Cholestasis, diseases of gallbladder and bile duct
Cholestasis, Gallbladder & Bile Duct Diseases
CHOLESTASIS
Definition and Overview
Cholestasis refers to a condition characterized by impaired bile formation or flow, leading to accumulation of bile components such as bile acids, bilirubin, and cholesterol in the liver and bloodstream. It may result from intrahepatic dysfunction (within the liver) or extrahepatic obstruction (in bile ducts).
Definition[edit | edit source]
- Cholestasis = impaired bile flow
Types[edit | edit source]
- Intrahepatic cholestasis (hepatocellular dysfunction)
- Extrahepatic cholestasis (biliary obstruction)
Pathophysiology
Under normal conditions, bile is produced by hepatocytes and transported through canaliculi into bile ducts. In cholestasis, this flow is disrupted, leading to retention of toxic bile acids that damage hepatocytes and bile duct cells.
Pathophysiology[edit | edit source]
- Impaired bile secretion or flow
- Accumulation of bile acids
- Hepatocellular injury
- Inflammation and fibrosis (chronic cases)
Causes
Intrahepatic causes: Viral hepatitis Alcoholic liver disease Drug-induced liver injury Pregnancy (intrahepatic cholestasis of pregnancy) Primary biliary cholangitis Extrahepatic causes: Gallstones Tumors (e.g., pancreatic carcinoma) Biliary strictures Primary sclerosing cholangitis
Causes of Cholestasis[edit | edit source]
Intrahepatic[edit | edit source]
- Viral hepatitis
- Alcohol
- Drugs
- Pregnancy
- Primary biliary cholangitis
Extrahepatic[edit | edit source]
- Gallstones
- Tumors
- Biliary strictures
- Primary sclerosing cholangitis
Clinical Features Cholestasis typically presents with symptoms related to bile retention, particularly jaundice and pruritus.
Symptoms[edit | edit source]
- Jaundice
- Pruritus (itching)
- Dark urine
- Pale stools
- Fatigue
Signs[edit | edit source]
- Hepatomegaly
- Steatorrhea (fat malabsorption)
Diagnosis
Diagnosis is based on laboratory findings and imaging studies.
Diagnosis[edit | edit source]
- Labs:
- ↑ ALP (alkaline phosphatase)
- ↑ GGT
- ↑ conjugated bilirubin
- Imaging:
- Ultrasound (first-line)
- MRCP / ERCP
Management
Treatment depends on the underlying cause, with relief of obstruction being essential in extrahepatic cholestasis.
Treatment[edit | edit source]
- Treat underlying cause
- Relieve obstruction (stones, tumors)
- Ursodeoxycholic acid
- Fat-soluble vitamin supplementation (A, D, E, K)
DISEASES OF THE GALLBLADDER Overview
The gallbladder stores and concentrates bile and releases it during digestion. Diseases of the gallbladder are most commonly related to gallstones (cholelithiasis) and their complications.
Cholelithiasis (Gallstones) Definition
Cholelithiasis refers to the formation of stones within the gallbladder, usually composed of cholesterol or pigment.
Types of Gallstones[edit | edit source]
- Cholesterol stones (most common)
- Pigment stones:
- Black (hemolysis)
- Brown (infection)
Pathophysiology
Gallstones form when bile becomes supersaturated with cholesterol or bilirubin, leading to crystallization and stone formation.
Risk Factors
Risk Factors[edit | edit source]
- Female
- Fat (obesity)
- Forty (age)
- Fertile (pregnancy)
- Rapid weight loss
Clinical Features
Most gallstones are asymptomatic, but they may cause biliary colic, characterized by episodic right upper quadrant pain.
Symptoms[edit | edit source]
- Right upper quadrant pain
- Pain after fatty meals
- Nausea and vomiting
Acute Cholecystitis Definition
Acute cholecystitis is inflammation of the gallbladder, usually caused by obstruction of the cystic duct by a gallstone.
Pathophysiology
Obstruction leads to bile stasis, inflammation, and possible infection. Clinical Features
Symptoms[edit | edit source]
- Severe RUQ pain
- Fever
- Nausea/vomiting
Sign[edit | edit source]
- Murphy's sign (inspiratory arrest on palpation)
Diagnosis
Ultrasound (first-line) Gallbladder wall thickening Pericholecystic fluid
Treatment
Treatment[edit | edit source]
- IV fluids
- Antibiotics
- Cholecystectomy (definitive)
DISEASES OF THE BILE DUCTS Overview
Bile duct diseases involve obstruction, inflammation, or malignancy of the biliary tree, often leading to cholestasis.
Choledocholithiasis Definition
Presence of gallstones in the common bile duct (CBD).
Clinical Features
Symptoms[edit | edit source]
- Jaundice
- RUQ pain
- Possible cholangitis
Diagnosis
Ultrasound MRCP ERCP (diagnostic + therapeutic)
Treatment
Treatment[edit | edit source]
- ERCP stone removal
- Cholecystectomy
Cholangitis Definition
Cholangitis is infection of the bile ducts, usually due to obstruction.
Clinical Features
Charcot's Triad[edit | edit source]
- Fever
- Jaundice
- RUQ pain
Reynolds Pentad[edit | edit source]
- Charcot triad +
- Hypotension
- Altered mental status
Treatment
Treatment[edit | edit source]
- Emergency!
- IV antibiotics
- Urgent biliary decompression (ERCP)
Primary Sclerosing Cholangitis (PSC) Overview
PSC is a chronic inflammatory disease causing fibrosis and strictures of bile ducts.
Features[edit | edit source]
- Multifocal strictures ("beading")
- Associated with ulcerative colitis
- Risk of cholangiocarcinoma
Summary Table
Summary of Key Diseases[edit | edit source]
| Condition | Key Feature | Diagnosis | Treatment |
|---|---|---|---|
| Cholestasis | Impaired bile flow | Labs + imaging | Treat cause |
| Cholelithiasis | Gallstones | Ultrasound | Observation/surgery |
| Cholecystitis | Inflamed gallbladder | Ultrasound | Surgery |
| Choledocholithiasis | CBD stones | MRCP/ERCP | ERCP |
| Cholangitis | Infection + obstruction | Clinical + imaging | Emergency ERCP |
