Path of Gallbladder & Biliary Tree (not done) Flashcards
What are the causes of gallstones and their complications?
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What is the mechanism of gallstone formation?
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What is the presentation of gallstones?
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What is the treatment of gallstones?
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What are the causes of acute calculous?
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What is the mechanism of acute calculous formation?
- Stone impaction in cystic duct or GB neck
- Causes bacteria colonization (usually GNRs or enterococci)
- Can lead to transmural inflammation => Distension and ischemia => GB perforation, sepsis or death if untreated
Which tests help diagnose acute calculous?
US
Present with:
- Severe RUQ pain
- Nausea
- Fever
What is the treatment for acute calculous?
- NPO (GB rest — nothing by mouth, only fluids, usually involves a hospital stay)
- IV hydration
- IV antibiotics
- Surgical removal of GB = the treatment (otherwise this will reoccur)
- Percutaneous or endoscopic drainage if pt is too sick for surgery
What are the causes of acalculous cholecystitis?
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What is the mechanism of acalculous cholecystitis development?
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Which tests help diagnose acalculous cholecystitis?
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What is the treatment for acalculous cholecystitis?
- Percutaneous drainage of GB
- Cholecystectomy
What are the causes of biliary strictures?
Benign:
- Surgery, radiation
- chronic pancreatitis
- Primary sclerosing cholangitis (PSC) — associated w/ UC
- Autoimmune pancreatitis
Malignant
- Pancreatic cancer
- Cholangiocarcinoma
- GB cancer
- Ampullary cancer
What is the presentation of biliary strictures?
Cholestasis:
- Jaundice,
- Dark urine (Choluria)
- Acholic stools
- Pruritis — bile gets into the skin!
RUQ pain
Elevated LFTs in cholestatic pattern (alk phos/GGT, bilirubin»_space; ALT/AST)
What are the diagnostic tests for biliary strictures?
- US or CT
- MRCP or ERCP for confirmation
- Cholangioscopy if uncertain
