Cholangitis

Cholangitis
What is cholangitis?
Cholangitis is an inflammation of the bile duct system that is usually related to a bacterial infection. The bile duct system is the drainage system that carries bile from the liver and gallbladder into the area of the small intestine called the duodenum. The infection may occur suddenly or may be chronic.

What causes cholangitis?

There are several conditions that may trigger an infection in the bile duct system. The primary cause of cholangitis is an obstruction or blockage somewhere in the bile duct system. The blockage may be from stones, a tumor, blood clots, a narrowing that may occur after a surgical procedure, swelling of the pancreas, or from parasite invasion. Other causes include a backflow of bacteria from the small intestine, a blood infection (bacteriemia), or following a diagnostic procedure such as an endoscopic examination. The infection causes pressure to build-up in the bile duct system.

What are the symptoms of cholangitis?

Symptoms for cholangitis may be moderate to severe. The following are the most common symptoms of cholangitis. However, each individual may experience symptoms differently. Symptoms may include:

Pain in the right upper quarter of the abdomen Fever Chills Jaundice - yellowing of the skin and eyes Clay-colored stools Dark urine Low blood pressure Lethargy Decreased level of alertness

The symptoms of cholangitis may resemble other medical conditions or problems. Always consult your physician for a diagnosis. What is a risk factor?

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors. Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors. But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

Who is at risk for cholangitis?

Cholangitis occurs more commonly in women than men. The onset is usually after age 55. Individuals who are at greater risk are those who have previously suffered from gallstones.

How is cholangitis diagnosed?

The pain associated with cholangitis often mimics gallstones. In addition to a complete medical history and physical examination, diagnostic procedures for cholangitis may include the following:

Blood tests, including the following: o Complete blood count (CBC) - measures the white blood cells which can be elevated with an infection. o Liver function tests - a series of special blood tests that can determine if the liver is functioning properly. o Blood cultures - to determine if there is a blood infection Cholangiography - x-ray examination of the bile ducts using an intravenous (IV) dye (contrast). Percutaneous transhepatic cholangiography (PTC) - a needle is introduced through the skin and into the liver where the dye (contrast) is deposited into the bile ducts and the bile duct structures can be viewed by x-ray. Endoscopic retrograde cholangiopancreatography (ERCP) - a procedure that allows the physician to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. The procedure combines x-ray and the use of an endoscope - a long, flexible, lighted tube. The scope is guided through the patient's mouth and throat, then through the esophagus, stomach, and duodenum. The physician can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope, and a dye is injected which will allow the internal organs to appear on an x-ray. Magnetic resonance cholangiopancreatography (MRCP) - uses magnetic resonance imaging (MRI) to obtain pictures of the bile ducts. The machine uses radio waves and magnets to scan internal organs and tissues. Ultrasound (also called sonography) - a diagnostic imaging technique which uses highfrequency sound waves to create an image of the internal organs. Ultrasounds are used to

view internal organs of the abdomen such as the liver spleen, and kidneys and to assess blood flow through various vessels.

Treatment for cholangitis:

Specific treatment for cholangitis will be determined by your physician based on:

Your age, overall health, and medical history Extent of the disease Your tolerance of specific medicines, procedures, or therapies Expectations for the course of the disease Your opinion or preference

The goal for treating cholangitis is to attack the bacterial infection with antibiotics and also to identify the blockage in the bile duct system and manage it. Treatment may include:

Intravenous (IV) antibiotics Surgery or an x-ray procedure, such as endoscopy (to decompress the bile duct system and remove the blockage) Treatment of blood pressure if it is too low

http://medicalcenter.osu.edu/patientcare/healthcare_services/liver_biliary_pancreatic_disease/disorde rs_of_biliary_system/cholangitis/Pages/index.aspx

Gallstones
Gallstones
About Gallstones There are two types of gallstones: cholesterol stones and pigment stones. Eighty percent of gallstones are cholesterol stones. The size of gallstones varies from a grain of salt to golf-ball size. A person can develop a single stone or several hundred.

What are gallstones?

Gallstones form when bile stored in the gallbladder hardens into stone-like material. Too much cholesterol, bile salts, or bilirubin (bile pigment) can cause gallstones.

When gallstones are present in the gallbladder itself, it is called cholelithiasis. When gallstones are present in the bile ducts, it is called choledocholithiasis. Gallstones that obstruct bile ducts can lead to a severe or life-threatening infection of the bile ducts, pancreas, or liver. Bile ducts can also be obstructed by cancer or trauma, but this is not related to gallstones.

What causes gallstones?

Cholesterol stones are believed to form when bile contains too much cholesterol, too much bilirubin, not enough bile salts, or when the gallbladder does not empty as it should for some other reason. Pigment stones tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anemia. The causes of these stones are uncertain.

What are the symptoms of gallstones?

At first, most gallstones do not cause symptoms. However, when gallstones become larger, or when they begin obstructing bile ducts, symptoms or "attacks" begin to occur. Attacks of gallstones usually occur after a fatty meal and at night. The following are the most common symptoms of gallstones. However, each individual may experience symptoms differently. Symptoms may include:

Steady, severe pain in the upper abdomen that increases rapidly and may last from 30 minutes to several hours Pain in the back between the shoulder blades Pain in the right shoulder Nausea Vomiting Fever Chills Jaundice (yellowing of the skin or eyes) Abdominal bloating Intolerance of fatty foods Belching or gas Indigestion

Persons who experience the following symptoms should consult their physician immediately:

Sweating Chills Low-grade fever Yellowish color of the skin or whites of the eyes Clay-colored stools

Some people with gallstones do not present any symptoms. These stones are called "silent stones," as they do not interfere with the function of the gallbladder, liver, or pancreas, and do not require treatment in most cases. The symptoms of gallstones may resemble other conditions or medical problems such as heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, or hepatitis. Always consult your physician for a diagnosis. What is a risk factor? A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors. Although these risk factors increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors. But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

Who is affected by gallstones?

The following are suggested risk factors for gallstones:

Obesity Obesity is a major risk factor for gallstones, especially in women. Estrogen Excess estrogen from pregnancy, hormone replacement therapy, or birth control pills appears to increase cholesterol levels in bile and decrease gallbladder movement, both of which can lead to gallstones. Ethnicity Native Americans have the highest rates of gallstones in this country and seem to have a genetic predisposition to secrete high levels of cholesterol in bile. Gender Women are twice as likely to develop gallstones than men. Age People over 60 are more likely to develop gallstones than younger people. Cholesterol-lowering drugs Drugs that lower cholesterol in blood can actually increase the amount of cholesterol secreted in bile, which, in turn, increases the risk of gallstones. Diabetes People with diabetes generally have high levels of fatty acids, called triglycerides, which increase the risk of gallstones.

Rapid weight loss As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones. Fasting Fasting decreases gallbladder movement, which causes the bile to become overconcentrated with cholesterol.

How are gallstones diagnosed?

In some cases, asymptomatic gallstones are discovered by accident - during testing for another diagnosis. However, when pain persists or happens again and again, your physician may want to conduct a complete medical history and physical examination, in addition to the following diagnostic procedures for gallstones:

Ultrasound - a diagnostic technique which uses high-frequency sound waves to create an image of the internal organs. Cholecystography - x-ray that shows the flow of contrast fluid through the intestines into the gallbladder. Blood tests (to look for signs of infection, obstruction, jaundice, and/or pancreatitis) Computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce crosssectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. Endoscopic retrograde cholangiopancreatography (ERCP) - a procedure that involves inserting an endoscope (viewing tube) through the stomach and into the small intestine. A special dye injected during this procedure shows the ducts in the biliary system. Sphincterotomy - opening the muscle sphincter, a ring of muscle around a natural opening that acts like a valve, wide enough so stones can pass into the intestine.

Treatment for gallstones:

Specific treatment for gallstones will be determined by your physician based on:

Your age, overall health, and medical history Extent of the condition Your tolerance of specific medicines, procedures, or therapies Expectations for the course of the condition Your opinion or preference

If the gallstones cause no symptoms, treatment is usually not necessary. However, if pain persists, treatment may include:

Gallbladder removal (cholecystectomy) - once removed, the bile flows directly from the liver to the small intestine. Side effects of this may include diarrhea, because the bile is no longer stored in the gallbladder.

Oral dissolution therapy - drugs made from bile acid are used to dissolve the stones. Methyl-tert-butyl ether - a solution injected into the gallbladder to dissolve stones. Extracorporeal shockwave lithotripsy (ESWL) - a procedure that uses shock waves to break stones up into tiny pieces that can pass through the bile ducts without causing blockages. Contact dissolution therapy - an experimental procedure that involves injecting a drug directly into the gallbladder to dissolve the stones.

Cholecystitis
Cholecystitis
What is cholecystitis?
Cholecystitis is an inflammation of the gallbladder wall and nearby abdominal lining. Cholecystitis is usually caused by a gallstone in the cystic duct, the duct that connects the gallbladder to the hepatic duct. Other causes of cholecystitis may include the following:

Bacterial infection in the bile duct system. The bile duct system is the drainage system that carries bile from the liver and gallbladder into the area of the small intestine called the duodenum. Tumor of the pancreas or liver. Decreased blood supply to the gallbladder. This can sometimes occur in persons with diabetes. Gallbladder "sludge." This "sludge" is a thick material that cannot be absorbed by bile in the gallbladder and most commonly occurs in pregnant women or individuals who have experienced a rapid weight loss.

Cholecystitis can occur suddenly or gradually over many years.

What are the symptoms of cholecystitis?

A typical attack of cholecystitis usually lasts two to three days. However, each individual may experience symptoms differently. Symptoms may include:

Intense and sudden pain in the upper right part of the abdomen Recurrent painful attacks for several hours after meals Pain (often worse with deep breaths and extends to lower part of right shoulder blade) Nausea Vomiting Rigid abdominal muscles on right side Slight fever Chills Jaundice - yellowing of the skin and eyes. Itching (rare)

Loose, light-colored bowel movements Abdominal bloating

The symptoms of cholecystitis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is cholecystitis diagnosed?

In addition to a complete medical history and medical examination, diagnostic procedures for cholecystitis may include the following:

Ultrasound (also called sonography). A diagnostic imaging technique which uses highfrequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen such as the liver, spleen, and kidneys and to assess blood flow through various vessels. Hepatobiliary scintigraphy. An imaging technique of the liver, bile ducts, gallbladder, and upper part of the small intestine. Cholangiography. X-ray examination of the bile ducts using an intravenous (IV) dye (contrast). Percutaneous transhepatic cholangiography (PTC). A needle is introduced through the skin and into the liver where the dye (contrast) is deposited and the bile duct structures can be viewed by X-ray. Endoscopic retrograde cholangiopancreatography (ERCP). A procedure that allows the physician to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. The procedure combines X-ray and the use of an endoscope - a long, flexible, lighted tube. The scope is guided through the patient's mouth and throat, then through the esophagus, stomach, and duodenum. The physician can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope, and a dye is injected which will allow the internal organs to appear on an X-ray. Computed tomography scan (CT or CAT scan). A diagnostic imaging procedure using a combination of X-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

What is the treatment for cholecystitis?

Specific treatment for cholecystitis will be determined by your physician based on:

Your age, overall health, and medical history Extent of the disease Your tolerance of specific medicines, procedures, or therapies Expectations for the course of the disease Your opinion or preference

Treatment for acute cholecystitis usually involves a hospital stay to reduce stimulation to the gallbladder. Antibiotics are usually administered to fight the infection. Fluids are given intravenously and the stomach is kept empty until symptoms resolve. Sometimes, the gallbladder is surgically removed, either immediately, or later after the episode of acut cholecystits has resolved. Other treatment options may include:

Oral dissolution therapy. Drugs made from bile acid are used to dissolve the stones. Medications. (To prevent the formation of gallstones.) Low-fat diet. Pain management.

The overall prognosis for cholecystitis is favorable. In some individuals, complications may arise if other organs are involved. Gallstones can return in the bile duct system after surgical removal of the gallbladder.