GB and Bile Ducts

Cholelithiasis Asymptomatic  Biliary Colic (1-4 % annual incidence) Acute Cholecystitis (20 % of the symptomatic patients if left untreated) In small number of patients, Acute cholecystitis can coexist with  Choledocholithiasis Cholangitis Gallstone pancreatitis Acute Calculous Cholecystitis  Pathogenesis Obstruction of the cystic duct in the presence of bile supersaturated with cholesterol.  Brief impaction may cause pain only, but if impaction is prolonged over many hours, inflammation can result. With inflammation, the gallbladder becomes enlarged, tense, and reddened, and wall thickening and an exudate of pericholecystic fluid may develop. The inflammation is initially sterile in most cases, but secondary infection with microorganisms in the Enterobacteriaceae family or with enterococci or anaerobes occurs in the majority of patients  Gangrenous Cholecystitis: GB Wall may get gangrenous  Emphysematous Chelecysitits: Gas forming organism causing superinfection Acute Calculous Cholecystitis NEJM 2008 Acute Calculous Cholecystitis NEJM 2008 Gallstones BMJ 2014 Ursodeoxycholic Acid for the Treatment of Primary Biliary Cirrhosis NEJM 2007 Medical Progress: Primary Biliary Cirrhosis NEJM 2005 GB Disease: Diagnosis and Treatment Cleve Clinic J 2002  Primary Sclerosing Cholangitis Primary Sclerosing Cholangitis Lancet 2013  Primary Sclerosing Cholangitis Lancet 2013  Is an extra intestinal manifestation of UC 2 main prognostic outcome Cholangiocarcinoma Colon Cancer  References: Primary Sclerosing Cholangitis Lancet 2013