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Patient 65-year-old of age who comes to the medical consultation with pain moderated pain in the right hypochondrium of “several years of evolution” but that it increased one week ago. Also, she shows pain in the umbilical region of “many years of evolution”, that is supported according to the patient - in a constant way.rnTo the examination, we observe an umbilical hernia, apparently divided into two parts. The hernia of the external region measures 25.1 centimeters x 18.0 centimeters and the one that occupies the average region measures 12.0 centimeters x 10.0 centimeters.rnPatient who comes to the medical consultation with moderated pain in the right hypochondrium of one year of evolution but it increased one week ago after eat duck.rnIn the ultrasound scan of the region of the right hypochondrium (patient came having breakfast, that is to say, without previous preparation ) we can observe the liver of 123.8 millimeters high, as well as the porta vein with a diameter of 7.3 millimeters.rnOn having observed the Gallbladder, we think that a side wall is increased in 2.7 mm (hyperechogenic) with several “echogenics points” in the interior (”Biliary Mud”).

The measurements of the gallbladder were: 39.0 x 17.4 millimeters.rnWe can appreciates an echogenic image in the interior that it would make think about stone. The stones are identified as echogenic foci casting acoustic shadowing but but this image did not appear and a re-evaluation is decided in 15 days.

Acalculous cholecystopathy which means disease or condition of the gallbladder without the presence of gallstones. You might also call it functional gallbladder disorder or impaired gallbladder emptying. Some causes may be chronic inflammation, a problem with the smooth muscles of the gallbladder or the muscle of the Sphincter of Oddi being too tight.

REMEMBER:
Umbilical hernia is a congenital malformation, especially common in infants of African descent, and more frequent in boys. An Acquired umbilical hernia directly results from increased intra-abdominal pressure and are most commonly seen in obese individuals.
Presentation:A hernia is present at the site of the umbilicus (commonly called a navel, or belly button) in the newborn; although sometimes quite large, these hernias tend to resolve without any treatment by around the age of 5 years. Obstruction and strangulation of the hernia is rare because the underlying defect in the abdominal wall is larger than in an inguinal hernia of the newborn. The size of the base of the herniated tissued is inversely correlated with risk of strangulation (i.e. narrow base is more likely to strangulate).
Babies are prone to this malformation because of the process during fetal development by which the abdominal organs form outside the abdominal cavity, later returning into it through an opening which will become the umbilicus.
Differential diagnosisrnImportantly this type of hernia must be distinguished from a paraumbilical hernia which occurs in adults and involves a defect in the midline near to the umbilicus, and from omphalocele.

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