GI: Gallbladder

Check GS Notes as well (more on Gallstones, Cholecystitis) 
 
Primary sclerosing cholangitis
Primary biliary cirrhosis
#
·
Young 🤵🏻
·
Sclerosing: fibrosis
·
Cholangiaits:
inflammation of CBD
·
intra & extra
hepatic
·
Common w/ UC
·
⤴️ Risk for cholangiocarcinoma
·
Bitch: middle
aged 👩🏻
·
Interlobular bile
duct destruction + portal triad
·
⤵️ secretion of
bile
Sx
·
Early:
Insidious onset:
·
pruritus
·
jaundice
·
HSM
·
Late:
·
Cirrhosis (Liver
failure /Ascites)
·
portal HTN
·
pruritis
·
chronic
cholecystitis
·
jaundice
·
hyperlipidemia
Dx
·
LFT:
⤴️
ALP / GGT
·
ERCP:
strings on beads appearance
·
⊖
Anti-mitochondrial ab
·
LFT:
⤴️
ALP
·
RUQ
US: ⓝ
·
⊕ Anti-mitochondrial
ab (anti-mama)
Tx
·
Endoscopic
balloon / stent 
·
Liver transplantation in
selected cases
·
1˚
Ursodeoxycholic acid
·
Liver Transplant
Malignant Biliary Obstruction
?
·
Cholangiocarcinoma
·
Pancreatic/HCC
·
Metastasis
(Colon, gastric)
Clx
·
Jaundice,
·
Pruritus, acholic
stools, dark urine
·
Weight loss
·
RIJQ pain
·
RUQ mass or
hepatomegaly
·
⤴️ Direct
bilirubin, ALP, GGT
Dx
·
Serum tumor
markers (CEA, CA-19, AFP)
·
Abdominal (US, CT
scan)
·
EUS or ERCP for
tissue dx if unclear
Acute Cholangitis
?
Ascending infection due to biliary obstruction
Clx
Triad ∆:
Fever / RUQ Pain / Jaundice
Hypotension, AMS (Reynolds pentad)
Dx
·
🆎
Cholestatic LFT
·
⤴️ Direct
bilirubin, alkaline phosphatase
·
Mildly ⤴️
aminotransferases
·
Biliary dilation
on abdominal US / CT
Tx
·
Abx coverage of
enteric bacteria
·
ERCP
w/i 24-48 h and drain biliary tree
Biliary cysts
Path
Type 1 cysts (most common): extrahepatic,
single cystic dilatation of the bile duct
S/S
∆ of:
·
pain,
·
jaundice
·
palpable mass
Majority present at age <10 years
Dx
·
 US
·
ERCP
Tx
Surgical resection to relieve obstruction &
prevent malignant transformation

 

Posted on