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Diseases of GB & bile ducts

A surgical overview

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Specimen 1

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Gall stones

Pigment

Cholesterol

Mixed

Primary

Secondary

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Pathogenesis

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Pathological effect

On the GB

On the CBD

On the liver On the intestine

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Specimen 2

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Cholesterol stone

Demographic/genetic factors

Obesity

Female sex hormones Increasing age

Gallbladder hypomotility

High-fat diet

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Specimen 3

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Pigment stone

Demographic/genetic factors: Asia, rural

setting

Chronic hemolysis

Chronic biliary tract infection, parasite

infections

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Diagnosis

USG of upper abdomen

CT scan

ERCP MRCP

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USG of GB

Advantages

Rapid

Accurate identification ofgallstones (>95%)

Simultaneous scanning of GB,liver, bile ducts, pancreas

"Real-time" scanning allowsassessment of GB volume,contractility

Not limited by jaundice,pregnancy

May detect very small stones

Limitations

Bowel gas

Massive obesity

Ascites

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St X ray abdomen

Advantages

Low cost

Readily available

Disadvantages

Relatively low yield

? Contraindicated in

pregnancy

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CT scan

Advantages

Simultaneous scanning ofGB, liver, bile ducts,pancreas

Accurate identification ofdilated bile ducts, masses

Not limited by jaundice, gas,obesity, ascites

High-resolution image Guidance for fine-needle

biopsy

Limitation

Extreme cachexia

Movement artifact

Ileus

Partial bile duct obstruction

Pregnancy

Reaction to iodinated

contrast, if used

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ERCP

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MRCP

Advantages

Useful modality forvisualizing pancreatic andbiliary ducts

Has excellent sensitivity forbile duct dilatation, biliarystricture, and intraductalabnormalities

Can identify pancreatic ductdilatation or stricture,pancreatic duct stenosis,and pancreas divisum

Disadvantages

Cannot offer therapeutic

intervention

High cost Claustrophobia

Certain metals - cardiac

pacing

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Imaging of GB & bile ducts

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Specimen 4

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Cholecystitis

Acute

Chronic

Calculous

Acalculous

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Acute cholecystitis

History Pain in RUQ with typical nature & radiation

Nausea & Vomiting

Fever O/E

Tachycardia

Jaundice

Tenderness +/- lump in RUQ

Lab Inv Leukocytosis

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Cholecystectomy

Gall bladder-stones.flv

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HP of chronic cholecystitis

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Cholangitis

Causes

PresentationCharcots triad

Sequele

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Specimen 5

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Things to remember

Gall stones types, effects, treatment

Acute cholecystitis

Chronic cholecystitis

Empyema

Mucocele

CBD stone

Radiological diagnostic methods

Cholesterosis

D/D of pain in right upper abdomen