of the Gallbladder and Biliary Tract DigiED的胆囊和胆道疾病数码课件.ppt

ERCP ERCP image shows multifocal strictures and irregularity of the right intrahepatic bile ducts. Treatment of PSC No effective medical therapies exist Ciprofloxacin Episodes of acute bacterial cholangitis Ursodeoxycholic acid (UDCA) improves symptoms and LFTs in adult patients with PSC. ERCP Balloon dilation of localized strictures. Repeated procedures improves survival. If major stricture – short term stent relieves symptoms and improves LFTs Surgical resection In patients without cirrhosis, resection of dominant bile duct stricture may improve survival vs. ERCP because of ↓risk cholangiocarcinoma. Prognosis of PSC Averages 10 years once symptoms appear Adverse prognostic markers: Older age Higher serum bilirubin and AST Lower albumin levels History of variceal bleeding Complications: Cholangiocarcinoma (10-15%) of adults with PSC. Colon CA/dysplasia In patients with ulcerative colitis, PSC is independent risk factor Strict adherence to colonoscopic surveillance program avised Neoplasms in the Biliary Tract Carcinomas of Biliary TractManifestations weight loss (77%) nausea (60%) anorexia (56%) abdominal pain (56%) fatigue (63%) pruritus (51%) fever (21%) malaise (19%) diarrhea (19%) constipation (16%) abdominal fullness (16%) Symptomatic patients usually have advanced disease, with spread to hilar lymph nodes before obstructive jaundice occurs. It is associated with a poor prognosis. Carcinoma of the Gallbladder Uncommon malignancy – 2.5/100,000 Most common of biliary tract cancers (54%) 90% are adenocarcinomas In Native Americans, GB carcinoma is the most commonly seen GI malignancy Male:Female = 1:3 Overall mean survival rate = 6 months, 5-year survival rate is 5% At diagnosis, most of the GB is replaced or destroyed by the cancer Risk Factors for GB Cancer Cholelithiasis often large and symptomatic stones present Chronic infection of gallbladder Salmonella Typhi Genetic Factors GB polyps 1cm in diameter Mucosal calcification of GB (