NMS. Surgery

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Chapter 10 ♦ Liver, Gallbladder, and Biliary Tree Disorders

III. Clinical presentation: Fever, nausea, vomiting, RUQ pain, Murphy sign (inspiratory arrest with RUQ palpation). IV. Diagnosis: A. Labs: Elevated bilirubin and alkaline phosphatase. B. Ultrasound: Shows gallstones, gallbladder wall thickening (>3 mm), and pericholecystic fluid. C. If ultrasound is equivocal, HIDA scan is gold standard. V. Treatment: A. Cholecystectomy B. If patient is not a surgical candidate, consider placing a percutaneous cholecystostomy tube. VI. Prognosis: Excellent. Quick Cuts • Cholelithiasis are stones in the gallbladder, whereas choledocholithiasis are stones in the biliary tree. • Acute cholecystitis is an infection of the gallbladder, and cholangitis is an ascending infection of the biliary tree. • The mainstay of treatment for choledocholithiasis and cholangitis is antibiotics and relief of the obstruction in the acute setting, followed by interval cholecystectomy. • Portal hypertension may present with variceal bleeding, which can be massive and difficult to treat. A. Cancer arising from the gallbladder epithelium. B. Chronic inflammation is a risk factor, but the precise cause is unknown. II. Clinical presentation: Pruritis, anorexia, weight loss, RUQ pain, jaundice. III. Diagnosis: Found on pathology after cholecystectomy for other cause. IV. Treatment: Surgical A. Confined to mucosa (T1): Cholecystectomy is curative. B. Invasive disease: Partial hepatectomy. V. Prognosis: Excellent for early stage, and poor for advanced disease. CHOLEDOCHOLITHIASIS I. Etiology: Stones in the bile ducts. II. Clinical presentation: RUQ pain, obstructive jaundice, acholic stools. III. Diagnosis: A. RUQ US and MRCP: Can show CBD stones or ductal dilation. B. ERCP: Definitive. C. Labs: Elevated bilirubin. GALLBLADDER CARCINOMA I. Etiology