Functional Biliary Disorders Flashcards
what is another name for functional biliary disorder
gallbladder dyskinesia
functional biliary disorder presents with what symptoms
RUQ biliary pain, can be associated with meals, can be worse at night, N/V
symptoms of cholelithiasis without stones
how do you diagnose functional biliary disorder
it is a diagnosis of exclusion that can use ROME IV criteria to aid in diagnosis
rule out other organic causes of pain like pancreatitis, cancer, peptic ulcers
imaging to rule out stones and structural abnormalities, EGD
HIDA scan with CCK to determine ejection fraction
labs LFTs, amylase, lipase normal
EF in functional biliary disorders is equal to
less than 35%
**do not give CCK if there is a physical obstruction this will hurt
management of functional biliary disorder
laparoscopic cholestectomy
what is the sphincter of oddi?
this is a ring of muscle in the duodenal wall that regulates the flow of bile and pancreatic secretions from common bile and pancreatic ducts
Biliary spinchter of oddi dysfunction presents clinically similar to
choledocholithiasis with no evidence of stones on imaging
how can the sphincter of oddi be dysfunctional
it can be stenotic or have dyskinesia (too tight- failure to relax)
pancreatic sphincter of oddi dysfunction causes
recurrent pancreatitis
imaging of biliary sphincter of oddi dysfunction shows
biliary pain with no gall stones or abnormalities
either elevated LFTS or dilated common bile duct (NOT BOTH)- this would be indicative of a true obstruction
biliary SOD may contribute to
post cholesctetomy syndrome (return of biliary pain post op)
workout of biliary and pancreatic SOD
imaging and diagnostic procedures to rule out gall
ERCP + sphincter mamometry(can differentiate between dyskinesia and stenosis)
sphincter of oddi manometry is associated with high rates of?
post ERCP pancreatitis
_ is associated with sphincter of oddi contraction and is therefore contraindicated in SOD
morphine
treatment of SOD
ERCP with sphincterotomy
