Gallbladder and Biliary Tract PDF

# Gallbladder and Biliary Tract ## I. Biliary Atresia * Failure to form or early destruction of extrahepatic biliary tree * Leads to biliary obstruction within the first 2 months of life * Presents with jaundice and progresses to cirrhosis ## II. Cholelithiasis (Gallstones) * Solid, round stones...

# Gallbladder and Biliary Tract ## I. Biliary Atresia * Failure to form or early destruction of extrahepatic biliary tree * Leads to biliary obstruction within the first 2 months of life * Presents with jaundice and progresses to cirrhosis ## II. Cholelithiasis (Gallstones) * Solid, round stones in the gallbladder * Due to precipitation of cholesterol (cholesterol stones) or bilirubin (bilirubin stones) in bile * Arises with: * Supersaturation of cholesterol or bilirubin * Decreased phospholipids (e.g., lecithin) or bile acids (normally increase solubility) * Stasis * Cholesterol stones (yellow) are the most common type (90%), especially in the West. * Usually radiolucent (10% are radiopaque due to associated calcium) * Risk factors include: * Age (40s) * Estrogen (female gender, obesity, multiple pregnancies and oral contraceptives) * Clofibrate * Native American ethnicity * Crohn disease * Cirrhosis ## III. Biliary Colic * Waxing and waning right upper quadrant pain * Due to the gallbladder contracting against a stone lodged in the cystic duct * Symptoms are relieved if the stone passes. * Common bile duct obstruction may result in acute pancreatitis or obstructive jaundice. ## IV. Acute Cholecystitis * Acute inflammation of the gallbladder wall * Impacted stone in the cystic duct results in dilatation with pressure ischemia, bacterial overgrowth (E coli), and inflammation. * Presents with right upper quadrant pain, often radiating to right scapula, fever with ↑ WBC count, nausea, vomiting, and ↑ serum alkaline phosphatase (from duct damage) * Risk of rupture if left untreated ## V. Chronic Cholecystitis * Chronic inflammation of the gallbladder * Due to chemical irritation from longstanding cholelithiasis, with or without superimposed bouts of acute cholecystitis * 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: * Shrunken, hard gallbladder due to chronic inflammation, fibrosis, and dystrophic calcification * Increased risk for carcinoma * Treatment is cholecystectomy, especially if porcelain gallbladder is present. ## VI. Ascending Cholangitis * Bacterial infection of the bile ducts * Usually due to ascending infection with enteric gram-negative bacteria * Presents as sepsis (high fever and chills), jaundice, and abdominal pain * Increased incidence with choledocholithiasis (stone in biliary ducts) ## VII. Gallstone Ileus * Gallstone enters and obstructs the small bowel * Due to cholecystitis with fistula formation between the gallbladder and small bowel ## VIII. Gallbladder Carcinoma * Adenocarcinoma arising from the glandular epithelium that lines the gallbladder wall. * Gallstones are a major risk factor, especially when complicated by porcelain gallbladder. * Classically presents as cholecystitis in an elderly woman * Poor prognosis The image shows two different depictions of gallstones. On the left, it shows the inside of a gallbladder with a large amount of gallstones. On the right, it shows a picture of gallstones from the external side.