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Cystic Duct Obstruction


Presentation

  • At present, though there are perspectives of rational conservative treat ment and though endoscopic techniques permit removing some of its complications even without laparotomy, the basic treatment method still remains, and probably shall remain for long[books.google.com]
  • This report presents a 56-year-old man with pancreatic cancer with malignant cystic duct obstruction who underwent percutaneous transhepatic gallbladder drainage.[gi-intervention.org]
  • RESULTS: Our presentation is the seventh case reported in the world literature.[ncbi.nlm.nih.gov]
  • We present here a case of 33-year-old female patient who presented with obstructive jaundice.[mjdrdypu.org]
  • We present the third case of metastatic lung cancer to the common bile duct presenting as abdominal distention and jaundice.[omicsonline.org]
Inflammation
  • However, the procedure of track dilation is difficult in case of severe gallbladder wall thickening with tumor involvement or inflammation.[gi-intervention.org]
  • Cells with a defective cytoprotection failed to inactivate free radicals induced by normal concentrations of hydrophobic bile salts resulting in chronic inflammation that may lead to acute inflammation.[ncbi.nlm.nih.gov]
  • Toyota N, Takada T, Amano H, et al. (2006) Endoscopic naso-gallbladder drainage in the treatment of acute cholecystitis: Alleviates inflammation and fixes operator’s aim during early laparoscopic cholecystectomy.[link.springer.com]
  • Typically diagnosed in mid-adulthood, these conditions create ongoing inflammation in the bile duct walls, which can narrow and scar the walls.[drugs.com]
  • Patients with acute inflammation of the gallbladder (and acalculus cholecystitis) may sometimes be treated first with "percutaneous drainage".[ddc.musc.edu]
Gangrene
  • False-negative morphine-augmented cholescintigraphy in a patient with gangrenous cholecystitis. Clin Nucl Med 1992;17:929-930. 12. Yen TC, King KL, Chang SL, and Yeh SH.[med.harvard.edu]
  • Though any patient who develops acute cholecystitis may go on to develop gangrene ( severe infection) of the gallbladder, diabetic patients are particularly prone to this.[canyonsurgicalutah.com]
  • Perforation of gallbladder K82.3 Fistula of gallbladder K82.4 Cholesterolosis of gallbladder K82.8 Other specified diseases of gallbladder K82.9 Disease of gallbladder, unspecified K82.A Disorders of gallbladder in diseases classified elsewhere K82.A1 Gangrene[icd10data.com]
  • Most patients with choledocholithiasis should be admitted for definitive treatment due to high rates of associated complications such as cholangitis, pancreatitis, gallbladder perforation and gangrene.[cdemcurriculum.com]
  • […] artifact Prominent ring down echo (gas) along GB wall with posterior ring down Serious painful complication of acute cholecystitis, eats away at GB to other places GB wall thick & has edema Gallstones/Sludge in 80-95% of cases Sonographic appearance of Gangrenous[quizlet.com]
Surgical Procedure
  • Available from Currently laparoscopic cholecystectomy (LC) and common bile duct exploration (LCBDE) has become the standard surgical procedure for cholecystolithiasis and choledocholithiasis.[medsci.org]
  • The tubes are left in place for as long as 6 months and then removed in another short surgical procedure or in the doctor's office, depending on the type of stent used. Another treatment is balloon catheter dilation (DCP).[kidshealth.org]
  • Other surgical procedures may be needed if a stone becomes stuck in the bile duct. After a gallbladder is removed You do not need a gallbladder to digest food. Bile still flows from the liver to the gut once the gallbladder is removed.[patient.info]
  • Surgical procedures can help cancer patients feel better, even if they cannot provide a cure. Surgery can reroute the bile duct to allow better drainage. Radiation treatments can help to shrink, but not cure, a bile duct tumor.[drugs.com]
  • -This classification may be helpful for making a diagnosis and planning the surgical procedure for individual cystic duct carcinoma patients.[wjso.biomedcentral.com]
Swelling
  • Suitable conditions for ETGBD application for cystic duct obstruction by impacted stones were as follows. 1) acute cholecystitis, 2) under 15 mm impacted stone size, 3) no gallbladder swelling and no severe wall thickening on ultrasonography, 4) over[jstage.jst.go.jp]
  • This blockage can lead to painful swelling of the gallbladder and sometimes requires surgery.[innerbody.com]
  • The increased pressure in the gallbladder leads to swelling and pain. This pain, known as biliary colic, is sometimes referred to as a gallbladder "attack" because of its sudden onset.[en.wikipedia.org]
  • Signs include redness at the inner corner of the eye and a slight tenderness and swelling or bump at the side of the nose.[kidshealth.org]
  • The build-up of bile along with the swelling can potentially prevent the healing of the bile duct resulting in a leakage of bile from the common bile duct into the tummy.[cochrane.org]
Jaundice
  • Jaundice occurred 70 days later as a result of tumor invasion above the segment with the stent, and an additional stent was placed.[ncbi.nlm.nih.gov]
  • Jaundice can often be seen as a yellowing of the skin and in the white part of the eyes. Jaundice is the most common symptom of bile duct cancer, but most of the time, jaundice isn't caused by cancer.[cancer.org]
  • All patients underwent stent placement in the bile duct, using an uncovered stent in 2 and a covered stent in 1, to relieve jaundice occurring 8–184 days (mean 120 days) before the development of acute cholecystitis.[link.springer.com]
Biliary Colic
  • The examination of patients with biliary colic may only reveal RUQ or epigastric tenderness.[cdemcurriculum.com]
  • Laparoscopic cholecystectomy for symptoms of biliary colic in the absence of gallstones. Am J Surg. 2003;186(1):1–3. 32. Henderson SO, Swadron S, Newton E. Comparison of intravenous ketorolac and meperidine in the treatment of biliary colic.[aafp.org]
  • Stones which form in the gallbladder and are known as gallstones, are responsible for a whole spectrum of disease entities ranging from simple biliary colic to fulminant cholangitis or necrotizing pancreatitis.[canyonsurgicalutah.com]
  • Investigations Stones in the gallbladder or cystic duct that are causing biliary colic are unlikely to produce abnormal lab test results.[almostadoctor.co.uk]
  • This pain, known as biliary colic, is sometimes referred to as a gallbladder "attack" because of its sudden onset.[en.wikipedia.org]
Gallbladder Enlargement
  • -Enlargement of the GB, caused by a slow progressive obstruction of the distal CBD from an external mass.[quizlet.com]
Suggestibility
  • These studies suggest that lithogenic bile that can deliver high cholesterol concentrations to the gallbladder wall causes hypomotility and creates a permissive environment that allows normal concentrations of hydrophobic bile salts to inflame the mucosa[ncbi.nlm.nih.gov]
  • Normal labs and the presence of gallstones without other findings on US suggest biliary colic.[cdemcurriculum.com]
  • An abdominal ultrasonography and computed tomography scan showed dilatation of intrahepatic biliary radicals with abrupt termination of common bile duct (CBD) suggestive of stricture and markedly distended gall bladder suggestive of obstructive pathology[mjdrdypu.org]
  • Patients with small gallbladder tumors may present with symptoms suggesting cholecystitis (e.g., abdominal pain, fever), whereas larger tumors may manifest late with jaundice and an abdominal mass.[clevelandclinicmeded.com]
  • Synonyms: Courvoisier’s sign, Courvoisier syndrome, Courvoisier-Terrier sign, Bard-Pic disease Over years, the use of the term Courvoisier’s sign or gallbladder has been suggested instead of law, because of rising number of exceptions.[epomedicine.com]

Workup

  • Approximately 70% of these patients will usually obtain relief of their symptoms following cholecystectomy if they have undergone a previous workup for their abdominal pain that is negative for any other cause of the pain[canyonsurgicalutah.com]
  • A cholecystokinin-HIDA scan is helpful in patients with suspected gallstones, but who have normal findings on ultrasonography and workup for their symptoms (e.g., upper endoscopy, upper gastrointestinal series, negative Helicobacter pylori serology).[aafp.org]
Cholesterol Increased
  • High concentrations of cholesterol increase its diffusion rates through the gallbladder wall where they are incorporated into the sarcolemmae of muscle cells by caveolin proteins.[ncbi.nlm.nih.gov]

Treatment

  • Attention is mostly paid to interventions on the biliary ducts with their wide scope of problems and to the prevention and treatment of postoperative disturbances.[books.google.com]
  • CONCLUSIONS: EUS-GBD is a feasible, safe, and effective modality for the treatment of malignant cystic duct obstruction in patients who are not indicated for surgery.[ncbi.nlm.nih.gov]
  • Miyayama S, Matsui O, Taki K, et al. (2006) Bile duct disruption after blunt hepatic trauma: Treatment with percutaneous repair.[link.springer.com]
  • We conclude that ETGBD is a useful method for treatment of acute cholecystitis caused by cystic duct obstruction by impacted stones.[jstage.jst.go.jp]

Prognosis

  • The prognosis of carcinoma of cystic duct is better than extrahepatic bile duct malignancies.[wjso.biomedcentral.com]
  • The high resectability of this small tumor also contributes to its better prognosis.[mjdrdypu.org]
  • The prognosis for primary sclerosing cholangitis and primary biliary cirrhosis has improved with better medical treatment and the potential for liver transplantation.[drugs.com]
  • Owing to advances in chemotherapy and endocrine therapy, the prognosis for breast cancer has improved over the years. Despite this, many patients continue to experience disease recurrence.[surgicalcasereports.springeropen.com]
  • Prognosis The prognosis as well as the mortality and morbidity of biliary obstruction depends on the cause. Complications Note the following: The complications of cholestasis are proportional to the duration and intensity of the jaundice.[emedicine.medscape.com]

Etiology

  • A rare etiology is hematogenous metastasis to the interior lumen of the CBD. Only two cases reported in the literature of hematogenous metastatic involve the CBD lumen [ 2, 3 ].[omicsonline.org]
  • The etiology of this disorder in patients who are HIV-positive is thought to be infectious (cytomegalovirus, Cryptosporidium species, and microsporidia have been implicated).[emedicine.medscape.com]
  • […] thickness off GB wall w/ a stone in the area of the GB neck or cystic duct; edema found within the GB wall Normal wall thickness ,3mm MOST COMMON form of GB inflammation * Recurrent inflammatory changes in Gb (recurring attacks of acute cholecystitis) Etiological[quizlet.com]
  • Gallstones and Cholecystitis Definition and Etiology Gallbladder stones are an extremely common disorder and are usually asymptomatic.[clevelandclinicmeded.com]

Epidemiology

  • Epidemiology More common in women. Cholesterol secretion is a massive factor in gallstone formation – particularly the amount of cholesterol secreted in relation to the concentration of bile salts.[almostadoctor.co.uk]
  • Over the past two decades, much has been learned about the epidemiology of this condition and its risk factors 2 ( Table 1 3 ).[aafp.org]
  • Epidemiologic studies have shown variations in the prevalence of gallstones in different ethnic populations, with particularly high rates in Native Americans.[clevelandclinicmeded.com]
  • Epidemiology United States data The incidence of biliary obstruction is approximately 5 cases per 1000 people. Race-related demographics The racial predilection depends on the cause of the biliary obstruction.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology and Natural History Most gallstones are composed primarily of cholesterol, with smaller amounts of mucus, calcium bilirubinate, and protein.[clevelandclinicmeded.com]
  • Postcholecystectomy pain syndrome: Pathophysiology of abdominal pain in sphincter of Oddi type III. Gastroenterology 1999; 116 (4):900–905. 10. Verne, GN, Robinson, ME, Vase, L, et al.[nature.com]
  • […] in the hepatodudoenal ligament and then courses through the head of the pancreas for approximately 2 cm; it joins the terminal part of the pancreatic duct to form the ampulla of Vater before passing through the papilla of Vater into the duodenum. [1] Pathophysiology[emedicine.medscape.com]
  • In Sleisinger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management, 6th edition, eds. M. Feldman, B. F. Scharschmidt, and M. H. Sleisinger. Philadelphia, PA: Saunders.[encyclopedia.com]

Prevention

  • On the contrary, the indications for such intervention are always widening, as its risks become always smaller and the requirements for prevention higher.[books.google.com]
  • Ursodeoxycholic acid salts (URSO) block these bile salts effects thereby preventing the generation of free radicals in muscle cells in vitro and development of cholecystitis in the ligated common bile duct in guinea pigs in vivo.[ncbi.nlm.nih.gov]
  • However, the study authors note that the effects were more preventative than curative. The primary goal of treatment of biliary obstruction is to remove the blockage, followed by improving bile flow to prevent further blockages.[livestrong.com]
  • The build-up of bile along with the swelling can potentially prevent the healing of the bile duct resulting in a leakage of bile from the common bile duct into the tummy.[cochrane.org]
  • Other symptoms result from the bile ducts' failure to deliver certain digestive juices (bile salts) to the intestines, preventing the absorption of some fats and vitamins.[drugs.com]

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