Biliary tract diseases resident survival guide: Difference between revisions

Revision as of 06:13, 4 January 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2]

Cholelithiasis

Definitions

Terms	Definitions
Cholelithiasis (gallstones)	Cholelithiasis (gallstones) are crystallized pieces of bile including cholesterol and bilirubin in the gallbladder, which can range from microscopic to more than one inch in size and from one stone to hundreds in number.
Microlithiasis (biliary sludge)	Microlithiasis (biliary sludge) are crystals and stones in the gallbladder that are too small to see with the naked eye.
Asymptomatic (incidential) cholelithiasis	Asymptomatic (incidential) cholelithiasis refers to incidentally detected gallstones during routine ultrasound for other abdominal conditions or occasionally by palpation of the gallbladder at operation in patients who do not have any abdominal symptoms or have symptoms that are not thought to be due to gallstones.
Symptomatic and uncomplicated cholelithiasis	Symptomatic and uncomplicated cholelithiasis refers to stones in the gallbladder that are associated with biliary colic in the absence of complications such as acute cholecystitis, cholangitis, or gallstone pancreatitis.
Symptomatic and complicated cholelithiasis	Symptomatic and complicated cholelithiasis refers to stones in the gallbladder that are associated with upper abdominal pain, not typical of biliary colic in the presence of complications such as acute cholecystitis, cholangitis, or gallstone pancreatitis.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Management

Characterize the symptoms:
❑ Asymptomatic
❑ Symptomatic

Asymptomatic:
Gallstones identified during
❑ Imaging evaluation of abdominal and pelvic diseases
❑ Palpation of gallbladder at operation

Symptomatic:
❑ Abdominal pain

❑ Right upper quadrant or epigastric or substernal pain

❑ Sharp, intermittent and cramping pain

❑ Pain for at least 30 minutes (but <6 hours)

❑ Pain radiating to right shoulder blade

❑ Pain after food intake

❑ Recurrent attacks ranging from hours to years

❑ Nausea & vomiting
❑ Diaphoresis

❑ Observation
❑ Expectant management
❑ Prophylactic cholecystectomy

@@ Line 18: / Line 18: @@
 |-
 |}
+===Causes===
+====Life Threatening Causes====
+Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
+====Common Causes====
+===Management===
+{{familytree/start |summary=Cholelithiasis}}
+{{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | |A01=<div style="float: left; text-align: left; line-height: 150% ">'''Characterize the symptoms:''' <br> ❑ Asymptomatic <br> ❑ Symptomatic </div> }}
+{{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
+{{familytree | | | | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | | | | | | | | | | | | }}
+{{familytree | | | | | | | | | B01 | | | | | | B02 | | | | | | | | | | | | | | | |B01=<div style="float: left; text-align: left; line-height: 150% ">'''Asymptomatic:'''<br> Gallstones identified during<br> ❑ Imaging evaluation of abdominal and pelvic diseases<br> ❑ Palpation of gallbladder at operation </div>|B02=<div style="float: left; text-align: left; line-height: 150% ">'''Symptomatic:'''<br> ❑ Abdominal pain<div class="mw-collapsible-content"> <div class="mw-collapsible mw-collapsed">
+:❑ Right upper quadrant or epigastric or substernal pain
+:❑ Sharp, intermittent and cramping pain
+:❑ Pain for at least 30 minutes (but <6 hours)
+:❑ Pain radiating to right shoulder blade
+:❑ Pain after food intake
+:❑ Recurrent attacks ranging from hours to years</div></div>
+<br>❑ Nausea & vomiting<br>❑ Diaphoresis </div>}}
+{{familytree | | | | | | | | | |!| | | | | | | |!| | | | | | | | |}}
+{{familytree | | | | | | | | | C01 | | | | | | |!| | | | | | | | |C01=<div style="float: left; text-align: left; line-height: 150% ">❑ Observation<br>❑ Expectant management<br>❑ Prophylactic cholecystectomy</div>}}