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biliary stricture - Coggle Diagram
biliary stricture
Causes
Biliary stricture is a narrowing or blockage of the bile ducts, which can lead to jaundice, itching, and other symptoms. There are several causes of biliary stricture, including:
- Cholangiocarcinoma: This is a type of cancer that affects the bile ducts. It can cause strictures due to tumor growth or invasion of the ducts.
- Primary sclerosing cholangitis (PSC): This is a chronic inflammatory condition that affects the bile ducts. It can cause strictures due to scarring and inflammation in the ducts.
- Intrahepatic cholestasis of pregnancy (ICP): This is a rare condition that affects pregnant women, causing itching and jaundice due to bile duct damage. It can cause strictures in some cases.
- Idiopathic sclerosing cholangitis: This is a type of stricture that occurs without an obvious cause. It is more common in older adults and can lead to cirrhosis and liver failure in severe cases.
- Choledocholithiasis: This is the presence of gallstones in the bile ducts, which can cause strictures due to stone impaction or inflammation.
- Trauma: Injury to the bile ducts during surgery or trauma can cause strictures due to scarring and inflammation.
- Infection: Bacterial or viral infections can cause inflammation and scarring in the bile ducts, leading to strictures.
- Autoimmune diseases: Conditions such as autoimmune hepatitis and primary biliary cholangitis (PBC) can cause inflammation and scarring in the bile ducts, leading to strictures over time.
Classification
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- Intrahepatic biliary stricture: This type of stricture occurs within the liver and is typically caused by primary sclerosing cholangitis (PSC), primary biliary cholangitis (PBC), or intrahepatic cholestasis of pregnancy (ICP).
- Extrahepatic biliary stricture: This type of stricture occurs outside the liver, typically in the common bile duct or the hepatic ducts. Extrahepatic strictures can be caused by choledocholithiasis, trauma, surgery, infection, or cancer (such as cholangiocarcinoma).
- Benign biliary stricture: This type of stricture is not cancerous and is typically caused by conditions such as PSC, PBC, ICP, or trauma.
- Malignant biliary stricture: This type of stricture is caused by cancer, such as cholangiocarcinoma or pancreatic cancer that has spread to the bile ducts.
- Ischemic biliary stricture: This type of stricture is caused by a lack of blood flow to the bile ducts due to conditions such as liver transplantation or vascular disease.
- Iatrogenic biliary stricture: This type of stricture is caused by medical procedures, such as surgery or endoscopic procedures, that damage the bile ducts.
- Recurrent biliary stricture: This type of stricture occurs after treatment for a previous stricture, either due to recurrence of the underlying condition or complications from previous treatments.
Management
Inv
CP (Cholangiopancreatography) and investigations of biliary stricture are medical procedures used to diagnose and evaluate biliary strictures.
CP is a radiological procedure that involves inserting a small tube (endoscope) into the duodenum (the first part of the small intestine) and passing it through the ampulla of Vater (the opening where the bile duct and pancreatic duct join the duodenum). This allows for the visualization of the bile ducts and pancreas using X-rays or other imaging techniques. CP can help to identify the location, cause, and severity of biliary strictures, as well as any associated conditions such as gallstones or tumors.
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- Blood tests: These can help to identify underlying liver or biliary disorders that may be causing the stricture, such as primary sclerosing cholangitis (PSC) or primary biliary cholangitis (PBC).
- Ultrasound: This is a non-invasive imaging technique that can help to identify gallstones, tumors, or other abnormalities in the liver and bile ducts.
- Magnetic resonance cholangiopancreatography (MRCP): This is a non-invasive imaging technique that uses magnetic resonance imaging (MRI) to create detailed images of the bile ducts and pancreas.
- Endoscopic retrograde cholangiopancreatography (ERCP): This is a more invasive procedure that involves passing an endoscope through the mouth and into the duodenum, then injecting contrast dye into the bile ducts to visualize any strictures or abnormalities. ERCP can also be used to perform procedures such as stone extraction or stent placement.
- Percutaneous transhepatic cholangiography (PTC): This is a procedure in which a catheter is inserted through the skin into the liver, then guided into the bile ducts using X-rays to visualize any strictures or abnormalities. PTC can also be used to perform procedures such as stone extraction or stent placement.
TTT
The management of biliary stricture depends on the location and cause of the stricture, as well as the overall health of the individual. Some common management outlines for biliary stricture include:
- Conservative management: This involves monitoring the stricture with regular imaging and blood tests to assess for any changes or complications. Conservative management may be appropriate for some individuals with mild or stable strictures, particularly if they have underlying liver or biliary disorders such as primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC).
- Endoscopic treatment: This involves using endoscopic techniques such as balloon dilation, stent placement, or sphincterotomy to relieve the obstruction caused by the stricture. Endoscopic treatment may be appropriate for some individuals with benign strictures, particularly if they are causing symptoms such as jaundice or abdominal pain.
- Surgical treatment: This involves surgically removing or bypassing the strictured area of the bile ducts. Surgical treatment may be appropriate for some individuals with malignant strictures, particularly if they are causing symptoms such as jaundice or pain, or if they have underlying liver or biliary disorders such as primary sclerosing cholangitis (PSC).
- Medical treatment: This involves using medications to manage underlying liver or biliary disorders such as primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC). Medical treatment may be appropriate for some individuals with these conditions, particularly if they are causing symptoms such as fatigue, pruritus, or weight loss.
It's important to note that these management outlines are not exhaustive and may vary depending on the individual's specific circumstances. It's essential to consult with a healthcare provider for an accurate diagnosis and appropriate treatment plan.
CP
The clinical picture of biliary stricture can vary depending on the location and cause of the stricture, as well as the overall health of the individual. Some common symptoms of biliary stricture include:
- Jaundice: This is a yellowing of the skin and eyes due to an accumulation of bilirubin (a substance produced during the breakdown of red blood cells) in the body. Jaundice is a common symptom of biliary stricture, particularly intrahepatic strictures.
- Pruritus: This is intense itching, often accompanied by jaundice, that can be a symptom of biliary stricture, particularly intrahepatic strictures caused by conditions such as primary biliary cholangitis (PBC).
- Abdominal pain: This can be a symptom of biliary stricture, particularly if the stricture is causing obstruction or inflammation in the bile ducts. The pain may be located in the upper right quadrant of the abdomen, where the liver is located.
- Fatigue: This can be a symptom of biliary stricture, particularly in individuals with underlying liver or biliary disorders such as primary sclerosing cholangitis (PSC).
- Fever: This can be a symptom of biliary stricture, particularly if the stricture is caused by infection or inflammation in the bile ducts.
- Weight loss: This can be a symptom of biliary stricture, particularly in individuals with underlying liver or biliary disorders such as primary sclerosing cholangitis (PSC).
- Nausea and vomiting: These symptoms can be a result of obstruction or inflammation in the bile ducts caused by the stricture.
It's important to note that these symptoms can also be caused by other conditions, so it's essential to consult with a healthcare provider for an accurate diagnosis and appropriate treatment plan.