Biliary tract tumor

Introduction to biliary tumors Biliary tumors are divided into gallbladder tumors and extrahepatic biliary tumors. Among them, gallbladder tumors are more common. Biliary tumors have benign and malignant points. Benign tumors such as adenomas and papillomas, fibroids, etc., the latter two are relatively rare. Malignant tumors are mainly adenocarcinomas, with gallbladder cancer and biliary tract cancer, the former being more than the latter. Gallbladder cancer occurs mostly in middle-aged and older women over the age of 50. There are fewer males and the ratio of female to male is about 34:1. The main clinical manifestations are: a history of chronic cholecystitis, a sudden deterioration of the disease after the onset of cancer, persistent pain in the right upper quadrant, loss of appetite, nausea or vomiting, jaundice may occur in the advanced stage, and progressive deepening, accompanied by fever, ascites And other symptoms. Because of the recurrent episodes of chronic cholecystitis, the stones in the gallbladder stimulate the gallbladder for a long time, and the normal gallbladder tissue cells are degenerated for a long time, and the degenerated tissue is prone to cancer. Therefore, the author advocates chronic cholecystitis with stones and repeated authors. The gallbladder should be surgically removed as soon as possible to avoid endless troubles. basic knowledge The proportion of illness: 0.004% Susceptible people: no special people Mode of infection: non-infectious complication:

Biliary tumor cause

According to the etiology analysis, gallbladder cancer is often caused by recurrent episodes of acute inflammation. Inflammation promotes the atrophy of the bile duct or gallbladder mucosa, causing lymphocytes and mononuclear cells to infiltrate in all layers of tissue, and the tissue is fibrotic. Due to long-term chronic inflammation, some cystic duct wall or cyst wall is hypertrophic due to edema and fibrous tissue hyperplasia, causing local tube stenosis, sometimes deep into the muscular layer, forming Luo A sinus. This phenomenon can be seen in about 90% of chronic gallbladder On the basis of this case, cancer can turn into gallbladder cancer.

Biliary tumor prevention

Early diagnosis of this disease is essential, and regular examinations for the prevention and treatment of biliary tract tumors.

Gallbladder cancer has a poor prognosis, and only a very small number of patients can survive for more than 6 months after surgery. In nearly 6000 cases of gallbladder cancer collected by Pithier et al, the 1-year survival rate was 11.8% and the 5-year survival rate was 4.1%. Therefore, prevention of the occurrence of gallbladder cancer is extremely important. To this end, for middle-aged and above, especially female patients with chronic atrophic cholecystitis, porcelain gallbladder, symptomatic gallstones and giant gallstones, gallbladder polyps >10mm, or broad-based polyps, or coexisting stones, should be Perform cholecystectomy as soon as possible.

Biliary tumor complications Complication

Patients with gallstones may have symptoms of gallstones. Occasionally, partial shedding of the papillary adenoma of the gallbladder leads to obstructive jaundice.

Symptoms of biliary tract tumors Common symptoms Fever with chills, gray stool, diarrhea, jaundice, abdominal mass, nausea and vomiting, lymphadenopathy

The main clinical manifestations are: a history of chronic cholecystitis, a sudden deterioration of the disease after the onset of cancer, persistent pain in the right upper quadrant, loss of appetite, nausea or vomiting, jaundice may occur in the advanced stage, and progressive deepening, accompanied by fever, ascites And other symptoms. Because of the recurrent episodes of chronic cholecystitis, the stones in the gallbladder stimulate the gallbladder for a long time, and the normal gallbladder tissue cells are degenerated for a long time, and the degenerated tissue is prone to cancer. Therefore, the author advocates chronic cholecystitis with stones and repeated authors. The gallbladder should be surgically removed as soon as possible to avoid endless troubles.

Astragalus is progressively aggravated or intermittent, painful and painful. The site is related to diet. There are fever, chills, nausea, vomiting, oil loss, loss of appetite, weight loss, diarrhea, grayish white stool changes, and urine color changes. Symptoms such as itchy skin. Physical examination of the sclera and skin jaundice, swelling of the upper bone lymph nodes, tenderness in the abdomen, liver tenderness, gallbladder enlargement and tenderness, splenomegaly, ascites and abdominal masses, if necessary, anal finger examination.

Biliary tumor examination

Medical examination

Pay attention to the general condition of the patient, body temperature, pulse, respiration and blood pressure, the condition and procedure of the sclera and skin jaundice, whether the supraclavicular lymph nodes are swollen, whether there is tenderness in the abdomen, how the liver texture is, whether there is tenderness, whether the gallbladder is swollen or tender. Whether the spleen is swollen, whether there is ascites and abdominal mass, if necessary, anal finger examination.

test

(1) Liver function test: containing bilirubin, transaminase, cholesterol, cholesterol ester ratio, white, globulin and protein electrophoresis, alkaline phosphatase, lactate dehydrogenase, -glutamyltransferase.

(2) blood biochemical examination: total potassium, sodium, chlorine, carbon dioxide, blood sugar, blood amylase renal function test.

(3) Hepatitis B virus serological indicators, as well as alpha-fetoprotein, CEA and CA19-9.

(4) Determination of bleeding time, clotting time and prothrombin time.

(5) Determination of urinary bilirubin, urobilin, urobilinogen and urinary amylase. Pay attention to the color of the stool and occult blood, and check the original fecal gallbladder.

Ultrasonography

It is a common imaging diagnostic technique for diagnosing biliary tumors. In the hilar cholangiocarcinoma, intrahepatic bile duct dilatation, gallbladder emptiness, extrahepatic bile duct dilatation, bile duct cancer can be seen in the lower bile duct, and intrahepatic bile duct enlargement, with gallbladder enlargement; middle bile duct cancer shows intrahepatic bile duct dilatation and hilar bile duct dilatation; Pancreatic head cancer can be seen in the head of the pancreas and a substantial mass in the head of the pancreas.

X-ray examination

Intravenous cholangiography is not suitable for obstructive jaundice or liver function damage. It is necessary for gastrointestinal barium meal examination when heart is needed. It has certain value for the diagnosis of pancreatic head cancer and duodenal papillary cancer.

CT examination

CT has the same diagnostic value for understanding the location of biliary obstruction. CT shows gallbladder lesions or gallbladder tumors, hepatic parenchymal lesions, hepatic and posterior peritoneal lymph nodes, and head and body lesions. The aspect is clearer than the ultrasound examination. Magnetic resonance cholangiopancreatography (MRCP) is extremely helpful in diagnosing biliary obstruction.

Endoscopic retrograde cholangiopancreatography

(ERCP) For patients with obstructive jaundice, understanding the location and cause of obstruction before surgery can provide an important diagnostic basis. For patients with incomplete biliary obstruction, the intrahepatic and extrahepatic bile ducts can be clearly indicated, suggesting that the lesion is in the hilar, middle bile duct or lower bile duct, and clearly shows the extent and extent of the lesion, providing an important basis for surgical treatment. In patients with complete biliary obstruction, ERCP can only show the truncation sign of the obstruction site, and can not show the extent of proximal bile duct and obstruction in the obstruction site; in order to understand the proximal bile duct obstruction, it depends on PTC examination. ERCP examination has the risk of causing acute suppurative cholangitis. Patients with obstructive jaundice should be very careful.

PTC check

To further diagnose cholangiocarcinoma, an important examination of the tumor site is identified. PTC can produce a variety of complications such as bleeding, infection, and leakage of the gallbladder. The indications should be strictly controlled, more than before surgery.

Diagnosis and diagnosis of biliary tract tumor

History: Ask if the time of onset of jaundice is progressive or exacerbated, whether it is painless or painful, the relationship between the site and diet, whether there is fever, chills, nausea, vomiting, irritability, loss of appetite, weight loss , diarrhea, stool grayish white changes, with or without urine color changes and skin itching and other symptoms. In the past, there was a history of jaundice, a history of hepatitis, and what kind of medical institutions were diagnosed and treated. Whether there is a history of cholelithiasis, whether there is a history of surgery and the details of the operation.

Physical examination: hepatomegaly, tenderness, splenomegaly and ascites suggest portal vein involvement, poor prognosis. Tumors located below the gallbladder can be swollen and gallbladder.

Laboratory examination: manifested as obstructive jaundice, AKP and elevated transaminase, some patients with positive stool occult blood test. B-ultrasound is the first choice to show the location and extent of the lesion, but the nature of the lesion cannot be determined. If the metastases or portal vein thrombosis are found, it is helpful for diagnosis. MRI, PTC and ERCP can determine the location and extent of the lesion, and the latter two are more accurate.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.