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BILIARY PATHOLOGY - Coggle Diagram
BILIARY PATHOLOGY
Cholelithiasis
gallstones in gallbladder
intermittent obstruction of cystic duct
biliary colic (functional spasm of duct)
intermittent RUQ pain
usually postprandial (since bile is being pumped out of gallbladder towards duodenum)
sudden onset, severe
not relieved by antacids
can radiate to back
CCK stimulates excretion of bile from gallbladder after eating
bile is pumped out of gallbladder
if chronic, muscular thickening and reactive changes of epithelium, sinus formation, adenomyosis
abdominal US
Cholecystitis
gallstone permanently obstructs cystic duct
inflammation of cystic duct and gallbladder
N/V, fever, RUQ pain
does not affect liver
bile stasis
bacteria grow and cause infection
empyema/ascending cholangitis
chronic
muscular wall thickening, adenomyosis, RA sinus formation, mild chronic inflammation, cholesterolosis
acute
can perforate if severe
abscess
peritonitis
epithelium eroded/denuded
inflammatory cell infiltration
may have surface fibrin and adhesions
typical macroscopic findings: oedema with congestion and fibrin
sometimes necrosis
other complications: empyema, ascending cholangitis, fistula
abdominal US
Choledocolithiasis
gallstone obstructing common bile duct
affects both liver and gallbladder
decreased bile flow through bile duct
bile stasis and backup into liver, injuring ductal tissue
Cholangitis
obstruction of common bile duct/biliary tree
gallstone
pancreatic head tumour
inflammation of bile ducts
infection
1 more item...
ascending
sepsis
fever, night sweats
elevated WCC
atrial fibrillation
2 more items...
ceftriaxone and metronidazole
Charcot's triad (RUQ pain, fever, jaundice)
infection e.g. E. coli translocates through major duodenal papilla
cholestatic disease
elevated ALP, GGT, bilirubin
decreased bile in GIT
decreased absorption of fat-soluble vit K
decreased synthesis of coagulation factors
elevated INR
decreased bilirubin in GIT
no stercobilin
pale stool
back-buildup of conjugated bilirubin in blood
elevated serum bilirubin
obstructive jaundice
scleral icterus
yellowed skin
bilirubin excreted by kidneys
dark urine
urinalysis
build-up of bile acid in blood
pruritus
scratch marks
UDCA
if stone blocks secretion of pancreatic enzymes
pancreatitis
ECRP (and MRCP)
Gallstones
high BMI, age, female (OCP, pregnancy, oestrogen), rapid weight loss, bile stasis, hypertriglyceridemia, medications
types
pure cholesterol (10%)
mixed cholesterol (80%)
pure black pigment (10%)
irritate gallbladder mucosa
intestinal metaplasia
low grade dysplasia
high grade dysplasia
adenocarcinoma (gallbladder cancer)
rare
endoscopic extraction via ERCP
ERCP