recent posts

ACUTE CHOLANGITIS,CARCINOMA OF THE BILE DUCT and Surgical Jaundice

ACUTE CHOLANGITIS,CARCINOMA OF THE BILE DUCT and Surgical Jaundice

ACUTE CHOLANGITIS

Mechanism:

  • obstruction of common bile duct leading to biliary stasis, bacterial overgrowth, suppuration, and biliary sepsis - life threatening

Etiology
  1. choledocholithiasis (60%)
  2. post-operative stricture
  3. pancreatic or biliary neoplasms

Organisms : E. coli, Klebsiella, Pseudomonas, Enterococci, B. fragilis, Proteus

Signs and symptoms :
  1. Charcot's triad:
    • fever
    • jaundice,
    • RUQ pain
  2. Reynold's pentad:
    • Charcot's triad +
    • mental confusion,
    • hypotension leading to renal failure

Diagnostic investigations
  1. elevated WBC
  2. elevated liver function tests and conjugated bilirubin
  3. U/S shows gallstones in gallbladder +/- stones seen in bile ducts (approximately 10-15%) +/- dilated extrahepatic or intrahepatic bile ducts

Treatment
  1. antibiotics, hydration
  2. urgent ERCP - diagnostic and therapeutic with papillotomy to remove stones
  3. if ERCP unavailable or unsuccessful, then PTC
  4. if ERCP, PTC unavailable, surgery to decompress CBD ----> T-tube
  5. if elderly, (usually) don’t have to remove gallbladder if adequate ERCP + papillotomy

CARCINOMA OF THE BILE DUCT 

  1. majority adenocarcinoma 
  2. 2% of cancer deaths (1/8 as common as pancreatic cancer) 
Associations
  1. age 50-70 years
  2. age 20-40 if chronic ulcerative colitis, Clonorchis  sinensis (a liver fluke)infestation, sclerosing cholangitis, choledochal cysts
  3. female:male = 2:1

Clinical presentation
  1. local: RUQ pain, palpable mass (if tumour in CBD)
  2. systemic: unremitting jaundice, pruritus, weight loss, anorexia 

Investigations
  • Klatskin tumour (at common hepatic duct bifurcation)causes increased ALP, bilirubin, but normal AST
Diagnosis:

  • U/S and CT (dilated bile ducts), ERCP and PTC (depict tumour)

Treatment
  1. +/- stents for palliation
  2. radiation or Whipple's if tumour at low end of CBD

Prognosis
  1. spread: growth into portal vein or hepatic artery, liver, hilar nodes
  2. 10-15% 5 year survival
  3. death results from progressive biliary cirrhosis, persistent intrahepatic infection and abscess formation, or sepsis

.

Surgical Jaundice

Surgical Jaundice

ACUTE CHOLANGITIS,CARCINOMA OF THE BILE DUCT and Surgical Jaundice ACUTE CHOLANGITIS,CARCINOMA OF THE BILE DUCT and Surgical Jaundice Reviewed by Radiology Madeeasy on September 03, 2010 Rating: 5
Powered by Blogger.