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Diseases of the gallbladder and biliary tree 

Diseases of the gallbladder and biliary tree
Chapter:
Diseases of the gallbladder and biliary tree
Author(s):

Colin Johnson

, and Mark Wright

DOI:
10.1093/med/9780198746690.003.0334
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date: 27 February 2021

Diseases of the gallbladder and bile ducts are common, with gallstones and their complications being most frequent. Less common are biliary strictures, usually malignant, which are caused by adenocarcinomas of the pancreas, bile ducts, ampulla of Vater, and gallbladder. Rarely encountered are sclerosing cholangitis and a variety of congenital disorders. Disorders of the biliary system include gallstones, which cause biliary colic and cholecystitis by obstruction of the cystic duct, and bile duct obstruction (cholestasis), with jaundice, dark urine, and pale stools, itching, and sometimes constant right hypochondrial pain. Fevers and rigors may indicate bacterial infection of the biliary tract (cholangitis), which frequently accompanies partial obstruction. Weight loss may be due to fat malabsorption but can also be caused by malignancy. Prolonged biliary obstruction leads to skin changes of increased pigmentation (due to melanin) and cholesterol deposition (xanthelasma and xanthoma). Biliary cirrhosis can cause portal venous hypertension and liver cell failure. Disorders of the biliary system generally give rise to the biochemical picture of cholestasis: the serum (conjugated) bilirubin concentration may be normal or raised; serum alkaline phosphatase, γ‎-glutamyl transferase, and bile acids are elevated; serum transaminases show only modest elevation. Bilirubinuria is present, with the disappearance of urobilinogen from the urine indicating complete biliary obstruction. Imaging is critical in the diagnosis of biliary disease, initially by ultrasonography, with CT and MRI in more complicated cases. However, these investigations sometimes provide insufficient anatomical detail for diagnosis or planning of treatment, and further imaging with the cholangiographic techniques of magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) are required. ERCP and PTC can be used to place biliary stents.

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