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Friday, September 10, 2010
  
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Cholangitis
Choledocholithiasis
  • Choledocholithias occurs when gallstones become stuck in the common bile duct, which connects the gallbladder and pancreas to the intestine. Cholangitis occurs when the common bile duct becomes infected.
  • Sudden, severe pain in middle upper abdomen
  • Pain may radiate to right shoulder
  • Occasionally painless
  • Fever
  • Chills
  • Nausea/vomiting
  • Severe case
  • Confusion
  • Lethargy
  • Low Blood Pressure
  • Examination:
    1. Tenderness in middle upper abdomen
    2. Yellow skin or eyes
  • Laboratory Findings:
    1. Elevated Bilirubin level
    2. Bilirubin in urine
    3. Elevated Alkaline phosphatase
    4. Amylase may be elevated
    5. ALT, AST (liver tests) may be elevated
    6. Prolonged Prothrombin time may occur
  • Imaging:
    1. Ultrasound
    2. CT scan
    3. Radio-nuclide scan
    4. ERCP (test passing a scope down the esophagus and into the opening of the common bile duct) -- ERCP can be used remove an obstructed stone.
  • Antibiotics intravenously
  • Vitamin K if clotting problems are present
  • Stone removal by ERCP (see above)
  • Lithotripsy (sound waves used to break apart) may be useful in some cases.
  • Biliary stenting (drainage tube placed in common bile duct) if necessary
  • Surgery if necessary
  • Biliary Cirrhosis  -- permanent damage to liver can occur especially if untreated.
  • Bleeding problems -- because the liver's ability to make clotting factors is damaged.
 


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