Biliary Tract Disease

Question 1

Lab/Imaging Modalities are available:

Answer 1

Noninvasive → basic labs & LFT’s

Noninvasive Imaging → US, CT, MRI

Invasive testing → EUS, ERCP/MRCP

LFTS → Hepatocellular (AST & ALT), Obstruction (Bilirubin, Alkaline Phosphatase, GGT), Function (Albumin, Prothrombin Time, Platelets)

*Bilirubin breakdown: Degradation of Hb → unconjugated Bilirubin → Conjugated Bilirubin → 90% released in feces & 10% reabsorbed → Excess bilirubin seen in hemolytic conditions

Question 2

Genetic causes conjugated or Not?

Answer 2

• Conjugated Hyperbilirubinemia
  
  • (CD ROM) Conjugated: Dubin-johnson syndrome & Rotor Syndrome
• Unconjugated Hyperbilirubinemia
  
  • (Use CNG) Unconjugated: Crigler-Najjar syndrome & Gilbert’s Syndrome

Question 3

Types of Gallstones

Answer 3

Question 4

Stone Formation

Answer 4

Cholesterol Supersaturation & Nucleation and Crystallization & Gallbladder Hypomotility and stasis → STONE GROWTH

Question 5

Risk Factors for Gallstones (4Fs)

Answer 5

Fat, Female, Fertile, Forty

rapid weight gain/loss,

Estrogen therapy,

Hereditary,

Hyperlipidemia,

Pima Indians

Impaired bile salts synthesis (chronic cholestatic liver disease - PBC, PSC)

abnormal bile salt loss (illeal disease - crohn’s disease)

Question 6

Gallstone Disease

Answer 6

• Prevalence: Female>Male, 10% in the US, Familial predisposition
• Natural Presentation: Asymptomatic (70-80%), Symptomatic (RUQ Pain may radiate to Right shoulder and increased when eating)
• Complications of Gallstones: Acute Cholecystitis, Mirizzi Syndrome, Cholangitis, Gallstone Pancreatitis
• Treatment: Ursodeocycholic Acid (to dissolve stone) or Shock Wave Lithotripsy

Question 7

Diseases of the Biliary System

Answer 7

Question 8

Cholangiocarcinoma

Answer 8

Risk factors: PSC, UC, Obesity, etc.
Treatment: Surgery if resectable, chemo/radiation, Decompression if jaundice (ERCP)