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Biliary Tract
Made up of:
Intra hepatic ducts
Exta hepatic ducts
Gallbladder
Common Bile Duct
The Gallbladder
The gallbladder concentrates and
stores bile.
Bile:
Secreted by the liver
Contains cholesterol, bile pigments
and phospholipids
Flows from the liver, through the
hepatic ducts, into the gallbladder
Exits the gallbladder via the cystic
duct
Flows from the cystic duct into the
common bile duct, into the small
intestine
In the small intestine, aids digestion
by breaking down fatty foods and
fat-soluble vitamins
Cholecystitis
Cholecystitis is an
inflammation of the
gallbladder wall and
nearby abdominal
lining.
Abdominal wall
Gallbladder
Those who are most at risk.
These are all adjectives to describe the person most at
risk of developing symptomatic gallstones.
Symptoms
Unwell, pain, jaundice, dark urine, pale stools
Charcot triad (ie, fever, right upper quadrant pain, jaundice) occurs in
only 20-70% of cases
Signs
Sepsis (Fever, tachycardia, low BP), Jaundice.
Investigations
Bloods U&E, FBC, LFT, Amylase, CRP, Coagulation screen
Ultrasound of abdomen
Treatment
Intravenous antibiotics
Endoscopic Retrograde CholangioPancreatogram
Diagnostics.
Fecal studies.
Ultrasound of the
gallbladder.
Diagnostics.
Oral cholecystogram
- the patient takes iodine-containing tablets by
mouth
- iodine is absorbed from the intestine into the
bloodstream
- removed from the blood by the liver and
excreted by the liver into the bile (it is
concentrated in the gallbladder )outlines the
gallstones that are radiolucent (x-rays pass
through them).
HIDA scan
imaging test used to examine the gallbladder and the
ducts leading into and out of the gallbladder
also referred to as cholescintigraphy.
Operative cholangiography
common bile duct is directly injected with radiopaque
dye.
Medical Management.
Lithotripsy If the attack of
for patients with only a cholelithiasis is mild
FEW stones. bed rest is prescribed.
patient is placed on
NPO to allow GI tract
and gallbladder to rest.
an NG tube is placed
on low suction.
fluids are given IV in
order to replace lost
fluids from NG tube
suction.
Medical Management.
If stones are present in the
common bile duct, an
endoscopic sphincterotomy
must be performed to remove
them BEFORE a
cholecystectomy is done.
Indications
A single complication of gallstones is an indication for
cholecystectomy (this includes biliary colic)
After a single complication risk of recurrent complications is high
(and some of these can be life threatening e.g. cholangitis,
pancreatitis)
Advantages:
Less post-op pain
Shorter hospital stay
Quicker return to normal activities
Disadvantages:
Learning curve
Inexperience at performing open cholecystectomies
Cholecystectomy when to perform?
After acute cholecystitis, cholecystectomy traditionally performed
after 6 weeks