Diseases of the biliary tract
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胆道疾病 Diseases of the Biliary tract. ● Anatomy and Physiology ● Examinations for biliary system disease ● Cholelithiasis ● Infection of the biliary tract system ● Biliary ascariasis ● Biliary tract tumor. 第一节 解剖和生理 Anatomy and Physiology.

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Diseases of the biliary tract

胆道疾病Diseases of the Biliary tract

Anatomy and Physiology●Examinations for biliary system disease● Cholelithiasis● Infection of the biliary tract system● Biliary ascariasis● Biliary tract tumor

Anatomy and physiology

第一节 解剖和生理Anatomy and Physiology

第一节 解剖和生理概要(1)1. Intrahepatic bile ducts● gradation 2. Extrahepatic bile ducts●segment●Vater’s ampulla● oddi’s sphincter3. Gallbladder●Heister’s valve● Hartmann’s pouch● Calot’s triangle

2 physiology storage bile condense bile regulate biliary tract pressure secrete mucus white bile

第一节 解剖和生理概要(2)Physiology● Storage bile● Condense bile● Regulate biliary tract pressure ● Secrete mucus: “White bile”

Examination methods for biliary system disease

第二节 胆道疾病检查方法Examination methods for biliary system disease

第二节 胆道疾病检查方法(1)1. Laboratory findings2. Ultrasonography3. X-ray examinations ●plain radiography●percutaneous transhepatic cholangiography (PTC)●endoscopic retrograde cholangiopancreatography (ERCP)●during or post operative cholangiogram

第二节 胆道疾病检查方法(2)●computed tomography (CT)●oral cholecystography●intravenous cholangiography●hypotonic duodenographyRadionuclide scansDuodenal drainageCholangioscopyMagnetic resonance imaging (MRI,MRCP)

Congenital cystic dilatation of bile duct

附:先天性胆总管扩张症congenital cystic dilatation of bile duct


第三节 胆石病Cholelithiasis

第三节 胆石病—概述(1)1. Prevalence2. Classification●cholesterol●pigment●mixed type●black3. Position●gallbladder●extrahepatic●intrahepatic

第三节 胆石病—概述(2)4. Mechanism for gallstone formation ●bile stasis●abnormal metabolization●infection●other factors: age, sex, weight, diet Cholesterol stones: Admirand-Small triangular coordinate grapy Pigment stones:

咖啡与预防胆结石 香喷喷的咖啡,是提神醒脑的饮品,而最新研究还发现,每喝几杯咖啡可以预防胆结石。最新一期美国医学协会期刊报道,美国哈佛大学研究人员发现,每喝两杯三杯咖啡的男性,得到胆结石的几率比不喝咖啡的人低了40%,而每天喝咖啡达四杯以上的话,得胆结石的几更降为45%。不过,无咖啡因的咖啡可就没有这种效果了,只有含咖啡因的咖啡,才能刺激胆囊收缩,并减少胆汁内容易形成胆石的胆固醇。而同样含有咖啡因的茶、可乐等其他饮料,由于咖啡因含量低于咖啡,因此无法达到同样效果。


第三节 胆石病—胆囊结石(1)1. Gallbladder stones(1) Clinical manifestations:●biliary colic, radiation of the pain, neusea, vomiting●tenderness in right upper quadrant, rebound tenderness, muscle rigidity, palpable distended gallbladder, or Murphy’s sign (+)●bile duct stones, cholangitis

第三节 胆石病—胆囊结石(2)●Mirizzi’s syndrome:(2) Diagnosis:●clinical manifestations: symptoms and signs●assistant examinations: B-US, CT, MRI

第三节 胆石病—胆囊结石(3)(3) Treatment:● no need for treatment: asymptomatic stones● drug therapies: seldom attack or unsuitable for operation● operative management: cholecystectomy: open and laparoscopic● other treatments: oral dissolution therapy contact dissolution therapy extracorporeal shock wave lithotripsy


第三节 胆石病—肝外胆管结石(1)2. Extrahepatic bile duct stones(1)Clinical manifestations:●Charcot’s triad: abdominal pain, chills and fever, jaundice● deep tenderness with or without rebound tenderness, muscle rigidity or palpable enlarged gallbladder

第三节 胆石病—肝外胆管结石(2)(2) Diagnosis:● previous biliary tract disease● clinical manifestations: Charcot’s triad● laboratory examinations:● assistant examinations: B-US, CT, PTC, ERCP, MRCP

第三节 胆石病—肝外胆管结石(3)Differential diagnosis:●viral hepatitis●carcinoma of pancreas●biliary ascariasis●benign stricture● renal colic, enterospasm

第三节 胆石病—肝外胆管结石(4)(3) Treatment:● Chinese medicine: dissolution, discharge● drug therapy: antispastic, analgesic● EST●operative management: exploratory choledochostomy and T-tube drainage choledocho-jejunostomy sphincteroplasty of Oddi

第三节 胆石病—肝内胆管结石(1)3. Intrahepatic duct stones(1) Clinical manifestations and diagnosis● Symptoms: ● Physical findings:● B-US, CT, PTC, ERCP, MRCP

第三节 胆石病—肝内胆管结石(2)(2) Treatment● Nonoperative treatment: anti-inflammatory and cholagogic● Operative treatment: hepatobiliary exploration cholangio-jejunostomy partial hepatectomy


Infection of the biliary tract system

第四节 胆道感染Infection of the biliary tract system


第四节 胆道感染—急性胆囊炎(1)1. Acute cholecystitis(1)Pathogenesis: ·bile stasis:obstruction, dysfunction ·bacteria ·other factors: bile salt, pancreatic juice

第四节 胆道感染—急性胆囊炎(2)(2) Pathology: simple, suppurative, gangrenous(3) Complications:·pericholecystic or cholecystic abscess · perforation: bile peritonitis, fistulization (external or internal ), gallstone ileus ·liver abscess, cholangitis, pancreatitis ·pylephlebitis, sepsis

第四节 胆道感染—急性胆囊炎(3)(4) Clinical manifestations and diagnosis·symptoms: pain, radiated pain, nausea, vomiting, fever · signs: tenderness, rebound tenderness, muscle rigidity, distended gallbladder with tenderness or Murphy’s sign(+) ·complications: ·assistant examinations: laboratory WBC↑, B-US

第四节 胆道感染—急性胆囊炎(4)Differential diagnosis·acute perforated duodenal or gastric ulcers ·acute pancreatitis ·acute appendicitis ·acute ileus

第四节 胆道感染—急性胆囊炎(5)(5) Treatment·nonoperative management: fasting, nasogastric suction; antispastic, analgisia; control of infection ·operative intervention: indication: acute calculous cholecystitis, recurrent chole-cystitis, no response to conservative treatmenttiming: early, delayedmethods: cholecystectomy, cholecystostomy

第四节 胆道感染—慢性胆囊炎(1)2. Chronic cholecystitis (1) Pathogenesis and pathology: (2) Clinical manifestations and diagnosis ·the history of recurrent cholecystitis ·symptoms: untold bitterness, discomfort, indigestion ·signs: deep tenderness in the right upper quadrant ·B-US(3) Treatment ·operative: cholecystetomy ·nonoperative: anti-inflammatory, cholagogic, low-fat meals

第四节 胆道感染—胆管炎(1)3. Cholangitis Pathologic type: ·acute obstructive suppurativecholangitis ·chronic simple cholangitis ·primary sclerosing cholangitis

Primary sclerosing cholangitis

附:原发性硬化性胆管炎primary sclerosing cholangitis

第四节 胆道感染—胆管炎(2)Acute obstructive suppurativecholangitis(1) Pathogenesis ·Complete bile duct obstruction: stones, benign strictures, malignant tumor, parasites ·Bacterial infections: E. Coli, Klebsiella, proteus, and anaerobic bacteria


第四节 胆道感染—胆管炎(3)(2) Pathophysiology ·completely obstruction, dilatation, high intraductal pressure·bacteria invasion, multiplication, pus bile ·retrograde enter the liver, acute liver infection ·systemic sepsis, infective shock, MSOF

第四节 胆道感染—胆管炎(4)(3) Clinical manifestations ·Abdominal pain ·chills and fever ·jaundice ·shock ·central nervous system depression: apathy, drowsiness, coma



·tenderness with or without rebound tenderness, muscle rigidity; enlarged liver with tenderness, percussion pain

第四节 胆道感染—胆管炎(5)(4) Diagnosis ·recurrent previous biliary tract disease ·Charcot’s triad + CNS + shock (Reynold’s pentad) ·physical examination results: ·assistant examinations: laboratory findings (WBC↑, hyperbilirubinemia), B-US

第四节 胆道感染—胆管炎(6)(5) Treatment · principle: immediate removal of the obstruction emergency bile duct decompression · methods: preoperative preparation: exploratory choledochostomy and T- tube drainage PTBD, ENBD

Biliary ascariasis

第五节胆道蛔虫病biliary ascariasis

第五节胆道蛔虫病(1)1. Pathogenesis:2. Pathophysiology ·colic ·obstructive jaundice ·complicated infection ·stone formation ·pancreatitis ·cirrhosis

第五节胆道蛔虫病(2)3. Clinical manifestations and diagnosis ·paroxysmal epigastric pain ·suddenly attack and suddenly stop ·serious symptoms but slight signs ·complicated infection: cholangitis ·fecal examination, B-US, CT

第五节胆道蛔虫病(3)4. Treatment ·nonoperative: antispastic, analgisia; cholagogic, expel parasites; control of infection ·operative: exploratory choledochostomy and T-tube drainage

Biliary tract tumors

第六节    胆道肿瘤biliary tract tumors

第六节胆道肿瘤—胆囊息肉(1)1. Gallbladder polyps (1) Classification: ·non-neoplastic polyps: inflammatory, cholesterol, hyperplastic ·neoplastic polyps: adenoma

2 2 clinical manifestations and diagnosis 3 treatment follow up operative cholecystectomy

第六节胆道肿瘤—胆囊息肉(2)(2) Clinical manifestations and diagnosis:(3) Treatment ·follow-up ·operative: cholecystectomy

第六节胆道肿瘤—胆囊癌(1)2. Carcinoma of the gallbladder (1) Pathogenesis: unclear (2) Clinical manifestations and diagnosis ·early: no specific ·advanced: jaundice, ascites, mass ·B-US, CT, MRI

第六节胆道肿瘤—胆囊癌(2)(3) Treatment ·operative: located in gallbladder wall: cholecystectomy protrude serosa or liver invasion: radical cholecystectomy unresectable: decompression and drainage ·nonoperative: PTBD, ENBD

第六节胆道肿瘤—胆管癌(1)3. Bile duct cancer (1) Pathogenesis: unclear(2) Clinical manifestations and diagnosis ·advancing jaundice ·pain, nausea, vomiting ·ascites, portal hypertension ·B-US, CT, PTC, ERCP, MRCP

2 3 treatment operative resection whipple s operation nonoperative ptbd enbd prosthesis

第六节胆道肿瘤—胆管癌(2)(3) Treatment ·operative resection: Whipple’s operation ·nonoperative: PTBD, ENBD, prosthesis

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胆道疾病重点内容1.胆囊结石的诊断和治疗。2.肝外胆管结石的临床表现、诊断和治疗。3.胆囊炎的病因、病理变化、临床表现、 并发症、诊断、治疗。4.急性梗阻性化脓性胆管炎的诊断和治疗。