胆é“疾病 Diseases of the...

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胆道疾病 Diseases of the Biliary tract. ● Anatomy and Physiology ● Examinations for biliary system disease ● Cholelithiasis ● Infection of the biliary tract system ● Biliary ascariasis ● Biliary tract tumor. 第一节 解剖和生理 Anatomy and Physiology. - PowerPoint PPT Presentation

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  • Diseases of the Biliary tract

  • Anatomy and Physiology

    Examinations for biliary system disease

    Cholelithiasis

    Infection of the biliary tract system

    Biliary ascariasis

    Biliary tract tumor

  • Anatomy and Physiology

  • 1

    1. Intrahepatic bile ducts gradation 2. Extrahepatic bile ducts segment Vaters ampulla oddis sphincter 3. Gallbladder Heisters valve Hartmanns pouch Calots triangle

  • 2 Physiology Storage bile Condense bile Regulate biliary tract pressure Secrete mucus: White bile

  • Examination methods for biliary system disease

  • 1

    1. Laboratory findings2. Ultrasonography3. X-ray examinations plain radiography percutaneous transhepatic cholangiography (PTC) endoscopic retrograde cholangiopancreatography (ERCP) during or post operative cholangiogram

  • 2

    computed tomography (CT) oral cholecystography intravenous cholangiography hypotonic duodenographyRadionuclide scansDuodenal drainageCholangioscopyMagnetic resonance imaging (MRI,MRCP)

  • congenital cystic dilatation of bile duct

  • Cholelithiasis

  • 1

    1. Prevalence2. Classification cholesterol pigment mixed type black3. Position gallbladder extrahepatic intrahepatic

  • 2

    4. Mechanism for gallstone formation bile stasis abnormal metabolization infection other factors: age, sex, weight, diet Cholesterol stones: Admirand-Small triangular coordinate grapy Pigment stones:

  • 40%45%

  • 1

    1. Gallbladder stones (1) Clinical manifestations: biliary colic, radiation of the pain, neusea, vomiting tenderness in right upper quadrant, rebound tenderness, muscle rigidity, palpable distended gallbladder, or Murphys sign (+) bile duct stones, cholangitis

  • 2

    Mirizzis syndrome:

    (2) Diagnosis: clinical manifestations: symptoms and signs assistant examinations: B-US, CT, MRI

  • 3(3) Treatment: no need for treatment: asymptomatic stones drug therapies: seldom attack or unsuitable for operation operative management: cholecystectomy: open and laparoscopic other treatments: oral dissolution therapy contact dissolution therapy extracorporeal shock wave lithotripsy

  • 1

    2. Extrahepatic bile duct stones(1) Clinical manifestations: Charcots triad: abdominal pain, chills and fever, jaundice deep tenderness with or without rebound tenderness, muscle rigidity or palpable enlarged gallbladder

  • 2

    (2) Diagnosis: previous biliary tract disease clinical manifestations: Charcots triad laboratory examinations: assistant examinations: B-US, CT, PTC, ERCP, MRCP

  • 3

    Differential diagnosis: viral hepatitis carcinoma of pancreas biliary ascariasis benign stricture renal colic, enterospasm

  • 4

    (3) Treatment: Chinese medicine: dissolution, discharge drug therapy: antispastic, analgesic EST operative management: exploratory choledochostomy and T-tube drainage choledocho-jejunostomy sphincteroplasty of Oddi

  • 1

    3. Intrahepatic duct stones (1) Clinical manifestations and diagnosis Symptoms: Physical findings: B-US, CT, PTC, ERCP, MRCP

  • 2

    (2) Treatment Nonoperative treatment: anti-inflammatory and cholagogic Operative treatment: hepatobiliary exploration cholangio-jejunostomy partial hepatectomy

  • Infection of the biliary tract system

  • 1

    1. Acute cholecystitis (1) Pathogenesis: bile stasis: obstruction, dysfunction bacteria other factors: bile salt, pancreatic juice

  • 2 (2) Pathology: simple, suppurative, gangrenous (3) Complications: pericholecystic or cholecystic abscess perforation: bile peritonitis, fistulization (external or internal ), gallstone ileus liver abscess, cholangitis, pancreatitis pylephlebitis, sepsis

  • 3

    (4) Clinical manifestations and diagnosis symptoms: pain, radiated pain, nausea, vomiting, fever signs: tenderness, rebound tenderness, muscle rigidity, distended gallbladder with tenderness or Murphys sign(+) complications: assistant examinations: laboratory WBC, B-US

  • 4

    Differential diagnosis acute perforated duodenal or gastric ulcers acute pancreatitis acute appendicitis acute ileus

  • 5 (5) Treatment nonoperative management: fasting, nasogastric suction; antispastic, analgisia; control of infection operative intervention: indication: acute calculous cholecystitis, recurrent chole-cystitis, no response to conservative treatment timing: early, delayed methods: cholecystectomy, cholecystostomy

  • 1

    2. Chronic cholecystitis (1) Pathogenesis and pathology: (2) Clinical manifestations and diagnosis the history of recurrent cholecystitis symptoms: untold bitterness, discomfort, indigestion signs: deep tenderness in the right upper quadrant B-US (3) Treatment operative: cholecystetomy nonoperative: anti-inflammatory, cholagogic, low-fat meals

  • 1

    3. Cholangitis Pathologic type: acute obstructive suppurative cholangitis chronic simple cholangitis primary sclerosing cholangitis

  • primary sclerosing cholangitis

  • 2

    Acute obstructive suppurativecholangitis

    (1) Pathogenesis Complete bile duct obstruction: stones, benign strictures, malignant tumor, parasites Bacterial infections: E. Coli, Klebsiella, proteus, and anaerobic bacteria

  • 3

    (2) Pathophysiology completely obstruction, dilatation, high intraductal pressure bacteria invasion, multiplication, pus bile retrograde enter the liver, acute liver infection systemic sepsis, infective shock, MSOF

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    (3) Clinical manifestations Abdominal pain chills and fever jaundice shock central nervous system depression: apathy, drowsiness, coma

    CharcotstriadReynoldspentad tenderness with or without rebound tenderness, muscle rigidity; enlarged liver with tenderness, percussion pain

  • 5

    (4) Diagnosis recurrent previous biliary tract disease Charcots triad + CNS + shock (Reynolds pentad) physical examination results: assistant examinations: laboratory findings (WBC, hyperbilirubinemia), B-US

  • 6

    (5) Treatment principle: immediate removal of the obstruction emergency bile duct decompression methods: preoperative preparation: exploratory choledochostomy and T- tube drainage PTBD, ENBD

  • biliary ascariasis

  • 1

    1. Pathogenesis: 2. Pathophysiology colic obstructive jaundice complicated infection stone formation pancreatitis cirrhosis

  • 2

    3. Clinical manifestations and diagnosis paroxysmal epigastric pain suddenly attack and suddenly stop serious symptoms but slight signs complicated infection: cholangitis fecal examination, B-US, CT

  • 3

    4. Treatment nonoperative: antispastic, analgisia; cholagogic, expel parasites; control of infection operative: exploratory choledochostomy and T-tube drainage

  • biliary tract tumors

  • 1

    1. Gallbladder polyps (1) Classification: non-neoplastic polyps: inflammatory, cholesterol, hyperplastic neoplastic polyps: adenoma

  • 2

    (2) Clinical manifestations and diagnosis:(3) Treatment follow-up operative: cholecystectomy

  • 1

    2. Carcinoma of the gallbladder (1) Pathogenesis: unclear (2) Clinical manifestations and diagnosis early: no specific advanced: jaundice, ascites, mass B-US, CT, MRI

  • 2

    (3) Treatment operative: located in gallbladder wall: cholecystectomy protrude serosa or liver invasion: radical cholecystectomy unresectable: decompression and drainage nonoperative: PTBD, ENBD

  • 1

    3. Bile duct cancer (1) Pathogenesis: unclear (2) Clinical manifestations and diagnosis advancing jaundice pain, nausea, vomiting ascites, portal hypertension B-US, CT, PTC, ERCP, MRCP

  • 2

    (3) Treatment operative resection: Whipples operation nonoperative: PTBD, ENBD, prosthesis

  • 1.2.3. 4.