Gallbladder and Biliary Tree Pathology

Question 1

Sphincter of Oddi Dysfunction (3 types)

Answer 1

• biliary pain and can cause acute pancreatitis
• Dx - manometry or ERCP (treatment is to cut sphincter)
• Type 1 - biliary pain (RUQ) associated w/ abnormal LFTs and see dilated common bile duct
• Type 2 - biliary pain + either LFTs or dilated common bile duct
• Type 3 - biliary pain alone

Question 2

3 Consequences of Bile Acid Malabsorption

Answer 2

• More bile acids reach colon –> diarrhea (use sequesterants) “osmotic”
• Steatorrhea
• Oxalate kidney stones - more fat in colon so more bound Ca++ which frees oxalate –> oxalate stones (so these stones common in Chron’s)

Question 3

Cholecystitis (presentation, tx, complications)

Answer 3

(inflammation of GB)

• Acute - inflammation of GB after persistent obstruction of GB outlet

PRESENTATION

• Triad - elevated WBC, RUQ pain, fever
• Murphy’s sign - winces/ceases on inspiration when palpate GB under ribs on R side
• Tx - abx and possible removal of GB
• Complications
  - Gangrene, necrosis, fistula, perforation
  - Gas-producing bacteria
  - Mirizzi’s Syndrome

Question 4

Mirizzi Syndrome

Answer 4

• complete biliary obstruction and sig jaundice
• when gallstone blocks cystic duct but impacted / inflammation so extensive that blocks common bile duct and/or common hepatic duct too; see distended hepatic duct upstream

Question 5

Choledochal Cysts (type 1 and type 5)

Answer 5

• See intermittent ab pain, smal RUQ ab mass and jaundice in infant
• Congenital cystic dilation of bile ducts
• Types (5 but most important below)
  
  • 1- most common; entire common bile duct dilated BUT normal intra-hepatic ducts
  • 5 - more chronic liver failure and requires liver transplant b/c dilation of INTRA-hepatic ducts

Question 6

Acute Cholangitis (risks, presentation, tx)

Answer 6

(infection/ inflammation of biliary tree)

• Bacterial infection ascends from duodenum
• Risks = stones or strictures (anything that causes stasis or blockage)

PRESENTATION

• Charcot’s Triad - fever, jaundice, RUQ pain
• Reynold’s Pentad - fever, jaundice, RUQ pain, hypotension, mental status change
• Tx - abx and decompression of biliary tree (by ERCP)

Question 7

Risks for GB cancer v. cholangiocarcinoma

Answer 7

BOTH usually adenocarcinoma

GB Cancer- gallstones, porcelain GB (calcified), GB polyps, PSC, Salmonella typhii, obesity

Cholangiocarcinoma - PSC, choledochal cysts, infection w/ liver flukes, chronic liver disease like Hep C