담도질환 Biliary stone disease Infectious/inflammatory disease Tumor Gallbladder stone CBD stone IHD stone Infectious/inflammatory disease Acute/chronic cholecystitis Cholangitis Primary sclerosing cholangitis Tumor Gallbladder Intrahepatic cholangiocarcinoma Klatskin tumor Extrahepatic bile duct cancer Ampulla of Vater cancer

Gallstones Cholesterol stone Pigment stone Obesity Female sex hormone Ileal disease Bile stasis: TPN, NPO, pregnancy, drug Weight loss Clofibrate Pigment stone Black pigment stone: hemolysis, cirrhosis, IV hyperalimentation Brown pigment stone: infection related

Gallbladder stone Asymptomatic Symptomatic: biliary colic Wait and see Symptomatic: biliary colic Cholecystectomy Oral dissolution therapy: UDCA, CDCA Functioning GB: oral GB or DISIDA scan Radiolucent stone < 1.5 cm Floating stone 이면 좋다

gallstones

Acute cholecystitis RUQ pain/fever Gallstone Leukocytosis GB wall thickening/pericholecystic fluid collection

Common Bile duct stone IHD stones Colic, fever, jaundice Treatment ERCP and basket/balloon removal Surgery IHD stones Asymptomatic-cholangitis Treatment Surgery PTCS

Biliary tract tumor Gallbladder cancer Intrahepatic cholangiocarcinoma 여자>남자, gallstone, AUPBD, GB polyp Incidental GB cancer Mucosal lesion: wait and see Intrahepatic cholangiocarcinoma Hilar cholangiocarcinoma Extrahepatic bile duct cancer Ampulla of vater cancer

Obstructive jaundice Related terminology Cause Bilirubin, Alk.P, rGT, Pruritus Biliary tree dilation Cause Biliary stone Tumor extrahepatic bile duct/Klatskin tumor Ampulla of vater Pancreatic head Gallbladder

Pancreatic cancer Risk factor 발생과 예후: Head > body/tail Smoking, chronic pancreatitis 아닌 것: coffee, alcohol, gallstone 발생과 예후: Head > body/tail Palliative resection을 하지 않는다. 확진: NAC

Acute pancreatitis Cause Gallstone Alcohol Surgery, drug, hyperTG, trauma, Sphincter oddi dysfunction, pancreas divisum Cf) gallstone: not a cause of chronic pancreatitis

Chronic pancreatitis Cause Complication Pancreatic functional study Alcohol, hereditary, idopathic, cystic fibrosis Complication Malabsorption related DM Local: BD stricture, pancreatic cancer, pseudocyst Pancreatic functional study

Pancreatic pseudocyst A complication of pancreatitis TX indication Size > 5 cm > 6 weeks Complication related to cyst: size increment, rupture, hemorrhage, infection Symptomatic Tx Internal drainage: standard External drainage: if infected