extrahepatic billiary diseases Flashcards
bile composition
pigment- bilirubin
bile acids- cholesterol
Gallstone formation factors
Cholesterol oversaturation
Mucin hypersecretion by the GB mucosa
Bile stasis (motility disorders)
Gallstone Risk Factors (5)
Fair Fat Fertile Female Forty
Gallstones Types
Cholesterol stones (85%)
Pigment stones (15%) :
Black- excess bilirubin enters the bile and polymerizes into calcium bilirubinate (chronic hemolysis)
Brown - bacteria secretion of beta glucuronidase and phospholipase
locations of gall stones
right hepatic duct gall bladder cytic duct common bile duct spincher of oddi
Cholelithiasis
Presence of stones
Asymptomatic vs. Symptomatic
Asymptomatic gallstones generally do not need to be treated
Biliary Colic
Intermittent obstruction of the cystic duct, no inflammation of GB
Severe epigastric/ RUQ pain - over 15 min and remaining constant up to 3h
Normal examination (unless in an attack)
Lab tests usually normal
US, EUS
Acute Calculous Cholecystitis
Impacted stone in the cystic duct
Fever, Murphy’s sign, palpable GB
Leucocytosis, normal or mild elevation of bilirubin
50% resolve spontaneously in 7-10 days
US – gallbladder wall thickening, EUS, CT
Choledocholithiasis
Intermittent obstruction of CBD
jaundice with pain
Elevated bilirubin
transient spike in Transaminases / Amylase
US, EUS, CT
treatment- ERCP - Endoscopic Retrograde CholangioPancreatography
ascending cholangitis
Impacted stone in CBD causing bile stasis
Bacterial superinfection
Charcot’s triad 70%
confusion, hypotension, RUQ tenderness, jaundice (80%)
Elevated WBC, BIL
treatment: ERCP
Acute biliary pancreatitis
Pancreatic duct obstruction or chemical inflammation
Signs - Variable – None to Sepsis
Bloods – U&E, WBC, LFT, Amylase, CRP
US
MRCP
CT Pancreas
treatment- ERCP
Gallstone ileus
small bowel Obstruction by a large gallstone
at the terminal ileum/acending colon
Acute Acalculous Cholecystitis
inflamed gallbladder in the absence of an obstructed cystic or common bile duct
occurs in the setting of a critically ill patient
ischemic basis
Biliary Tract Cysts
Choledochal cysts (risk of malignancy)
90% diagnosed before age 30
Surgery
Biliary Tract Tumors
Cholangiocarcinoma
slow
to infiltrate locally and metastasize late
90% adenocarcinoma
Cancer of the Gall Bladder