Diseases of GB & bile ducts

A surgical overview

Specimen 1

Gall stones
Pigment Cholesterol Mixed Primary Secondary

Pathogenesis

Pathological effect
On the GB On the CBD On the liver On the intestine

Specimen 2

Cholesterol stone
Demographic/genetic factors Obesity Female sex hormones Increasing age Gallbladder hypomotility High-fat diet

Specimen 3

Pigment stone
Demographic/genetic factors: Asia, rural setting Chronic hemolysis Chronic biliary tract infection, parasite infections

Diagnosis
USG of upper abdomen CT scan ERCP MRCP

USG of GB
Advantages
Rapid Accurate identification of gallstones (>95%) Simultaneous scanning of GB, liver, bile ducts, pancreas "Real-time" scanning allows assessment of GB volume, contractility Not limited by jaundice, pregnancy May detect very small stones

Limitations Bowel gas Massive obesity Ascites

St X ray abdomen
Advantages Low cost Readily available Disadvantages Relatively low yield ? Contraindicated in pregnancy

CT scan
Advantages Simultaneous scanning of GB, liver, bile ducts, pancreas Accurate identification of dilated 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

ERCP

MRCP
Advantages Useful modality for visualizing pancreatic and biliary ducts Has excellent sensitivity for bile duct dilatation, biliary stricture, and intraductal abnormalities Can identify pancreatic duct dilatation or stricture, pancreatic duct stenosis, and pancreas divisum Disadvantages Cannot offer therapeutic intervention High cost Claustrophobia Certain metals - cardiac pacing

Imaging of GB & bile ducts

Specimen 4

Cholecystitis
Acute Chronic
Calculous Acalculous

Acute cholecystitis
History
Pain in RUQ with typical nature & radiation Nausea & Vomiting Fever

O/E
Tachycardia Jaundice Tenderness +/- lump in RUQ

Lab Inv
Leukocytosis

Cholecystectomy

Gall bladder-stones.flv

HP of chronic cholecystitis

Cholangitis
Causes Presentation Charcots triad Sequele

Specimen 5

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