The aim of this study is to determine a referential value of normal GB size and thickness which can be used as baseline in this environment to determine GB disease and for follow-up of these patients.
Materials and Methods: This is a cross-sectional study conducted on 400 normal adults aged 15–70 years at the radiology department over a period of 10 months. Subjects had their GB scanned with 3.5 MHz transducer after fasting overnight. The length, width, and height were measured and the volume obtained using the ellipsoid formula. GB thickness was also recorded.
Results: The overall mean age was 40.70 ± 14.97. Mean age of males and females were 46.32 ± 15.64, and 36.61 ± 12.33 respectively. The mean values for length, width, height, volume, and wall thickness of the GB was 6.40 ± 1.06 cm, 2.38 ± 0.77 cm, 2.77 ± 0.25 cm, 23.46 ± 8.14 cm3 and 0.27 ± 0.08 cm respectively. The mean values for, length, width, height, volume, and wall thickness of GB for males were 6.36 ± 1.03 cm, 2.46 ± 0.87 cm, 2.81 ± 0.29 cm, 24 ± 8.66 cm3 and 0.28 ± 0.76 cm and for females were 6.44 ± 1.10 cm, 2.30 ± 0.67 cm, 2.75 ± 0.22, 22.98 ± 7.63 cm3, and 0.26 ± 0.27 cm. Mean GBV was higher in males than females.
Conclusion: Normal values of GB dimensions have been established in the north central Abuja using ultrasound. These values can be used as reference values in management of GB disease.
Keywords: Adult, gall bladder, normal, ultrasound
|How to cite this article:|
Oluseyi KYH. Ultrasound determination of gall bladder size and wall thickness in normal adults in Abuja, North Central Nigeria. Arch Int Surg 2016;6:214-8
|How to cite this URL:|
Oluseyi KYH. Ultrasound determination of gall bladder size and wall thickness in normal adults in Abuja, North Central Nigeria. Arch Int Surg [serial online] 2016 [cited 2020 Feb 21];6:214-8. Available from: http://www.archintsurg.org/text.asp?2016/6/4/214/220333
| Introduction|| |
The gallbladder (GB) is a saccular structure situated in the GB fossa of the posterior right hepatic lobe. It is divided into fundus, body, infundibulum, (Hartmann's pouch, which is the portion of body that joins the neck) and neck. It has a pear or teardrop shape. Its primary function is to store and concentrate bile for release into the duodenum for normal digestive process of fat. In normal individual bile flows from the GB into the cystic duct which is joined by the common hepatic duct to form the common bile ducts that open into the ampulla of Vater.
It is paramount to determine the normal GB size since physiological states like pregnancy  and pathological conditions like cholelithiasis, primary sclerosing cholangitis, primary biliary cirrhosis, and noninsulin-dependent diabetes mellitus  can increase the GB volume (GBV). Also, a thick-walled GB is a proof of GB disease and considered hallmark of acute cholecystitis. Although, this finding is not specific and can be found in other diseases of the GB and extracholecystic pathological conditions.
The increasing public awareness and need for qualitative care as well as the ever increasing role of technology in modern day medical care has placed a huge responsibility on imaging practitioners. Among the many challenges facing the radiologist is the early and accurate diagnosis of diseases as well as prognostication diseases which may be difficult.
Measurement of the GBV and gall bladder wall thickness (GBWT) are important tools in assessing the status of the GB in disease conditions such as acute cholecystitis, cholelithiasis, pancreatitis, diverticulitis, and hepatitis so that early intervention could be instituted considering that the correct diagnosis has a direct impact on the treatment and that in some cases some of these diseases require surgical approach.
This effect is a strong reason for establishment of an acceptable cut-off value for GBV and GBWT, beyond which further evaluation becomes imperative. The non-invasiveness of ultrasonography and the fact that it is devoid of radiation allows for repeated monitoring of these disease entities. This method allows the detailed real-time study of the GB, thus avoiding unnecessary cholecystectomies and their complications.,,
Imaging methods available for assessing the GB include cholecystography, ultrasonography, computed axial tomography, and magnetic resonance imaging. However, transabdominal ultrasonography is the modality of choice because it is cheap, reproducible, and does not utilize ionizing radiation. It provides information about GB size and wall thickness and has high specificity and sensitivity in identifying GB pathologies such as distension, contraction, sludge, stones, and tumors. Ultrasound is the first method of choice of imaging when GB disease is suspected.
The aim of study was to determine the normal GB size and wall thickness in normal adults in Abuja and its relationship with age and sex.
| Patients and Methods|| |
This cross-sectional study was conducted over a period of 10 months at the radiology department of University of Abuja teaching hospital on 400 subjects comprising of 190 males and 210 females. Inclusion criteria include all normal consenting individuals without hepatobiliary symptoms aged 15 years and above. Exclusion criteria include pregnancy, diabetes, sickle cell disease, hepatobiliary surgery, and GB pathology observed during scanning and ascites.
Patients were scanned following overnight fast using EMP G70, China ultrasound scanner with 3.5 MHz curvilinear probe. Subjects fasted overnight to reduce gastric and intestinal bowel gas and also for adequate distension of the GB.
A brief history and physical examination was done before patient was scanned. The height and weight of the subjects were measured. The height (m) was measured with a stadiometer and the weight (kg) was determined with calibrated balance beam scale. The body mass index (BMI) was calculated as a ratio of measured weight to square of measured height kg/m 2. With the patient in supine position coupling gel was applied to the abdomen (right upper quadrant). The stomach and duodenum were checked for presence of food particles and fluid so as to ensure patient complied with the directive of fasting overnight. GB measurements (cm) were taken with the probe placed in the right hypochondrial, in midclavicular line and angled cephalad in both longitudinal and transverse planes. Maximal longitudinal and transverse measurements were taken. The length (L) and gallbladder wall thickness (GBWT) were taken in the longitudinal plane on arrested respiration [Figure 1]a and [Figure 2], while the width (W) and height (H) were taken in the transverse plane after the probe was rotated through 90° from the longitudinal view to obtain maximal transverse view [Figure 1]b. Gallbladder volume (GBV) (cm 3) was then calculated using the prolate ellipsoid formula (L × H × W × 0.523) because it is the simplest and most widely accepted method for clinical practice as proposed by Dodds et al. The age and sex of the participants were recorded.
|Figure 1: Longitudinal (a) and transverse image (b) of the gallbladder showing measurement of the maximum length (L), width (W) and the height (H)|
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|Figure 2: Longitudinal image of the gallbladder showing measurement of the gall bladder wall thickness (yellow arrows)|
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Data were analyzed using SPSS 19.0 software. Mean ± SD was presented for age, length, renal width, wall thickness, and volume of the GB. Frequencies and percentages were computed for gender and age groups. Pearson's correlation coefficient (r) was computed to assess correlation with age, sex, and BMI. P < 0.05 was considered significant.
| Results|| |
A total of 400 consecutive subjects comprising 190 (47.5%) males and 210 (52.5%) females were recruited for this study [Table 1]. The mean age for the subjects was 40.70 ± 14.97 years (range: 15–65 years). The majority (25.5%) are in the age range of 20–29 years [Table 1]. The mean BMI was 23.55 ± 5.07. The mean age of males was 46.32 ± 15.64 years and that of females was 36.61 ± 12.3 years. The mean BMI for males and female was 22.85 ± 1.72 and 24.19 ± 1.68 respectively. This was statistically significant. (P = 0.05).
The overall mean GB length (GBL) was 6.40 cm ± 1.07 cm, mean GB width (GBW) 2.37 ± 0.77 cm, and mean GB height (GBH) 2.77 ± 0.25 cm.
Overall mean GBV and GBWT was 23.46 ± 8.14 cm 3 and 0.27 ± 0.06 cm respectively.
The mean GBL for males was 6.36 ± 1.03 cm, GBW 2.45 ± 0.87 cm, GBH 2.81 ± 0.29 cm, GBV 24 ± 8.66 cm 3, and GBWT 0.28 ± 0.08 cm. Readings for females were GBL 6.44 ± 1.10 cm, GBW 2.30 ± 0.67 cm, GBH 2.75 ± 0.22 cm, GBV 22.98 ± 7.63 cm 3, and GBWT 0.26 ± 0.09 cm [Table 2].
There was statistical significance difference in GBL and GBH between males and females (P< 0.05 and P < 0.05 for GBL and GBH respectively. However, no statistical difference in the GBW between males and females (P > 0.05). The mean GBV was higher in males than females. The difference was statistically significant (P = 0.05). There was positive correlation between GBV and gender (Pearson correlation = 0.82).
GBWT was higher in males than females. This was statistical significant (P = 0.03, Pearson correlation = 0.66).
The highest mean GBV was recorded in 60–69 years age group (26.13 ± 8.3 cm 3) while age group <19 had the smallest mean (GBV 15.10 ± 8.31 cm 3) [Table 3]. The highest GBWT was recorded in 40–49 years age group (0.32 ± 0.09 cm) while age group >70 recorded the smallest 0.21 ± 0.06 [Table 3]. However, no significant correlation between age, GBV, and GBWT (Pearson correlation = 0.075; P = 0.132, and Pearson correlation = 0.032; P = 0.057 respectively). BMI correlated positively with GBV and GBWT (Pearson correlation = 0.68; P = 0.03). There was negative correlation between BMI and GBWT (Pearson correlation = -0.31; P = 0.05) [Table 4].
| Discussion|| |
The study population in this study comprises of 190 (47.5%) males and 210 females (52.5%). There was preponderance of female in this study group. This was contrary to study by Ewunonu  and Idris et al. where 31 males and 29 females; 238 males (59.5%) and 162 (40.5%) were scanned respectively. However, it is consistent with study by Adeyekun et al. where 133 males and 189 females were scanned.
The overall mean GBV recorded in the present study was higher than the mean value reported in a previous study in Nigeria. Ewunonu  in South east Nigeria recorded a value of 19.78 ± 9.63 cm 3. Higher values compared to the index study were reported by Adeyekun  in South-south Nigeria and Idris et al. in northwest Nigeria. The reported values were 27.2 ± 12.8 cm 3 and 24.2 ± 8.4 cm 3 respectively. Comparably higher mean GBV were reported in studies outside Nigeria. Kishk et al.and Huang et al. In separate studies in Wisconsin and Egypt documented mean GBV of 28.1 cm and 28.2 cm respectively. The observed differences in GBV among different regions in the index country Nigeria and other countries outside may suggest possible variation in GBV among different ethnic groups, countries, and race. Reports have shown that GB dimensions vary in individuals in different parts of the world and in diseased conditions.
In this study the mean GBWT was 0.27 ± 0.08 which is higher than figure reported by Adeyekun et al. and lower than value obtained by Ewunonu  and Mohammed et al. reported GBWT range of 0.17–0.27 cm. Although it is known that greater GBWT may be a nonspecific finding. However, in adults as well as in children, an increase in thickness may result from a large spectrum of pathological conditions.
Some studies have reported that GBV and GBWT vary with age, sex, and BMI.,, In this study there was no correlation between age, GBV, and GBWT. This was in agreement with the findings of Adeyekun, in their study of sonographic determination of GBV and Mohammed et al. in their work on sonographic GBWT in normal adult population in Nigeria, but contrary to findings by Caroli-Bosc et al. in their work on the relationship between GBV and demographic parameters where they documented that there was increased in GBV in subjects of 50 years and above (P = 0.001) and GBV correlated positively with age. Increase in GBV with age after 50 years above as observed in their study could be due to hypocontractility of the GB with subsequent decrease in GB contraction index. This could be attributed to the effect of aging where normal smooth muscle fibers are replaced with fibrous tissue.
Also a study on the sonographic measurement of normal GB sizes in Korean children by Yoo et al. and Ngige et al. in Nigeria showed positive correlation between GBV and age. Gradual increase in GBWT with age was observed in children by McGahan  in their work on sonography of the normal pediatric GB and biliary tree. However, these studies were carried out among children therefore the reason for the positive correlation could be due to the fact that most organs tend to increase in size during the active growth phase. This shows that the effect of age on GB is probably most significant in the extremes of life. The studied population in this study did not include children and few elderly subjects were recruited.
Adeyekun  and Ngige et al. established that there was no significant correlation between sex, GBV, and GBWT. However, this is contrary to findings of Mohammed et al. and Idris et al. In this study there was statistical significant difference in GBV and GBWT between males and females. Males had higher than females values. This is in line with the fact that organ sizes in men are generally larger than those in women. This was further collaborated by Ewunonu  and Caroli-Bosc et al.
This study established a relationship between BMI and GBV. BMI correlated positively with GBV. A positive statistically significant relationship was found between BMI, GBV, and wall thickness in both sexes. A similar observation was made by other studies,,, but contrary to findings by Adeyekun et al. The reason for this may probably be due to influence of body habitus on bladder dynamics. Sari et al. in their study on sonographic evaluation of GBV and ejection fraction in obese women without gallstones documented greater fasting GBV, residual GBV, postprandial volumes values with slower GB emptying rates in obese subjects than in non-obese controls. This explains the reason for higher values in patients with high BMI.
| Conclusion|| |
This study has established normal GB dimension for normal adult population in Abuja north central Nigeria. GBV and GBWT correlated positively with sex and BMI. These values can be used as reference values in management of GB disease.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Stephanie R, Michelle M, Stephen E. Anatomy for Diagnostic Imaging. 2nd
ed. London; Elsevier: 2004. p. 178.
Van Bodegraven AA, Bohmer CJ, Manoliu RA, Paalman E, Van der Klis AH, Roex AJ, et al
. GB contents and fasting GB volumes during and after pregnancy. Scand J Gastroenterol 1998;33:993-7.
Akintomide A. Eduwem DU. Ultrasonographic Assessment of the Fasting GB Volume in Healthy Adults in Calabar; Correlation with Body Weight IOSR-JDMS 2013;4:48-64.
Sanders RC. The significance of sonographic GB wall thickening. J Clin Ultrasound 1980;8:143-6.
Wibbenmeyer LA, Sharafuddin MJ, Wolverson MK, Heiberg EV, Wade TP, Shields JB. Sonographic diagnosis of unsuspected GB cancer: Imaging findings in comparison with benign GB conditions. Am J Roentgenol 1995;165:1169-74.
Spence SC, Teichgraeber D, Chandrasekhar C. Emergent right upper quadrant sonography. J Ultrasound Med 2009;28:479-96.
Patriquin HB, DiPietro M, Barber FE, Teele RL. Sonography of thickened GB wall: Causes in children. Am J Roentgenol 1983;141:57-60.
Rosenthal SJ, Cox GG, Wetzel LH, Batnitzky S. Pitfalls and differential diagnosis in biliary sonography. Radiographics 1990;10:285-311.
Dodds WJ, Groh WJ, Darweesh RM, Lawson TL, Kishk SM, Kern MK. Sonographic measurement of GB volume. AJR Am J Roentgenol 1985;145:1009-11.
Ewunonu EO. Sonographic evaluation of GB dimension in healthy adults of a South-Eastern Nigerian population. JSIR 2016;25:96-9.
Idris N, Idris SK, Saleh MK, Suwaid MA, Tabari AM, Isyaku K, et al
. Sonographic measurement of fasting GB volume in healthy adults in North-West, Nigeria. Niger J Basic Clin Sci 2016;13:23-9. [Full text]
Adeyekun AA, Ukadike IO. Sonographic evaluation of GB dimensions in healthy adults in Benin City, Nigeria. West Afr J Radiol 2013;20:4-8. [Full text]
Kishk SM, Darweesh RM, Dodds WJ, Lawson TL, Stewart ET, Kern MK, et al
. Sonographic evaluation of resting GB volume and postprandial emptying in patients with gallstones. AJR Am J Roentgenol 1987;148:875-9.
Huang SM, Yao CC, Pan H, Hsiao KM, Yu JK, Lai TJ, et al
. Pathophysiological significance of GB volume changes in gallstone diseases. World J Gastroenterol 2010;16:4341-7.
Mohammed S, Tahir A, Ahidjo A, Mustapha Z, Franza O, Okoye IA, et al
. Sonographic GB wall thickness in normal adult population in Nigeria. SA J Radiology 2010;14:84-7.
Caroli-Bosc FX, Pugliese P, Peten EP, Demarquay JF, Montet JC, Hastier P, et al
. GB volume in adults and its relationship to age, sex, body mass index, body surface area and gallstones. An epidemiologic study in a non-selected population in France. Digestion 1999;60:344-8.
Yoo JH, Kwak HJ, Lee MJ, Suh JS, Rhee CS. Sonographic measurements of normal GB sizes in children. J Clin Ultrasound 2003;31:80-4.
Ngige EN, Renner JK, Temiye EO, Njokanma OF, Arogundade RA, David AN. Ultrasonographic measurement of the hepatobiliary axis of children with sickle cell anaemia in steady state. Niger J Clin Biomed Res 2006;1:44-50.
McGahan JP, Phillips HE, Cox KL. Sonography of the normal pediatric GB and biliary tree. Radiology 1982;144:873-5.
Sari R, Balci MK, Coban E, Karayalcin U. Sonographic evaluation of GB volume and ejection fraction in obese women without gallstones. J Clin Ultrasound 2003;31:352-7.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]