Card Set Information
Gallstones typical features
: biliary colic or episodes of chlolecystitis.
- Obstructive type
- small calibre gallstones -> pass through the cystic duct.
- In Mirizzi syndrome the stone may compress the bile duct directly-
one of the rare times that cholecystitis may present with jaundice
- Usu obstructive
- Charcots triad
: pain, jaundice, fever
- Ascending infection of the bile ducts usually by E. coli
- by definition occurring in a pool of stagnant bile.
Pancreatic cancer features
painless jaundice with palpable gallbladder (Courvoisier's Law)
Pancreatic cancer pathogenesis
- Direct occlusion: distal bile duct or pancreatic duct by tumour.
- Sometimes nodal disease at the portal hepatis may be the culprit in which case the bile duct may be of normal calibre.
Bile duct injury pathogenesis
- bile duct is excised
+ jaundice offers rapidly post operatively
+ often due to diff cholecystectomy
- more insidious: bile duct stenosis <- clips or diathermy injury.
- Primary sclerosing cholangitis is a RF
- gradual onset obstructive pattern
Diagnosis 1st line
what and what it shows
US of liver and biliary trree
- bile duct calibre
- presence of gallstones
- may visualise pancreatic masses and other lesions.
The most important clinical question is essentially the extent of
and its distribution.
Diagnosis 1st and next
* 1st line
: US liver and biliary tree
* Next if suspect
- pancreatic neoplasia
: prancreatic protocol CT scan
- liver tumours and cholangiocarcinoma
: MRI/MRCP. If failed, ERCP.
- PET scans
: to stage