Gallbladder and Biliary tract

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17 Cards. Created by Kamran ().
 
Term  
Definition

Biliary atresia

failure to form or early destruction of extrahepatic biliary tree. a failure to form the lumen. leads to biliary destruction. sometimes can be congenital or sometimes can be destroyed by infection. present with neonatal jaundice early in life. back pressure in liver. can progress to cirrhosis

cholelithiasis

refers to gall bladder stones. precipitation of cholesterol or bilirubin bile. occurs due to super saturation. can occur when there's decreased phospholipids in bile acids - helps dissolve cholesterol e.g. lecithin. decreased recycling of bile acids can lead to this e.g. by cholestiramine - cholesterol stones. stasis can also increase risk - growth of bacteria - can decongigate billirubin in bile

cholesterol stones

most common, radioluscent (cannont be seen), yellow in colour

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cholesterol stone risk factors

age, estrogen (increases HMG-CoA reductase, can alos increase lipoprotein receptors on hepatocytes), clofibrate (lipid lowering agent that increase HMG-CoA reductase activity, inhibits conversion of chol to bile acid - increase precipitation), ethnicity (native american), Crohn's disease (damage to ilium decrease bile acid and bile salt recycling - less solubilisation), cirrhosis (decrease prod of bile salts - cholesterol not solubilised)

bilirubin stones

radiopaque, shows up on imaging. black in colour

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bilirubin stone risk factors

extravascular hameolysis - large amount of un-biluribin by endoreticulothelium system, splenic macrophages

biliary tract infection - bacteria deconjugate bilirubin, and decreases solubility of bilirubin, increasing risk of gallstones

Gallstone symptoms?

usually assymptomatic, complications include: -biliary colic -acute and chronic chelecystitis -ascending cholangitis -galstone ileus -gallbladder cancer

Biliary colic

patients present with waxing and waining right upper quadrant pain -due to gallbladder contracting against lodged gallstone in cystic duct

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acute cholecystitis

acute inflammation of the gallbladder wall -stone stuck in cystic duct - pressure builds up, squeezes blood vessels of gallbladder wall -gallbladder ischemia -bacterial infiltration -inflammation

acute cholecystitis presentation

-RUQ pain -radiates to RIGHT SCAPULA -fever with high WBC count -nausea and vomitting -increased serum alkaline phosphatase (epithelium lining gallbladder and biliary tract) -risk of rupture if untreated

chronic cholecystitis

chronic inflammation of gallbladder due to chemical irritation from longstanding cholelithiasis -hallmark: formation of ROKITANSKY-ASCHOFF sinuses

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chronic cholecystitis presentation, abdoXR

-vague RUQ pain especially after eating -porcelain gallbladder - late complication, more chemical damage leads to increased risk of dystrophic calcification

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chronic cholecystitis treatment

cholecystectomy, particularly if porcelain gallbladder is presentation (risk factor for gallbladder cancer)

Ascending Cholangitis

Bacterial infection of bile ducts usually due to ascending infection with enteric gram negative bacteria

increased incidence with choledocholithiasis (stone within duct prevents flow, allows bacteria to work way up into the duct)

Ascending Cholangitis Presentation

-sepsis -jaundice -abdominal pain

Gallstone Ileus

gallstone enters and obstructs the small bowel

due to cholecystitis, inflammation of gallbladder wall, causes rupture of the wall, fistula forms between gallbladder wall and duodenum, large stones are then able to enter small bowel and potentially obstruct small bowel

Gallbladder Carcinoma

Adenocarcinoma

arises from glandular epithelium that lines gallbladder wall

Major risk: gallstones, porcelain gallbladder

classic presentation of cholecystitis in elderly women (especially if new onset)

particularly poor prognosis

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