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Flashcards in gallbladder pathophysiology Deck (38):
1

components of bile

water, bile acids (active ingredient), cholesterol, phospholipids, lecithn, electrolytes

2

Function of gallbladder and bile duct

gallbladder stores and concentrates bile when fasting, then contracts to deliver bile to duodenum. Ducts are route for excretion of cholesterol, minerals, drugs

3

compare bile in the liver vs gallbladder

Bile is much more concentrated in gallbladder

4

Control of gallbladder release

During fasting, PSNS vagal tone and CCK levels are decreased so sphincter of Oddi is closed. During eating, CCK and vagal tone increase, gallbladder and bile duct peristalsis, transport into duodenum

5

Causes of gallstones

Too much cholesterol in bile, too little water, or both. Caused by gallbladder/bile duct dysmotility, hereditary mutations in cholesterol chain structure, or inflammation in the gallbladder.

6

Types of gallstones

Cholesterol (white or yellow), brown (bacterial), or pigment stones (black and hard bile stasis)

7

What causes cholesterol gallstones

genetic mutations in cholesterol side chains, bile acid hypersecretion, gallbladder stasis, or a combination

8

What causes pigment stones

develop in patients with increased concentrations of bilirubin in the bile, especially those with hemolytic states such as sickle cell anemia. Also as result of stasis. More common in asians. Can develop in gallbladder or bile duct

9

Chief component of pigment stones

calcium bilirubinate

10

gallstones risk factors

5 Fs: obesity, female, age >30, family history, estrogen use, rapid weight loss, biliary obstruction

11

Diagnosis of gallstones

abd ultrasound, or CT if cause of abd pain is unclear. For stones in bile duct, MRI of biliary tree (MRCP: magnetic resonance cholangiopancreatography) or endoscopic retrograde cholangiopancreatography (ERCP).

12

gallstone treatment

endoscopic retrograde cholangiopancreatography (ERCP)

13

Gallstone complications

biliary colic, acute cholecystitis, ascending cholangitis, gallstone pancreatitis, gallbladder carcinoma

14

What is biliary colic

•Caused by movement of stone into cystic duct or gallbladder neck

15

biliary colic symptoms

•Intermittent pain in epigastrium or RUQ. After meals, particularly fatty foods. Peaks in an hour, remits 3-8 hrs later

16

biliary colic management

•Laparoscopic cholecystectomy is curative.

17

Acute calculus cholecystitis

•Stone in cystic duct or gallbladder neck. Bacteria colonization, transmural inflammation. GB, perforation, sepsis or death may result if untreated

18

Acute calculus cholecystitis presentation

–Severe pain in RUQ, nausea, fever. Murphys sign (pt stops exhaling on palpation of RUQ)

19

Acute calculus cholecystitis treatment

NPO (rest), IV hydration, IV antibiotics, surgical removal of gallbladder, percutaneous drainage if too ill for surgery

20

Acalculous cholecystitis

Usually from ischemia of gallbladder. Risk factors = sepsis, recent surgery, trauma/burns, hypotension.

21

Choledocholithiasis

stones in bile ducts, most migrate from gallbladder.

22

Choledocholithiasis symptoms

jaundice, dark urine, abd pain, acute pancreatitis

23

Choledocholithiasis diagnosis and management

liver chemistries, ultrasound, MRCP or ERCP. Treatment: ERCP with extraction and/or lithotripsy, surgery if refractory

24

Ascending cholangitis

Bacterial infection of bile duct. Almost always a complication of choledocholithiasis

25

Ascending cholangitis symptoms

Charcots triad: fever, RUQ pain and jaundice. Sepsis or death may occur if untreated

26

Ascending cholangitis management and diagnosis

history, labs, US are suggestive, but ERCP is definitive for diagnosis and management. Hospital admit NPO, broad spectrum IV Abx, IV fluids.

27

Causes of benign biliary stricture

surgery, radiation, Primary sclerosing cholangitis (PSC), chronic pancreatitis, autoimmune pancreatitis, chronic choledocholithiasis

28

Causes of malignant biliary stricture

Pancreatic cancer, Cholangiocarcinoma, Gallbladder cancer, Ampullary cancer

29

Biliary stricture presentation

RUQ pain, cholestasis (jaundice, dark urine, acholic stools, pruritus),

30

Biliary stricture labs

liver function tests elevated. Alk phos/GGT, bilirubin >> ALT/AST

31

Biliary stricture diagnosis

ultrasound or CT showing dilated ducts. MRCP or ERCP for confirmation. Biopsy to differentiate benign vs malignant

32

Biliary stricture management

ERCP with dilation or stenting. Biopsy to rule out malignancy. Surgery if refractory or malignant

33

Primary sclerosing cholangitis (PSC)

an idiopathic, intra- and extrahepatic inflammatory disorder causing numerous Benign biliary strictures throughout the biliary tree. association with IBD (UC > crohns)

34

Primary sclerosing cholangitis (PSC) symptoms and labs

RUQ pain, jaundice, fevers all due to cirrhosis of liver. Alk phos/GGT > AST/ALT. Bilirubin rises late.

35

Primary sclerosing cholangitis (PSC) therapy

none effective except liver transplant. ERCP with stent if jaundiced.

36

What is sphincter of Oddi dysfunction

motility disorder- intermittent.

37

sphincter of Oddi dysfunction presentation and diagnosis

–Recurrent RUQ pain. ALT/AST/Alk phos elevations. Dilated bile duct on US. ERCP with sphincter of Oddi manometry

38

Sphincter of Oddi dysfunction treatment

biliary sphincterotomy