Gall Bladder 2 Flashcards
What is Caroli disease?
A congenital disorder characterized by multifocal, segmental dilatation of large intrahepatic bile ducts
What is Caroli syndrome?
cystic biliary dilation and congenital hepatic fibrosis
What are some other associated conditions Caroli disease may increase the risk in?
increased risk for cholangiocarcinoma, cholangitis, intrahepatic stones/abscesses
How would you treat a person with Caroli disease?
- resection of the involved lobe
- liver transplantation
What is cholangitis?
acute inflammation of the wall of the bile ducts, mostly a result of bacterial infection
What is the most common cause of cholangitis?
- Choledocholithiasis (most common)
Pathogenesis of ascending cholangitis.
Propensity of bacteria, once within the biliary tree, to infect intrahepatic biliary ducts (more likely enter the biliary tract through the sphincter of Oddi, rather than by the hematogenous route)
What is a common pathogen to enter the biliary system in ascending cholangitis that you need to remember?
clonorchis sinensis
What are the clinical features of Charcots Triad in ascending cholangitis?
Fever with chills + abdominal pain + jaundice (Charcot triad)
What does ERCP stand for?
Endoscopic retrograde cholangiopancreatography (ERCP)
Main features of acute cholecystitis?
Right upper quadrant pain + fever + absolute neutrophilic leukocytosis
No jaundice
Main features of choledocholithiasis?
Right upper quadrant pain + jaundice
no fever
Main features of Ascending cholangitis.
Right upper quadrant pain + jaundice + fever (Charcot triad)
Reynold’s Pentad: Charcot’s Triad + confusion and hypotension
What are some of the main causes of secondary biliary cirrhosis?
- Extrahepatic Cholelithiasis (most common)
- Biliary atresia
- Malignancies of biliary tree and head of the pancreas
- Strictures from previous surgical procedures
Be able to reproduce chart differentiating primary biliary cirrhosis, secondary biliary cirrhosis, and primary sclerosing cholangitis.
What is biliary atresia?
congenital condition where there is a blockage of tubes (ducts) that carry bile from liver to gallbladder
What is the most common malignancy of the extra hepatic biliary tract.
carcinoma of gallbladder
Is carcinoma of the gallbladder often discovered in resectable stage?
no rarely discovered at resectable stage and therefore poor prognosis
What is the most important risk factor for gallbladder cancer?
gallstones
Name another major risk factor for gallbladder cancer that’s not gallstones?
abnormal choledocho-pancreatic duct junction is a risk factor
Where are adenocarcinomas of the gallbladder most often detected?
in the fundus
Risk factors for cholangiocarcinomas?
Primary Sclerosing Cholangitis, congenital fibropolycystic diseases of the biliary system, HCV infection, hepatolithiasis, chronic infection with liver flukes (Opisthorchis and Clonorchis)
Cholangiocarcinomas or tumors arising from the extra hepatic bile ducts as opposed to cholangiocarcinomas from intrahepatic bile ducts are also named what?
biliary adenocarciomas
What is a Klatskin tumor?
tumor found at the junction of the right and left hepatic ducts forming common hepatic duct
Prognosis for cholangiocarcinomas?
Poor; most patients have unresectable tumors
Another name for Courvoisier’s Law?
Palpable gallbladder
What is Courvoisier-Terrier sign?
common bile duct obstruction secondary to stone rarely results in bladder dilatation
while in contrast a malignant obstruction of the duct commonly causes bladder dilatation
What are the major clinical features of malignancy of the biliary tract or pancreas?
Non-tender palpable gall bladder + Jaundice
Painless enlarged gall bladder with jaundice could indicated what condition?
malignancy most likely pancreatic adenocarcinoma
What is another name for Primary biliary cirrhosis?
Primary biliary cholangitis
