MRAD 4218- MODULE 3 BILIARY

Jaundice

symptom of liver or gallbladder pathology (not a pathology in its own right)

- also known as icterus

- excess accumulation of bile pigment (bilirubin)

bilirubin

byproduct of red blood cell hemolysis

- sent to the liver to be metabolized and turned into bile

3 types of jaundice

hemolytic, hepatocellular, obstructive

hemolytic jaundice

increased amount of RBC breakdown

- The increased amount of bilirubin in the bloodstream makes it difficult for the liver to metabolize it all

hepatic jaundice

damage to the liver that reduces its ability to metabolize bilirubin

- both hepatitis and cirrhosis can cause jaundice

obstruction induce jaundice

An obstruction caused by biliary calculi (gall bladder stones) in the hepatobiliary ducts or narrowing of the hepatobiliary ducts caused by a diseased liver my prevent the proper excretion of bile into the digestive system

biliary system

- right and left hepatic ducts which gather bile from the liver

- bile is drained into the common hepatic duct and then enters the cystic duct for storage in the gallbladder

where is bile created

liver

where is bile stored

gallbladder

what occurs when fatty food enters the digestive system?

gallbladder will contract expelling bile back through the cystic duct, down the common bile duct and into the duodenum to help with digestion

Choliolithiasis

- gallbladder stones

- composed of differing amounts of cholesterol and bilirubin and calcium salts (a component of bilirubin).

2 main types of gallstones

cholesterol and pigment

cholesterol stones

Composed mostly of cholesterol, bilirubin and calcium salts, these stones are seen in approximately 75% of the population who develop gallstones.

-appear green

pigment stones

Composed of mainly of cholesterol and bilirubin, these stones are seen in approximately 25% of the population who develop gallstones.

- appear darker

Choliolithiasis

classification of choliolithiasis

inflammatory

4 F's of choliolithiasis

forty

fat

female

fertile

where does pain most likely occur in choliolithiasis

upper right quadrant pain as well as nausea

Pain caused by gallstones tends to occur approximately 20-30 minutes after eating. Why?

That is the amount of time it takes for food to enter the duodenum from the stomach, thus triggering the gallbladder to release bile into the digestive tract.

Choledocholithiasis

This term is used to describe biliary stones stuck in the common bile duct.

imaging for choliolithiasis

sonography

- ERCP

radiographic sign of choliolithiasis

mercedes sign

positioning for imaging choliothiasis

upright abdomen

As both biliary stones and right sided renal stones occur in the Right Upper Quadrant of the abdomen, what additional projection could be done if calcified calculi appear in the RUQ of the abdomen on a plain abdominal image?

An RPO abdomen image will displace biliary stones laterally and renal stones medially due to the relational position of the gallbladder to the right kidney.

medication to treat choliolithiasis

anti-spasmodic drugs and analgesics.

Cholecystitis

inflammation of the gallbladder

- associated with patients who have cholelithiasis and have a biliary stone stuck in the cystic duct.

-may lead to rupturing of the gallbladder

Emphysematous Cholecystitis

- acute cholecystitis w/ gas in the GB walls, lumen, or tree

- more common in diabetic males

- comet-tail, reverb artifact