Pathophysiology of gall bladder and biliary tree Flashcards
what is the Chief constituent of pigment stones
calcium bilirubinate
what causes the biliary colic
Caused by movement of stone into cystic duct or gallbladder neck
what is biliary colic?
Intermittent pain in epigastrium or RUQ
After meals, particularly fatty foods
what is the Tx of acute calculous cholecystitis
NPO (gallbladder rest)
IV fluids
IV antibiotics
Surgical removal of the gallbladder (cholecystectomy) when stable.
Percutaneous drainage of gallbladder in unstable patients or with major comorbidities
what causes acalculous cholesystitis
Usually from primary ischemia of gallbladder
what are the risk factors for acalculous cholesystitis
sepsis, vascular disease, hypotension
what are the symptoms of Choledocholithiasis
jaundice, dark urine, and RUQ abdominal pain
what is the MGMT of Choledocholithiasis
ERCP with extraction and/or lithotripsy (procedure that uses shock waves to break up stones in the kidney, bladder, or ureter)
what is ascending cholangitis
Bacterial infection of bile duct,
Usually a complication of choledocholithiasis
Biliary stricture - symptoms include: _________
RUQ pain Cholestasis: Jaundice Dark urine (choluria) Acholic stools (Pale or clay-colored stools) Pruritus
what is the management of biliary stricture
ERCP (Endoscopic retrograde cholangio- pancreatography) with dilation or stenting
Biopsy to rule out malignancy, if applicable
Surgery for refractory or malignant cases
what is the management of Primary sclerosing cholangitis (PSC)
No effective treatment except liver transplant
Consider biliary stent for dominant stricture
what is Sphincter of Oddi dysfunction (SOD)
Motility disorder of Sphincter of Oddi
what is the clinical presentation of Sphincter of Oddi dysfunction
Recurrent RUQ pain
Dynamically elevated ALT/AST/alk phos
Dilated bile duct on US
what is the treatment for Sphincter of Oddi dysfunction
biliary sphincterotomy (cutting of the biliary sphincter)
