Gall Bladder Disorders Author:

Yan Yu
Reviewers:
Paul Ratti
Amy Maghera
Understanding the terminology: Eldon Shaffer*
• ”Chol-” = bile * Indicates faculty member
• ”-docho-”= duct at time of publication
• ”-lith-” = stone
• ”-ang-” = vessel
• ”-iasis” = process
• ”-stasis” = standing still
• ”-itis” = inflammation
Liver

R & L Hepatic Ducts Cholelithiasis:

Presence of gallstones
in the gallbladder
Cholestasis:
obstruction of bile Common Hepatic Duct
flow along the biliary
tract anywhere Choledocholithiasis:
from the liver to the Cystic Duct Presence of gallstones
duodenum in the biliary tract

Gallbladder

Common Bile Duct Ascending Cholangitis:

Inflammation or infection
of the biliary tree, due most
commonly to gallstone(s)
obstructing the billiary tract
Duodenum (other, rarer causes exist)

Pancreatic duct

Pancreas

Illustration by Yan Yu, May 13th, 2012

Legend: = pathophysiology = mechanism = sign/symptom/lab finding = complications Published August 7th, 2012 on www.thecalgaryguide.com
Cholestasis: Author:
Yan Yu
Causes, Signs and Symptoms Reviewers:
Paul Ratti
Primary Sclerosing cholangitis (PSC) Amy Maghera
Hepatic Neoplasms Eldon Shaffer*
* Indicates faculty member
Parasitic infestation of bile Choledocholithiasis (stones/
Sepsis due to Primary Biliary at time of publication
ducts (i.e. by flukeworms strictures in common bile
hepatic infection Sclerosis (PBC)
such as clonorchis) duct – usually benign)
Hepatic Inflammation (due Congenital Pancreatic or bile Congenital abnormalities
to drugs, ethanol, TPN, etc) deformities duct malignancy (i.e. biliary atresia)

Blockage of bile flow occurs within Blockage of bile flow occurs bile
the liver, so bile ducts (external to the ducts external to the liver, so
liver) look normal on Ultrasound they look dilated on Ultrasound

Intra-hepatic cholestasis Extra-hepatic cholestasis

Cholestasis
Obstruction of bile flow from liver to duodenum

Bile backed up in the liver → Less bile passes into GI tract

enters systemic circulation to be excreted via stool

Bile (and the bilirubin it Complex mechanisms, not Bilirubin in the blood Less bilirubin in stool
contains) accumulates: completely understood filtered into urine to deepen stool color

Fatigue Dark Urine Pale Stools

Under the sclera Under the skin

Scleral icterus Jaundice Bilirubin binds

(yellowing of (skin becomes sensory receptors
the sclera) yellow) under the skin

Scratching produces
Pruritus (itching) Excoriations (scratch-marks)

Legend: = pathophysiology = mechanism = sign/symptom/lab finding = complications Published August 7th, 2012 on www.thecalgaryguide.com
Cholelithiasis: Authors:
Yan Yu
Formation of Gallstones, and their Complications Eldon Shaffer*
Reviewers:
6 F’s: Female, Fertile, Fat, Forty+ (age), Family (Aboriginals > Paul Ratti
Note: Amy Maghera
• Gallstones do not cause Hispanics > whites), Pharmacology (octreotide, fetriaxone) * Indicates faculty member
an elevation of ALP unless at time of publication
obstructing the bile ducts
• 80% of gallstones are silent. Presence of certain Impaired gallbladder
• Gallstones only become gallbladder proteins Supersaturation of Bile (↑ contractility, gallbladder
symptomatic when they cholesterol relative to bile
obstruct a duct.
(mucin, immunoglobulins) hypomotility
acid solubilizing agent)

↑ nucleation points ↓ mixing of gallbladder

physically facilitating contents, ↑ residence
gallstone crystallization time for stone growth
within the gallbladder

Cholelithiasis
Presence of gallstones in the gallbladder, 20% of which develop complications:

Mechanical and chemical Gallbladder contractions Gallstone migration into biliary

irritation of the gall (in response to hormonal/neural tract (Choledocholithiasis)
bladder’s epithelial mucosa stimulation after food ingestion) force
stone(s) against cystic duct opening Blocks sphincter of oddi Blocks the common bile duct,
or the ampulla of vater, preventing normal bile flow
obstructs pancreatic duct!
↑ intra-gallbladder pressure Cholestasis Infection of the biliary
Backed up pancreatic
Acute inflammation tree as duodenal
secretions ↑ pressure on
of the gallbladder bacteria “ascend” up
Impulses propagated acinar cells, injuring them
the bile duct
Bacteria colonization via autonomic nerves
of the gallbladder Acinar cell injury auto-
occurs in 50-85% of Biliary Colic: activates pancreatic Ascending Cholangitis
cases, can worsen constant, crescendo pain, proteases, which digest (medical emergency)
inflammation starting in RUQ, radiating pancreatic tissue
to the back and chest
Acute Cholecystitis Acute Pancreatitis

Legend: = pathophysiology = mechanism = sign/symptom/lab finding = complications Published August 7th, 2012 on www.thecalgaryguide.com