Gall bladder and Biliary disease Dr Umit Akyuz

Gall bladder and Biliary disease Dr. Umit Akyuz Gastroenterology Department Yeditepe University, Istanbul

Biliary stone disease Acute cholecytitis Primer sclerosane cholangitis Primer biliary cirrhosis Tumors

CHOLELITHIASIS Chole – CYSTO - GALLBLADDER - DOCHO – D. CHOLEDOCHUS CHOLESTEROL PIGMENT(blb, ca) %75 % 25

CHOLESTROL STONES CHARACTERISTICS: – PURE OR MIXED – SMALL OR LARGE – SOLITARY OR MULTIPLE PIGMENT STONES CHARACTERISTICS: – – – ELDERLY HEMOLYTIC STATES CIRRHOSIS MULTIPLE, IRREGULAR CENTRAL CALCIFICATION

RISK FACTORS 4 F: – – Female Fat Fertile Forty 3 D – – – Diabetes Drugs Diet 2 H – HLP – Heredity Bile Salt Malabsorbtion

COMPLICATIONS STONE – PASSAGE – HYDROPS – CHOLECYSTITIS – ICTERUS Ac. CHOLECYTITIS EMPYEMA PERFORATION Chr. CHOLECYTITIS

CLINICS COLIC: – RUQ crampy Pain RADIATION BACK DYSPEPSIA Ac. CHOLECYTITIS + COMPLICATIONS

DIAGNOSIS USG X-Ray Plain Film ERC / P PTC CT

THERAPY Spasmolytica Antibiotics SURGERY – Absolute Complications – Relative Complications Medical: – Oral Lytholysis – Ursodeoxy-cholic Acid – ESLW

therapy

ACUTE CHOLECYSTITIS Acute Inflammation Primary Secondary Abacterial Bacterial Enterococcus E. Coli Gr. (-) Bacilli Anaerobs – Bacteroides – Clostridia – Fusobacterium

Symptoms Biliary colic Fever, chills, anorexia, nausea, vomiting Enlarged Gallbladder Murphy’s sign : RUQ-Palpation increased Pain in Inspiration

Diagnosis: Clinics, US, biochemistry Complications Empyema Gangrene Perforation Ileus

Therapy PE - Nutrition Antibiotics Cholecystectomie ? for Complications !

CHOLANGITIS Charcot’s Triad Biliary pain Jaundice Fever

Bacteria E. coli Klebsiella Proteus E. bacter Pseudomonas Clostridium

Complications Sepsis Hepatic Abcess Bil. Strictures Gallstones Sec. Bil. Cirrhosis PHT

Treatment ERCP Antibiotics

Primary Sclerosing Cholangitis İdiopathic intra+extrahepatic Chronic Fibrosing, Diffuse of bile Ducts Clinics: Cholestasis Bile D. Obliteration Cirrhosis

Clinics Jaundice Pruritus Fatique Weight loss UC 75 %, CD, RA, Sarcoidosis, Sjögren Syndrome M/F 1/3 ANCA + ; Ig. M

Complications 5–C Cholestasis Cirrhosis Cholangitis Cholelithiasis Cholangiocarcinoma

Therapy AB Cholestyramine Ursodeoxycholicacid Surgical : Liver Transplantation !

Primary Biliary Cirrhosis İnterlobuler and septal bile ducts Middle aged population 100 -150/1 million

Clinics Fatigue Piruritis Asymtomatic Jaundince Variciel bleeding ascites

Assosiated Disease keratoconjuctivites sikka (50%) Thyroid disease (15%) Artrithes (10%) Reynaud (9%) Scleroderma Renal stones Breast cancer

Diagnosis AMA >1/40 (M 2 band) 95% AST, ALT high Ig. M high Biluribune high Hypercholesterolemia 80% Pathology: florid duct lesions

Complications Osteopenia Fat soluble vit. Deficiency hypercholesterolemia

Treatment Ursodeoxycholic acid Corticosteroids Azothioprine Cyclosporine Methotraxate Penicilamine, colhicine no benefit Transplantation

TUMORS BENIGN – Polips – Adenomyomatosis – Cholesterosis MALIGN – Carcinoma – Adeno – Squamous Ductus Carcinoma – Pat 60 Years