Tumors of the gallbladder and the bile ducts
Gallbladder and the bile duct tumors are frequent cause of extrahepatic biliary obstruction. Symptoms may be absent but often are constitutional or reflect biliary obstruction.
Diagnosis is based on ultrasound, CT, or cholangiography. Prognosis is usually poor.
Mechanical bile drainage can often relieve pruritus, recurrent sepsis and pain due to biliary obstruction
Cholangiocarcinomas and other bile duct tumors which are rare, are usually malignant. Cholangiocarcinomas occur predominantly in the extrahepatic bile ducts, 60 to 80% in the perihilar region (Klatskin tumors) and 10 to 30% in the distal ducts.
Risk factors include older age, primary sclerosing cholangitis,infestation with liver flukes, and chledochal cyst.
Gallbladder carcinoma has an incidence of 2.5/100000 and is most common in South America and Asia. The median survival is 3 mo.
Gallbladder polyps are asymptomatic mucosal projections of cholesterol ester and lipid < 10 mm in diameter that develop in the lumen of the gallbladder.
They results from cholesterolosis and are found in about 5 % of people undergoing ultrasound. True adenomas are rare and benign.
Symptoms and Signs
Patients with cholangiocarcinomas most commonly present with pruritus and painless obstructive jaundice ( typical age, 50 to 70 years ).
Early perihilar tumors may produce only vague abdominal pain, anorexia, and weight loss.
Other features may include acholic stool, palpable mass, hepatomegaly, or dissented gallbladder
(courvoisiers sign , with distal cholangiocarcinoma).
Pain may resemble that of biliary colic (reflecting biliary obstruction) or may be constant and progressive.
Sepsis is unusual but may be induced by ERCP.
Patients with gallbladder carcinoma present with symptoms ranging from an incidental finding at cholecystectomy done for biliary pain and cholelithiasis ( 70 to 90% have stones ) to advanced disease with constant pain,weight loss, and an abdominal mass.
Diagnosis
Cholangiocarcinomas are suspected when extrahepatic biliary obstruction is unexplained .
Laboratory tests reflect the degree of cholestasis.
Diagnosis is based on Ultrasound or CT.
If these methods are inconclusive, magnetic resonance cholangiopancreatography (MRCP) or ERCP with percutaneous transhepatic cholangiography may be necessary.
In some cases ERCP not only detects the tumor, but also with brushings, provides a tissue diagnosis, making ultrasound or CT guided needle biopsy unnecessary. Contrast enhanced CT assist in staging.
Gallbladder carcinomas are better defined by CT than by ultrasound. Open laparotomy is necessary to determine disease extent which guides therapy.
Treatment
Stenting or surgically bypassing the obstruction relieves pruritus, jaundice, and perhaps fatigue.
Hilar cholangiocarcinomas with CT evidence of spread are stented percutaneously or via ERCP.
Distal duct cholangiocarcinoma appears localized, surgical exploration determines respectability by hilar resection or pancreaticoduodenectomy .
Adjuvant chemotherapy and radiation therapy are showing promising results for cholangiocarcinomas.
Many gallbladder carcinomas are treated symptomatically.
Pain may resemble that of biliary colic (reflecting biliary obstruction) or may be constant and progressive.
Sepsis is unusual but may be induced by ERCP.
Patients with gallbladder carcinoma present with symptoms ranging from an incidental finding at cholecystectomy done for biliary pain and cholelithiasis ( 70 to 90% have stones ) to advanced disease with constant pain,weight loss, and an abdominal mass.
Diagnosis
Cholangiocarcinomas are suspected when extrahepatic biliary obstruction is unexplained .
Laboratory tests reflect the degree of cholestasis.
Diagnosis is based on Ultrasound or CT.
If these methods are inconclusive, magnetic resonance cholangiopancreatography (MRCP) or ERCP with percutaneous transhepatic cholangiography may be necessary.
In some cases ERCP not only detects the tumor, but also with brushings, provides a tissue diagnosis, making ultrasound or CT guided needle biopsy unnecessary. Contrast enhanced CT assist in staging.
Gallbladder carcinomas are better defined by CT than by ultrasound. Open laparotomy is necessary to determine disease extent which guides therapy.
Treatment
Stenting or surgically bypassing the obstruction relieves pruritus, jaundice, and perhaps fatigue.
Hilar cholangiocarcinomas with CT evidence of spread are stented percutaneously or via ERCP.
Distal duct cholangiocarcinoma appears localized, surgical exploration determines respectability by hilar resection or pancreaticoduodenectomy .
Adjuvant chemotherapy and radiation therapy are showing promising results for cholangiocarcinomas.
Many gallbladder carcinomas are treated symptomatically.
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