What is biliary atresia? how does it present?
failure to form extrahepatic biliary tree
conjugated jaundice in a 3 month old
can progress to cirrhosis
What are the three general causes of cholethiasis?
- decrease phospholipids
What drugs are notorious for causing cholesterol gallstones?
cholestyramine , clofibrate
What are the most common stones in the west?
Besides age over 40, and the drugs previously mentioned, name some other risk factors for gallstones?
- native american ethnicity
- crohn disease - dec uptake of bile salts
- cirrhosis - dec bile salt production
Describe how bilirubin stones vs cholesterol stones appear on xray?
cholesterol stones - radioluscent
bilirubin - radioopaque
What are two causes of bilirubin stones?
- extravascular hemolysis - heme –> unconjugated bilirubin
2. biliary tract infection - deconjugates bilirubin
How does the pain present in acute cholecystiasis?
RUQ pain that radiates to right scapula
What serum marker will be increased in acute cholecystiasis?
How does chronic cholecystiasis present?
vague RUQ pain especially after eating
What are some complications of chronic cholecystiasis?
- porcelain GB - dystrophic calcification
What is a pathognomonic finding of chronic cholecystiasis?
rokitansky aschoff sinus - outpouching of mucosa into SM
What usually causes ascending cholangitis?
gram negative bacteria
What inc the risk of ascending cholangitis?
choledocholithiasis - stone in bile duct
How do you get gallstone ileus?
cholecystiasis and fistula btwn duodenum and GB wall
How does adenocarcinoma typically present?
cholecystiasis in an elderly women