Hepatobiliary Pathologies

Question 1

Cholelithiasis (Gallstones)

Answer 1

• condition characterized by freely moving stones in the gallbladder
• commonly made of cholesterol that has precipitated out of the bile, because of chemical imbalances or the gallbladders failure to empty regularly

symptoms:
- gallstones can block any of the ducts in the biliary tree
- pain
- if a stone blocks the common bile duct, bile cannot reach the duodenum and bile pigments will be absorbed into the blood stream causing jaundice and grey-white feces
- if only the cystic duct is blocked, jaundice will not occur as bile cannot be absorbed directly from the gall bladder

indications:

• usually ultrasound as only 20% of stones have enough calcium to be seen on radiograph
• patients are examined to various positions to allow stones to roll to the dependent portion of the gallbladder (gravity)
• stones may be broken up with lithotripsy, dissolved with meds, removed during ERCP, laparoscopic or abdominal surgery

FIVE F’s:

• female -over 40 yrs
• overweight -family history
• increased fat diet -extreme fast weight loss

Question 2

Cholecystitis

Answer 2

• acute inflammation of the gallbladder
• most often caused (95%) by obstruction of the cystic duct by a gallstone

symptoms:

• gallstones can damage mucosal layers which allows bacteria to enter the tissues
• edema in the gallbladder wall and pain over the RUQ

indications:

• diagnosis is by a sonographic exam or radionuclide cholescinitigraphy
• also cholecystectomy

Question 3

Hepatitis

Answer 3

• most common inflammatory disease of the liver
• HEP A and E:
  - transmitted in GI tract by ingesting food or H2O contaminated with fecal matter
  - usually self-limiting with a good prognosis
• HEP B: (serum)
  - spread through blood, blood products and sexual contact
• HEP C:
  - most common cause of chronic hepatitis, cirrhosis or liver cancer
  - spread by blood transfusion or sexual contact

symptoms:
-jaundice, pain, nausea, vomiting, tenderness over liver, cirrhosis, portal hypertension, hepatocellular necrosis with inflammation and “fatty liver”
-increased risk for hepatocellular carcinoma
(trouble blood clotting, grey-white feces, dark urine)

indications:

• not visible in early stages
• cirrhosis or CA can be seen in more advanced stages
• prevention is the best medicine (ex. vaccines- only for A and B) and standard precautions
• antiviral drugs can be used to control the disease once it has been contracted