Biliary Tract Disorders Quiz

Biliary Tract Disorders

• Biliary Atresia:
  • Failure of the extrahepatic biliary tree to form or early destruction
  • Leads to biliary obstruction within the first two months of life
  • Presents with jaundice and cirrhosis
• Cholelithiasis (Gallstones):
  • Solid, round stones formed in the gallbladder
  • Primarily composed of cholesterol (90%) or bilirubin
  • Factors contributing to stone formation:
    • Supersaturation of cholesterol or bilirubin in bile
    • Decreased phospholipids or bile acids
    • Stasis (slow movement of bile)
  • Cholesterol stones are typically yellow and radiolucent, while bilirubin stones are usually radiopaque
  • Risk factors for cholesterol stones include age (40s), estrogen, obesity, multiple pregnancies, oral contraceptives, clofibrate, Native American ethnicity, Crohn's disease, and cirrhosis.

Other Biliary Tract Conditions

• Biliary Colic:

  • Waxing and waning right upper quadrant pain
  • Due to gallbladder contractions against a lodged stone in the cystic duct
  • Symptoms resolve if the stone passes
  • Obstruction in the common bile duct can lead to acute pancreatitis or obstructive jaundice

• Acute Cholecystitis:

  • Inflammation of the gallbladder wall
  • Caused by an impacted stone in the cystic duct, leading to pressure, ischemia, bacterial overgrowth, and inflammation
  • Presents with right upper quadrant pain, often radiating to the right scapula
  • Associated symptoms include fever, increased white blood cell count, nausea, vomiting, and elevated serum alkaline phosphatase

• Chronic Cholecystitis:

  • Chronic inflammation of the gallbladder wall
  • Often caused by chemical irritation from gallstones
  • Characterized by herniation of gallbladder mucosa into the muscular wall (Rokitansky-Aschoff sinus)
  • Presents with vague right upper quadrant pain, especially after eating
  • Porcelain gallbladder is a late complication involving shrunken, hard gallbladder due to chronic inflammation, fibrosis and dystrophic calcification

• Ascending Cholangitis:

  • Bacterial infection of the bile ducts
  • Typically due to ascending infection from the intestines
  • Characterized by sepsis (high fever, chills), jaundice and abdominal pain
  • Increased association with choledocholithiasis (stones in the common bile duct)

• Gallstone Ileus:

  • Gallstone enters and obstructs the small bowel
  • Resulting from cholecystitis with formation of a fistula between the gallbladder and small bowel

• Gallbladder Carcinoma:

  • Adenocarcinoma of the gallbladder wall
  • Gallstones, especially porcelain gallbladder, are major risk factors

• Increased risk: Gallbladder disorders are associated with an increased risk of carcinoma or cancer

• Treatment: Cholecystectomy (removal of the gallbladder) is often the standard treatment for many gallbladder disorders, especially if porcelain gallbladder is present.