Gall Bladder Flashcards
Gallbladder (fxn)
stores and concentrates bile (fasting)
delivers bile to duodenum (fed state, IN RESPONSE TO DUODENAL RELEASE OF CCK)
Bile (composed of?)
bile salts, phospholipids, protein, cholesterol, bilirubin, water+bicarb
Bile ducts
conduit for bile
excretion for cholesterol, minerals, certain drugs
Sphincter of Oddi
conserves bile acids
prevention of biliary infection (cholangitis)
GALLBLADDER DYSFXN
Cholelithiasis (Risks)
Fat (obesity) Female Fertile (pregnancy of estrogen use) Family Hx Forty (>30 yrs) Hispanic or Native Americans, rapid weight loss, biliary stricture Occur in 10-20% of adults
GALLBLADDER DYSFXN
Cholelithiasis (CHOLESTEROL)
50% asymptomatic
CHOLESTROL: white-yellow crystalline, most common
Risks: Cholesterol supersaturation
Phospholipid deficiency
GALLBLADDER DYSFXN
Cholelithiasis (PIGMENT)
PIGMENT: black-brown, made of Ca and unconjugated bilirubin, can be from bacterial/parasitic infx/HEMOLYTIC ANEMIA
Risks: biliary obstruction
GALLBLADDER DYSFXN
Cholelithiasis (BROWN)
BROWN: develop de novo in bile duct from infx in pts with prostheses (tubes/stents) or downstream obstruction
GALLBLADDER DYSFXN
Cholelithiasis (diagnx/treat)
Abd US (>90% accurate), MRI/CT, MRCP/ERCP Treat with Cholecystectomy
GALLBLADDER DYSFXN
Cholecystitis (Acute vs Chronic info)
Acute: usually with gallstone obstruction of cystic duct, but can be acalulous cholecystits from dehydration, many blood transfusions, vasculitis
Chronic: usually follows repeated episodes of subclinical acute, >90% have gallstones, increased risk of gallbladder cancer
GALLBLADDER DYSFXN
Cholecystitis (Acute pres)
Acute: RUQ pain (poss radiation to shoulder or flank), fever, nausea, vomiting
infx/transmural infl leading to inschemia –> can perforate and lead to sepsis
Cholecystitis vs Choledocholithasis
Cholecystitis: FEVER
Choledocholithasis: JAUNDICE/DARK URINE
GALLBLADDER DYSFXN
Cholecystitis (Acute diagnx/treat)
Elevated Alkaline Phosphatase, acute infl cell infiltrate
Treat: IV fluids, AB, pain meds, NPO, then cholecystectomy when pat is stable in 1-2 weeks
GALLBLADDER DYSFXN
Bacterial (ascending) Cholangitis
Bacterial infx above a common bile duct obstruction (ascending)
If sepsis then CHARCOT’S TRIAD: RUQ PAIN + JAUNDICE + FEVER
(with confusion and hypotension then its the Reynold’s Pentad)
Diagnx: urgent ERCP
Treat: IV ABX, ERCP for stone extraction, stent placement
GALLBLADDER DYSFXN
Cholecystitis (Chronic diagnx/treat)
fibrosis, chronic infl cells, outpouching of mucosa (Rokitansky-Aschoff sinuses)
TREAT: cholecystectomy
GALLBLADDER DYSFXN
Biliary colic
Stone occludes gallbladder intermittently
Pain (intermittent) in epigastrium or RUQ after fatty meals (peaks after 1 hr then gone by 2-6 hrs)
Diagnx with Abd US
No treatment discussed
GALLBLADDER DYSFXN
Choledocholithiasis
Gallstone obstruction of COMMON BILE DUCT
Epigastic or RUQ WITH jaundice and dark urine
Detect with US/ERCP
Treat: cholecystectomy
BILIARY STRICTURE
Benign Biliary Stricture
From edema & fibrosis, iatrogenic causes, chronic choledocholithiasis, chronic pancreatitis, primary sclerosing cholangitis
Can lead to CHOLESTASIS (jaundice, dark urine, pruritis, acholic stools)
Diagnx: MRCP/ERCP, CT/US
Treat: surgery
Spincter of Oddi dysfxn (SOD)
Dysfunctional contraction of SOD, F>M, age 20-50, may lead to epigastric RUQ pain, mimics choledocholithiasis
ELEVATED LFTs during pain, SOD manomerty for definitce diagnx
Treat: spincherotomy
BILIARY STRICTURE
Malignant Biliary Stricture
Adenocarcinoma of ampulla, pancreatic cancer, other cancers, usually present LATE
Presents as CHOLESTASIS (jaundice, dark urine, pruritis, acholic stools)
Diagnx: MRCP/ERCP, CT/US
Treat: surgery (whipple if early), ERCP with palliative stent placement
Gallbladder Carcinoma
Elderly with gallstones and/or history of chronic cholecystitis
Asia: link to liver fluke parasite infx
Presents late and invades liver (5 yr survival
