Gallbladder and Biliary Tract Flashcards
What is biliary atresia?
Failure to form or early destruction of the lumen of the extrahepatic biliary tree leading to biliary obstruction and progression to liver cirrhosis
What is cholelithiasis?
Solid, round stones in the gallbladder due to precipitation of cholesterol or bilirubin
How are stones formed in the gallbladder?
-Supersaturation of cholesterol and bilirubin due to decrease phospholipids (that helps solubilize cholesterol) and decrease bile acids that also increase solubility of bilirubin. Stasis can lead to growth of bacteria that can deconjugate bile and leads to bilirubin stone formation
What is the most common type of gallbladder stone?
Cholesterol stones. Are usually radiolucent, so cannot be seen on xray unless they are associated with calcium.
What are the risk factors for development of cholesterol gallbladder stone?
- Age (40yo))
- Estrogen (Female, obesity, multiple pregnancies, OCPs)
- Clofibrate -lipid lowering aging that decreases bile acids and increases cholesterol
- Native American ethnicity
- Crohn Disease
- Cirrhosis
What type of gallbladder stones are radiolucent and which are radioopaque?
- Radiolucent –> Cholesterol stones
- Radioopaque –> Bilirubin stones
What are the risk factors for bilirubin stones?
Extravascular hemolysis, biliary tract infection
What are the 6 key complications/conditions that can result from gallstones?
- Biliary colic
- Cholecystitis
- Choledocolithiasis
- Ascending Cholangitis
- Gallbladder Ileus
- Gallbladder Cancer
What is acute cholecystitis?
Acute inflammation of the gallbladder wall
What causes cholecystitis?
Impacted stone in the cystic duct results in gallbladder dilation with pressur ischemia, serving as a nidus for bacterial overgrowth (especially E.coli), and inflammation.
What are the clinical features of cholecystitis?
Epigastric/RUQ pain that often radiates to the R scapula, fever with leukocytosis, nausea, vomiting, and increase Alk Phos from duct damage
What is the risk of NOT treating cholecystitis?
RUPTURE
What is chronic cholecystitis?
Chronic inflammation of the gallbladder wall
What causes chronic cholecystitis?
Chemical irritation form longstanding cholelithiasis w/wo superimposed bouts of acute cholecystitis
What characterizes chronic cholecystitis?
Herniation of gallbladder mucosa into the muscular wall (Rokitansky-Aschoff sinus)
What is a late complication of chronic cholecystitis?
Procelain gallbladder - shrunken, hard gallbladder due to chronic inflammation, fibrosis, and dystrophic calcification. Increases the risk for carcinoma
What is the treatment for cholecystitis?
Lap or open cholecystectomy
What is ascending cholangitis?
Bacterial infecition of the bile ducts typically due to an obstructing stone allowing for the ascension of enteric gram negative bacteria.
What are the features of cholangitis?
- Charcot’s triad: RUQ pain, jaundice and fever
- Reynaud’s Pentad: Charcot’s triad, hypotension, altered mental status
What is gallstone ileus?
When a gallstone enters and obstructs the small bowel. Often in the setting of cholecystitis with fistula formation between the gallbladder and small bowel allowing the passage of large stones from the Gb into the small bowel that is capable of causing an SBO
What is gallbladder carcinoma?
Adenocarcinoma arising from the glandular epithelium that lines the gallbladder wall with major risk factor being gallstones
How does gallbladder carcinoma classically present?
Cholecystitis in an elderly woman. Poor prognosis
