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Normal and Abnormal Development of the Biliary Tree
Published in Gianfranco Alpini, Domenico Alvaro, Marco Marzioni, Gene LeSage, Nicholas LaRusso, The Pathophysiology of Biliary Epithelia, 2020
Congenital cystic dilatation of the common bile duct (choledochal cyst) is nonheritable extrahepatic lesions. While they may be seen in association with cystic dilatations of the intrahepatic biliary tree, these extrahepatic choledochal cysts do not arise from ductal plate malformations. These cystic dilatations are classified in four categories (Table 6), all of which communicate with the flow of bile.110–112 Choledochal cysts are more common in Japan than in Western countries.113 and are more common in females. Approximately 60% of patients present before the age of 10 years, but presentation in adulthood is not uncommon. Presenting symptoms are variable: epigastric pain, fever and jaundice, or an abdominal mass. The triad of all three sets of symptoms occurs in less than 25% of patients.114 Ascending cholangitis and/or obstruction are potential underlying causes of the symptoms. Complications other than obstruction include stone formation (in approximately 8% of patients), pancreatitis (infrequent), carcinoma (in approximately 4% of patients), and rarely perforation.106 Surgical resection of the choledochal cyst is the preferred treatment owing to the risk of carcinoma, which increases with age.115,116
Abdomen and pelvis cases
Published in Lt Col Edward Sellon, David C Howlett, Nick Taylor, Radiology for Medical Finals, 2017
Faye Cuthbert, Amanda Jewison, Olwen Westerland
Ascending cholangitis is a surgical emergency:The patient is septic and should be treated with IV fluids and antibiotics, analgesia, and careful monitoring of fluid balance. ABCDE approach, monitoring, routine investigations to include blood cultures, and senior discussion.Urgent ERCP should be performed, the CBD stones retrieved, and the obstruction relieved. A CBD stent may need to be sited if there is a stricture.
Gallbladder disease
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
N Alexander Jones, Onyebuchi Ukabiala
Ascending cholangitis is a dreaded complication of biliary obstruction. The combination of high fevers with rigors and laboratory evidence of common bile duct obstruction requires aggressive intravenous fluid resuscitation and appropriate antibiotics.
Same day endoscopic retrograde cholangio-pancreatography immediately after endoscopic ultrasound for choledocholithiasis is feasible, safe and cost-effective
Published in Scandinavian Journal of Gastroenterology, 2021
Wisam Sbeit, Anas Kadah, Amir Shahin, Tawfik Khoury
The prevalence of choledocholithiasis in western countries is about 1.5%–4% of adult population. Retained choledocholithiasis can lead to serious complications with a potential of causing death, including biliary pancreatitis, obstructive jaundice, ascending cholangitis and sepsis. Therefore, patients with proven choledocholithiasis should undergo stone extraction by either endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative bile duct exploration during cholecystectomy [1]. ERCP is an invasive procedure with a potential of significant post-procedural complications including 1.3%–6.7% risk of pancreatitis, 0.6%–5% risk of infection, 0.3%–2% risk of hemorrhage and 0.1%–1.1% perforation risk, in addition to the high cost of the procedure itself [2–4]. In order to avoid unnecessary invasive interventions, all recent guidelines advocate stratifying patients into low, moderate and high risk of choledocholithiasis according to certain predictors. Patients presented with high risk should undergo ERCP for stone extraction, while in patients with moderate risk it is advocated to perform prior noninvasive examination by magnetic resonance cholangiopancreatography (MRCP), or minimally invasive examination by endoscopic ultrasound (EUS) to look for choledocholithiasis before decision about ERCP [5].
Predicting variceal bleeding in patients with biliary atresia
Published in Scandinavian Journal of Gastroenterology, 2019
Hanbyul Sohn, Sowon Park, Yunkoo Kang, Hong Koh, Seok Joo Han, Seung Kim
The limitations of this study are that we could not follow up every patients at the same timeline, and the number and timing of endoscopic exams and FibroScan® exams vary between patients because it was a retrospective study; and that other factors such as ascending cholangitis, sonographic findings which could be associated with prognosis were not included in the analysis. Although this study is single-center, retrospective study, it is based on single disease entity, and the data was obtained in a long period of time in large number of patients. A well-designed, prospective study on guideline based on multicenter with validation cohort should be made in the future, and, furthermore, study on periodic surveillance, medical/endoscopic therapy for varix, or proactive liver transplantation could be done in pediatric patients.
Twelve tips for interpreting abdominal CT scans
Published in Medical Teacher, 2021
Sailantra Sivathasan, Jakub Nagrodzki, David McGowan
The biliary tree is another common cause of patients presenting with an acute abdomen (NHS Digital 2019a). Common diagnoses include choledocholithiasis, obstruction from external compression such as in pancreatic malignancy or sphincter of Oddi stricture, or biliary sepsis, usually secondary to cholecystitis and ascending cholangitis.