Medical Archive

Anatomy and Physiology

General Considerations in Biliary Tree Pathophysiology

Symptoms

Laboratory tests

Imaging studies

Bacteriology

Benign Biliary Disease

https://hsnowhome.wpcomstaging.com/2020/05/11/c339-diseases-of-the-gallbladder-and-bile-ducts/

Calculous Biliary Disease

Chronic Cholecystitis

Acute Calculous Cholecystitis

Choledocholithiasis

Gallstone Pancreatitis

Biliary Dyskinesia

Sphincter of Oddi Dysfunction

Surgery for Calculous Biliary Disease

Postcholecystectomy Syndromes

• Cystic duct stump syndrome
• SOD stenosis and SOD dyskinesia, and biliary dyskinesia

• Bile leak (??? ??) ~1?
  • ?? ???? ? ???? fluid collection ?? ? ERCP + PerQ drain ? stent ? 6-8? ? ??
  • Cystic duct stump? ?? bile leak
    • ERCP ?? ????? EST c stent insertion ?? ??.
• Bile duct injury (??? ??) ~ ???
  • ???? ??, ??+?? ? cholangiogram
  • ?? ? ??? CBD, CHD? ??
    • ?? ?? 50% ?? ??: ?? ?? + T-tube ??
    • ?? ?? 50% ?? ??: Roux-en-Y choledocholjejunostomy (hepaticojejunostomy)
  • ?? ??? ?? ??
    • ??? ????? PTBD ??
    • ?? ?? ?? ??? ???? 6-8? ? Roux-en-Y ? ??? ???.
• Bile salt-induced diarrhea and gastritis
  • ~10% of patients post-cholecystectomy
  • Pathophysiology
    1. Bile acid enters the small intestines more rapidly, which can overwhelm the resorptive capacity of the terminal ileum
    2. Unresorbed bile acid then spills into the colon, causing mucosal irritation and secretory diarrhea. 
  • Clinical features
    • Diarrhea that persists despite fasting (eg, nocturnal diarrhea)
    • Unremarkable lab.
  • Management
    • Bile-acid resins, including cholestyramine, colestipol, and colesevelam

Noncalculous Biliary Disease

Malignant Biliary Disease

https://hsnowhome.wpcomstaging.com/2020/07/15/c78-tumors-of-the-liver-and-biliary-tree/

Gallbladder Cancer

Bile Duct Cancer

Klatskin tumor

• Surgical option
  • Type I: Local excision
  • Type II: Local excision + caudate lobectomy
  • Type IIIa: Ext. RHH (I, V, VI, VII, VIII)
  • Type IIIb: Ext. LHH (I, II, III, IV)

?? ? ???? ?? ?? ???? ????.

• ??? ???
  • ?? ???? ???? ??? ?? ??? ???? ?? ?? ??? ?? ?? ??.
  • ?? ? 2-4? ?? ??
• ?? ? ??? ???
  • Bilirubin? 2-3??? ??? ?? ??? ??.
  • PTBD, ENBD ? ?? ???: ??? ?? ??
  • ERBD: ?????

Periampullary cancer

Courvoisier’s sign (+)

• Surgical option
  • Proximal: Bile duct resection
  • Distal: Whipple’s op (PD) or PPPD

Metastatic and Other Tumors