Biliary Tract Disorders Quiz

Study Notes

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.