Medical Archive

Anatomy

Gallbladder / 1309 Bile Ducts / 1310 Anomalies / 1312

Physiology

Bile Formation and Composition / 1312 Gallbladder Function / 1313 Sphincter of Oddi / 1313

Diagnostic Studies

Blood Tests / 1314 Ultrasonography / 1314 Oral Cholecystography / 1314 Biliary Radionuclide Scanning (HIDA Scan) / 1315 Computed Tomography / 1315 Percutaneous Transhepatic Cholangiography / 1315

Magnetic Resonance Imaging / 1315 Endoscopic Retrograde Cholangiopancreatography / 1315 Endoscopic Ultrasound / 1316

Gallstone Disease

Prevalence and Incidence / 1316 Natural History / 1317 Gallstone Formation / 1318 Symptomatic Gallstones / 1319 Cholangiohepatitis / 1324

Operative Interventions for Gallstone Disease

Cholecystostomy

Cholecystectomy

Complications

• Cystic duct stump syndrome
• SOD stenosis and SOD dyskinesia, and biliary dyskinesia
• Bile salt-induced diarrhea and gastritis

• Bile leak (??? ??) ~1?
  • ?? ???? ? ???? fluid collection ?? ? ERCP + PerQ drain ? stent ? 6-8? ? ??
• Bile duct injury (??? ??) ~ ???
  • ???? ??. ??+?? ? cholangiogram ? ERBD/ENBD ?? or ???
  • ? ? ?? ?????, cystic duct stump syndrome, ??? ?? ??

• Bile acid diarrhea (BAD)
  • ~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

Common Bile Duct Exploration

Common Bile Duct Drainage Procedures

Transduodenal Sphincterotomy

Other Benign Diseases and Lesions

Acalculous Cholecystitis / 1327 Biliary Cysts / 1330 Sclerosing Cholangitis / 1331 Stenosis of the Sphincter of Oddi / 1331 Bile Duct Strictures / 1331

Injury to the Biliary Tract

Gallbladder / 1331 Extrahepatic Bile Ducts / 1332

Tumors

Carcinoma of the Gallbladder / 1334 Bile Duct Carcinoma / 1335