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Biliary Disease Differential Diagnosis

Discussion in 'Gastroenterology' started by Egyptian Doctor, Jul 8, 2012.

  1. Egyptian Doctor

    Egyptian Doctor  Moderator Verified Doctor

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    Biliary colic : is pain associated with irritation of the viscera secondary to cholecystitis and gallstones. Unlike renal colic, the phrase 'biliary colic' refers to the actual cholelithiasis.

    Although it is frequently described as a colic, the pain is steady, starts rapidly, intense and lasts at least 30 minutes and up to several hours. Many patients complain of right upper quadrant pain, right flank pain, or even mid chest pain with cholelithiasis. There may be radiation to the back and shoulders and other concomitant symptoms such as vomiting and diarrhea. Fatty foods can provoke biliary pain, but this association is relatively non-specific.

    Biliary pain can be associated with objective findings (dilation of the biliary tract, elevation of plasma liver enzyme concentration, elevation of bilirubin, gamma-GT and alkaline phosphatase).

    Acute cholecystitis : This should be suspected whenever there is acute right upper quadrant or epigastric pain, other possible causes include:
    Perforated peptic ulcer
    Acute peptic ulcer exacerbation
    Amoebic liver abscess
    Acute amoebic liver colitis
    Acute pancreatitis
    Acute intestinal obstruction
    Renal colic
    Acute retro-colic appendicitis

    Chronic cholecystitis : The symptoms of chronic cholecystitis are non-specific, thus chronic cholecystitis may be mistaken for other common disorders:
    Peptic ulcer
    Hiatus hernia
    Colitis
    Functional bowel syndrome, is defined pathologically by the columnar epithelium reaching down to the muscular layer.

    Cholangitis : is an infection of the bile duct , usually caused by bacteria ascending from its junction with the duodenum . It tends to occur if the bile duct is already partially obstructed by gallstones.

    Cholangitis can be life-threatening, and is regarded as a medical emergency.Characteristic symptoms include jaundice, fever, abdominal pain, and in severe cases, low blood pressure and confusion. Initial treatment is with intravenous fluids and antibiotics, but there is often an underlying problem (such as gallstones or narrowing in the bile duct) for which further tests and treatments may be necessary, usually in the form of endoscopy to relieve obstruction of the bile duct.

    Acute pancreatitis : is a sudden inflammation of the pancreas. It can have severe complications and high mortality despite treatment. While mild cases are often successfully treated with conservative measures, such as NPO and aggressive intravenous fluid rehydration, severe cases may require admission to the intensive care unit or even surgery to deal with complications of the disease process.

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    Last edited: Nov 3, 2013

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