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 - DOCHO – D. CHOLEDOCHUS CHOLESTEROL%75 PIGMENT(blb, ca)% 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 EMPYEMAPERFORATION Chr. CHOLECYTITIS

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

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

THERAPY SpasmolyticaAntibioticsSURGERY –Absolute Complications –Relative Complications Medical: –Oral Lytholysis –Ursodeoxy-cholic Acid –ESLW

therapy

ACUTE CHOLECYSTITIS Acute Inflammation PrimaryAbacterial SecondaryBacterial 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 Perforation  Ileus

Therapy  PE - Nutrition  Antibiotics Cholecystectomie ? Cholecystectomie ? for Complications ! for Complications !

CHOLANGITIS Charcot’s Biliary pain Charcot’s Biliary pain TriadJaundice TriadJaundiceFever

Bacteria E. coli KlebsiellaProteus E. bacter PseudomonasClostridium

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

Treatment ERCPAntibiotics

Primary Sclerosing Cholangitis İdiopathicintra+extrahepaticChronic Fibrosing,Diffuse of bile Ducts Clinics:Cholestasis Bile D. Obliteration Cirrhosis

Clinics JaundicePruritusFatique Weight loss UC75 %, CD, RA, Sarcoidosis,Sjögren Syndrome UC75 %, CD, RA, Sarcoidosis,Sjögren Syndrome M/F 1/3 ANCA + ; IgM 

Complications 5 – C CholestasisCirrhosisCholangitisCholelithiasisCholangiocarcinoma

Therapy ABCholestyramineUrsodeoxycholicacid Surgical : Liver Transplantation !

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

Clinics FatiguePiruritisAsymtomaticJaundince Variciel bleeding ascites

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

Diagnosis AMA >1/40 (M2 band) 95% AST, ALT high IgM high Biluribune high Hypercholesterolemia 80% Pathology: florid duct lesions

Complications Osteopenia Fat soluble vit. Deficiency hypercholesterolemia

Treatment Ursodeoxycholic acid CorticosteroidsAzothioprineCyclosporineMethotraxate Penicilamine,colhicine no benefit Transplantation

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