We’re gonna be talking about biliary tract disease.
We’re gonna go ahead and start out with a quick case
and patient presentation.
So a 41-year-old woman comes to the Emergency Department
with a chief complain of right upper quadrant abdominal pain
with associated nausea and vomiting.
So first and foremost, what should you be thinking about here?
So right upper quadrant pain is definitely concerning
for disease of the liver or the gallbladder
because that’s where the liver and the gallbladder exist in the abdomen.
Concomitant or associated nausea and vomiting
should definitely make you increasingly concern
for a possible issue in the liver or the gallbladder.
So let’s take a quick moment
to just review the anatomy of the right upper quadrant.
So the liver is a large structure in the right upper quadrant
and the gallbladder is attached to the liver.
What essentially happens is the liver secretes enzymes into the gallbladder
or the gallbladder makes enzymes and those enzymes are then secreted
into the common bile duct and the cystic duct,
and those enter into the abdominal cavity into the intestines,
and help and aid with digestion of food.
So when you eat, essentially what happens is your gallbladder
will contract after you eat and it will secrete those
or release those digestive enzymes into the intestinal tract
and when they’re released into the intestinal tract,
they’ll help with digesting the food that you ingested.
The pancreas also involved and located in that area,
the pancreas is a little bit more centrally located
but is connected to the liver and the gallbladder as well.
So what are gallstones made of?
What are these things made of that cause problems for lots of patients?
The most common stones are cholesterol stones.
Cholesterol stones are due to increased cholesterol
and bile or decreased bile acid.
Cholesterol stones are associated with the four F’s,
the four F’s of gallbladder disease are fat, forty, female, and fertile.
So those are the four things that you wanna think about.
Now, it’s not all patients that are gonna be in these four F’s kind of a category.
So you wanna think about it in other patients as well,
but that’s the classic presentation
or the classic risk factors that we think about.
Other risk factors associated with cholesterol stone development
are rapid weight loss, a family history of gallstones,
and then also oral contraceptive use.
Pigment stones are somewhat less common.
They’re related to a high concentration
of calcium bilirubinate or related to infection.
So most commonly related to a parasitic infection.
The interesting thing about pigment stones is they can be seen sometimes
on plain film x-ray if they contain greater than 4% calcium.
So that can be a helpful or interesting diagnostic thing to see
if your patient happens to get a plain film x-ray of their abdomen,
you may be able to see these stones.