Biliary obstruction

Introduction Cold and fever, jaundice, pain in the right upper quadrant, white stool. Such a condition is related to gallstones, cholecystitis, etc., generally refers to acute inflammation of the biliary system caused by bacterial infection, often accompanied by biliary obstruction. When the biliary obstruction is relatively complete and the bacterial infection in the biliary tract is severe, severe clinical symptoms may occur.

Cause

Pathological changes after obstruction of the bile duct depend on three factors:

(1) The internal pressure of the bile duct is continuously increased or the intermittent fluctuation is increased, that is, the obstruction is completely or intermittently incomplete.

(2) The histological and physiological functional status of the biliary wall before occlusion, that is, the elastic contraction function of the bile duct wall.

(3) The influence of Laplace's law of fluid mechanics, when the pressure is the same, the size of the bile duct is proportional to the inner diameter of the lumen, that is, under the same pressure, the pressure of the common bile duct is greater than that of the intrahepatic bile duct, and the degree of dilatation of the bile duct is proportional to the obstruction time.

These three factors interact to morphologically represent bile duct lumens, bile duct walls, and changes in primary or secondary bile lumen bile components, which are reflected in the CT image and serve as a diagnostic basis.

an examination

Related inspection

Electrocardiogram cholangiography, venous cholangiography, endoscopic biliary decompression, percutaneous transhepatic biliary drainage

In cases of extrahepatic obstructive jaundice, more than 90% are caused by lesions such as bile duct stones, cholangiocarcinoma, and periampullary carcinoma. Generally, the echo of the stone is strong, and the bile duct wall is clearly decomposed and has mobility. Most of them have obvious sound and shadow, while the soft tissue masses such as cholangiocarcinoma and pancreatic head cancer are silent, and the boundary with the bile duct is unclear, no mobility, and the cancer is caused. The degree of bile duct expansion is significantly higher than that of stones.

For the diagnosis of bile duct stones, upper cholangiocarcinoma, pancreatic head cancer, etc., ultrasound diagnosis can obtain satisfactory results. However, for small stones, small tumors and some inflammatory lesions, especially in the lower part of the bile duct, the diagnosis is more difficult. In addition, obesity, high liver position, more intestinal gas, and some patients after biliary surgery, ultrasound imaging is often unsatisfactory, difficult to determine the diagnosis, must rely on other imaging studies.

Differential diagnosis

The diseases that cause obstructive jaundice are roughly classified into two types, benign diseases and malignant diseases. Biliary stones are the most common benign diseases, followed by biliary inflammatory stenosis (such as duodenal papillary stenosis, acute and chronic cholangitis, etc.), benign biliary tumors (such as choledochal cysts, etc.). The appearance of these benign lesions of jaundice, its prominent accompanying symptoms are upper abdominal pain, chills and fever, the nature of abdominal pain is generally painful and painful, sometimes cramping is a significant symptom, and there is a history of recurrent episodes, generally Acute and subacute symptoms appear. Malignant diseases include various primary and metastatic cancers that occur in the common bile duct area. Common cholangiocarcinoma, pancreatic head cancer, and duodenal papillary cancer.

The lesions of malignant tumors generally show a chronic process, which is painless jaundice, which does not cause patients to pay attention. It is often late for medical treatment, most of them are about 1 to 2 months, and the symptoms are generally atypical. Pancreatic cancer is often highlighted by right upper abdominal pain. Symptoms, but the pain is mild, generally with dull pain and dull pain, while cholangiocarcinoma is mainly caused by abdominal distension, indigestion and loss of appetite. Duodenal papillary cancer can be digested in the early stage of urinary tract and anemia. The main symptoms of bleeding are. These non-specific symptoms do not cause the patient to pay attention, but also mislead the doctor's diagnosis, thus delaying the condition, should be taken as a warning. In addition, rare cystic duct stones compress the common bile duct to cause obstructive jaundice (Mirizzi syndrome).

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