Anatomy and Investigation of Gallbladder and Biliary System
Basic Anatomy and Physiology of Gallbladder and Biliary System
- Gallbladder: a pear-shaped organ under the liver, stores bile produced by the liver.
- Bile duct: carries bile from the liver and gallbladder to the duodenum.
- Liver: produces bile, filters blood, and stores glycogen.
Indications for Imaging Studies in Suspected Biliary Disease
- Abdominal pain
- Jaundice
- Abnormal liver function tests (LFTs)
- Mass in the abdomen
- Abdominal tenderness
Role of Liver Function Tests (LFTs) in Assessing Biliary Obstruction and Differentiating Hepatic vs Post-hepatic Jaundice
- LFTs assess liver function, including albumin, bilirubin, alkaline phosphatase, and transaminases.
- Elevated LFTs indicate liver dysfunction.
- Biliary obstruction: alkaline phosphatase and bilirubin levels are elevated.
- Hepatic vs post-hepatic jaundice:
- Hepatic jaundice: elevated LFTs, including transaminases.
- Post-hepatic jaundice: elevated bilirubin levels, normal LFTs.
Role of ERCP and MRCP in Diagnosis and Management
- ERCP (Endoscopic Retrograde Cholangiopancreatography): visualizes bile and pancreatic ducts.
- MRCP (Magnetic Resonance Cholangiopancreatography): non-invasive imaging of bile and pancreatic ducts.
- ERCP and MRCP are used to diagnose and manage biliary obstruction, bile duct stones, and pancreatic disorders.
Pathology of Gallbladder and Biliary System
Types of Gallstones
- Cholesterol stones: composed of cholesterol, occur in 80% of gallstones.
- Pigment stones: composed of bilirubin, occur in 20% of gallstones.
- Mixed stones: combination of cholesterol and pigment.
Clinical Features of Gallbladder and Biliary System
- Gallstones: asymptomatic in 80%, symptomatic in 20%.
- Gallbladder inflammation (cholecystitis): abdominal pain, fever, leukocytosis.
- Biliary obstruction: jaundice, abdominal pain, elevated LFTs.
- Bile duct cancer (cholangiocarcinoma): jaundice, abdominal pain, weight loss.
Complications of Gallbladder and Biliary System
- Cholecystitis: inflammation of the gallbladder.
- Cholangitis: inflammation of the bile ducts.
- Bile peritonitis: bile leakage into the peritoneal cavity.
- Bile duct stricture: narrowing of the bile duct.
Management and Treatment of Gallbladder and Biliary System
- Conservative treatment: analgesics, fluids, and antibiotics.
- Surgery: cholecystectomy (gallbladder removal), bile duct exploration.
- ERCP: stone extraction, stent placement.
- MRCP: non-invasive imaging for diagnosis and management.
Investigation and Diagnostic Procedure
- Abdominal ultrasound: detects gallstones and bile duct dilatation.
- CT scan: detects gallbladder inflammation and bile duct obstruction.
- ERCP: visualizes bile and pancreatic ducts.
- MRCP: non-invasive imaging of bile and pancreatic ducts.
Surgical Procedure
- Cholecystectomy: gallbladder removal.
- Bile duct exploration: stone extraction, stent placement.
- ERCP: stone extraction, stent placement.
Homoeopathic Therapeutic Medicines
- Aloe: for gallbladder inflammation.
- Chelidonium: for bile duct obstruction.
- Bryonia: for abdominal pain and inflammation.
- Arsenicum album: for jaundice and abdominal pain.