Hemobilia Flashcards
Hemobilia is defined as
bleeding into the biliary tree from an abnormal communication between a blood vessel and bile duct.
The most common causes of hemobilia are
iatrogenic trauma ( MC )
accidental trauma
gallstones
tumors
inflammatory disorders»_space; abscess, Cholangitis
vascular disorders.»_space; aneurysms, angiodysplasia, and hemangiomas
MC with Blunt or Penetrating Trauma ?
Hemobilia secondary to accidental trauma is more common with blunt than with penetrating abdominal trauma
Which is more common arterial or venous bleeding ?
arterial hemobilia, the most common source, can be dramatic.
Classic Triad ?
upper abdominal pain
upper gastrointestinal hemorrhage
and jaundice.
The symptoms and signs of major hemobilia
melena (90% of cases)
hematemesis (60% of cases)
biliary colic (70% of cases)
jaundice (60% of cases).
first evaluation should be
upper gastrointestinal endoscopy
» rules out other sources
» visualize bleeding from the ampulla of Vater
Other Diagnostic Studies ?
- Ultrasound or CT
» intrahepatic tumor or hematoma. - CT Contrast
» pooling contrast material
» intraluminal clots
» biliary dilation.
CT may also show risk factors associated with hemobilia, such as cavitating central lesions and aneurysms
when significant hemobilia is suspected , what to do ?
Arterial angiography is now recognized as the test of choice
Tx of Minor Hemobilia
- Correction of coagulopathy
- adequate biliary drainage (only if necessary)
- close observation
Tx for Major Hemobilia ?
The first line of therapy»_space; transarterial embolization
Surgery if this Fails
What surgical options ?
- ligation of bleeding vessels
- excision of aneurysms
- nonselective ligation of a main hepatic artery
- Hepatic resection may be necessary if all fails
- Cholecystectomy if from GB
The management of hemobilia after percutaneous transhepatic biliary drainage
- removal of the catheter or replacement with larger catheters but may require transarterial embolization.
The incidence of minor self-limited hemobilia has increased secondary to
the rising number of percutaneous hepatic procedures
What is Bilhemia ??
bile flows into the bloodstream through the hepatic veins or portal vein branches.
> > high intrabiliary pressure exceeding that of the venous system.
What is the cause and Outcome?
The cause can be
- gallstones eroding into the portal vein
- accidental or iatrogenic trauma.
The condition can be fatal secondary to embolization of large amounts of bile into the lungs.
Diagnosis and Treatment ?
- This diagnosis is best determined by ERCP.
- Treatment is directed at lowering intrabiliary pressures through stents or sphincterotomy.
