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Gallstones (Formation (Cholesterol Stones: 20% (Risk factors (Female, OCP,…

- - - - Pregnancy, OCP
      - TPN, fasting
  - - - ↓ bile salts
      - ↓ lecithin
      - ↑ cholesterol
    - - Female
      - OCP, pregnancy
      - ↑ age
      - High fat diet and obesity
      - Racial: e.g. American Indian tribes
      - Loss of terminal ileum (↓ bile salts)
- - - - Injection of contrast into biliary tree via needle
        directly through skin.
      - Not commonly performed now
  - - - Non-invasive and no contrast necessary
      - No therapeutic capabilities: Dx only
    - - Filling defects
      - Strictures
      - Duct dilatation
  - - - Side-viewing endoscope
      - Cannulation of sphincter of Oddi
      - Injection of radiocontrast allows biliary tree
      - imaging
    - - Filling defects: stones
      - Duct dilatation
      - Stricturing
        
        PSC
        
        Lap chole
        
        Cholangiocarcinoma
      - Extrinsic compression: Ca pancreas
    - - Sphincterotomy + trawling of ducts allows stone
        removal.
      - Strictures may be stented or dilated
    - - Pancreatitis: 5%
      - Bleeding: esp. in jaundiced pts.
        Check clotting first
      - Bowel perforation
      - Contrast allergy