Overview
Biliary tract disorders are diseases that occur in the biliary system. The biliary system begins with the capillary bile ducts in the liver, gradually converges into branches of intrahepatic bile ducts at various levels, and then becomes the left and right hepatic ducts in the porta hepatis, and finally the common hepatic duct in the foreign exchange of the liver. The gallbladder is connected to the common hepatic duct through the cystic duct, and from the cystic duct to the common hepatic duct below the connection is called the common bile duct, which has Oddi’s sphincter at its end, and the common bile duct and the pancreatic duct converge and open at the duodenal papilla. Common biliary tract disorders include stones, tumors, parasitic diseases, and congenital malformations. Diseases of the biliary tract can cause biliary obstruction and bile stagnation, which further affects liver function and often leads to secondary infections. Chronic irritation, such as biliary stones, can also induce malignant tumors.
Etiology
The etiology is related to the anatomical location and physiological function of the biliary tract.
Symptoms
Patients may be asymptomatic, and episodes are mainly characterized by gastrointestinal symptoms and biliary tract-related symptoms, such as right upper abdominal pain, which may radiate to the right scapular region and back. Cholecystitis may be accompanied by chills and fever, and increased white blood cell count; acute cholangitis may present with Chaco’s triad or Reynolds’ pentad; biliary obstruction may present with obstructive jaundice; and biliary hemorrhage may present with periodic upper gastrointestinal bleeding.
Examination
1. Ultrasonography
Ultrasonography is the preferred primary screening method for biliary tract diseases, with an accuracy of over 90% for diagnosis of gallbladder stones, but its significance for diagnosis of bile duct stones is limited. In addition, intraoperative ultrasonography and endoscopic ultrasonography are of special significance for intraoperative localization and identification of biliary tract lesions.
2. CT examination, magnetic resonance imaging (MRI)
It can clearly show the extent and degree of dilatation of intrahepatic and extrahepatic bile ducts, and shows lesions of the biliary tract more clearly.
3. Cholangioscopy
It can directly observe whether there is any lesion in the bile duct, the nature and location of the lesion, and it can remove bile duct stones and dilate the narrowed bile duct.
4. Percutaneous transhepatic cholangiography (PTC)
A kind of invasive examination, which is of great significance in diagnosing bile duct stones and determining the cause and location of bile duct obstruction.
5. Tumor markers
Checking serum carcinoembryonic antigen (CEA), glycan antigen 199 (CA199), glycan antigen 125 (CA125) and other tumor markers is helpful in the diagnosis of biliary tract malignant tumors.
Diagnosis
Symptoms related to biliary tract are the main basis for diagnosis of biliary tract diseases. ultrasound has high diagnostic accuracy, and for those who have difficulty in ultrasound diagnosis, CT, magnetic resonance imaging, percutaneous transhepatic cholangiopancreatography, tumor markers and other auxiliary examinations can be chosen to further clarify the diagnosis.
Treatment
1. Non-surgical treatment
(1) Pharmacological treatment: oral choleretic drugs; application of ursodeoxycholic acid, goose deoxycholic acid, lithotripsy and other stone dissolution; deworming treatment for those with parasitic infection.
(2) Drainage: non-surgical drainage is also a common treatment for biliary tract diseases, such as percutaneous hepatic puncture biliary drainage, endoscopic nasobiliary drainage and internal stent drainage.
2.Surgical treatment
There are laparoscopic cholecystectomy, open cholecystectomy or cholecystostomy, choledochotomy, T-tube drainage, hepatectomy and so on. Surgical resection is preferred for biliary tract tumors.
Nursing care
1. Keep the mood comfortable, avoid emotional excitement, and actively treat the disease at an early stage.
2. Avoid greasy food, avoid overeating and drinking.
3. Review ultrasound in 3 months after biliary lithotripsy.
4. If surgical treatment is performed, master the methods of postoperative T-tube self-care and discomfort control.
5. If abdominal pain, chills, high fever, jaundice, etc. occur, consult the doctor promptly.