What is the function of gallbladder?
1.Storage and concentration of bile. When not eating, most of the bile secreted by the liver flows into the gallbladder, and the mucous membrane absorbs the water and inorganic salts therein, thus making it concentrated for storage, and it is recorded that the normal gallbladder can concentrate the bile secreted by the liver up to 10 times.
2, contraction of bile discharge function. After eating, especially after greasy food, under the action of hormones in the body, the gallbladder can contract more substantially, discharging 50-70% of its bile, so that the food chyme and bile can be mixed to help digestion and absorption of food, especially fat.
3.Secretion function. The mucous membrane of gallbladder can secrete mucus, which has the function of protecting the mucous membrane of gallbladder.
What is the effect of gallbladder removal on human body?
On the whole, removal of gallbladder does not have a great impact on human body. Under normal circumstances, after eating fatty foods, the gallbladder contracts and discharges bile to mix with the food to facilitate the digestion and absorption of lipids. After removal of the gallbladder, bile is lost as a storage site, and bile secreted by the liver can be discharged into the intestine at any time. Although the hepatocytes can increase some bile secretion with the reflex when eating, in general, the bile excretion and the eating of lipid food are less coordinated than before. Therefore, some patients may experience diarrhea after eating lipids for a period of time after surgery, but digestive function can generally return to normal with compensatory functions such as bile duct expansion.
What is the role of the bile ducts?
The role of the bile ducts is to serve as a conduit for the transport of bile. The bile duct above the confluence of the common hepatic duct and the cystic duct mainly allows bile secreted by the liver to flow into the gallbladder, while the common bile duct is mainly responsible for transporting gallbladder bile into the intestine.
What foods contain high levels of cholesterol?
In addition to fatty meat and egg yolk, there are many foods that are rich in cholesterol. For example, mollusks such as snails and seafood such as cuttlefish, and animal offal.
What does the change in the size of the gallbladder reflect?
Normally, the gallbladder volume of normal people also changes. When eating, the gallbladder contracts and discharges bile with an average volume of about 15ml, while the gallbladder volume can reach 90ml when fasting, which is mainly the result of the coordination between the discharge and storage of bile and eating. In patients with cholecystitis and gallbladder stones, especially those with frequent attacks, the gallbladder becomes smaller and smaller in volume due to repeated inflammation, and loses its ability to contract, finally becoming a layer of fibrous tissue wrapped in stones and completely losing its function, which is medically known as atrophic cholecystitis.
Why do cholesterol stones tend to occur in the gallbladder?
The gallbladder is used to store and concentrate bile, so the concentration of bile cholesterol in the gallbladder is relatively high and crystals are more likely to precipitate. When the gallbladder contracts, some of the bile remains, and the concentration of cholesterol in this residual bile is even higher, making it easier for cholesterol crystals to form. In addition, some glycoproteins secreted by the gallbladder will further promote the formation of cholesterol crystals, so cholesterol stones are more likely to occur in the gallbladder.
What symptoms should people with a history of biliary tract disease visit the hospital for?
There are many types of biliary tract diseases, each with different symptoms. Patients should be aware of the following conditions and should go to the hospital once they appear.
1, sudden onset, pain is more intense than before, accompanied by frequent vomiting, should immediately go to the hospital, because it may be biliary colic, biliary ascariasis and other acute morbidity, must go to the hospital for treatment; if the condition is heavy, there are chills and high fever, yellow eyes, indicating an attack of acute cholangitis, there is the possibility of toxic shock, more should immediately send the patient to the hospital, otherwise the lighter delay, the more life-threatening.
2, although the biliary tract disease has had a clear diagnosis in the past, but this time the symptoms are different than before or development, but still should go to the hospital for examination. If you had gallbladder stones and never had jaundice before, but have jaundice this time, you should consider gallbladder stones falling into the common bile duct causing secondary choledocholithiasis; if you had gallbladder polyps or chronic cholecystitis, but recently you feel that your symptoms have worsened with wasting/weakness, you should consider whether the disease is malignant.
If you have a history of biliary tract surgery and have recently developed epigastric pain, jaundice, fever, etc., go to the hospital to check whether there are residual stones or stone recurrence, and it is also necessary to find out whether this attack is related to the previous surgery, such as patients who had previous biliary tract internal drainage surgery and have frequent epigastric discomfort with fever, it may be caused by retrograde infection.
What are the characteristics of fever in biliary tract disease?
Fever is the most common symptom in patients with biliary tract disease and is mainly associated with inflammation of the biliary tract. The level and pattern of fever varies depending on the urgency, slowness, mildness and severity of the inflammation and the patient’s condition and degree of response. Acute cholecystitis fever is characterized by abdominal pain followed by fever, which is not too high, around 37.5~38.5 degrees, usually without chills, and most patients can relieve themselves after symptomatic treatment; acute cholangitis patients are mainly characterized by chills and high fever, accompanied by abdominal pain and jaundice, but a few patients (intrahepatic bile duct stones, Calori disease) can have no abdominal pain or jaundice. Those with persistent high fever or flaccid fever (no fever or only low fever in the morning, but high fever in the afternoon with a temperature difference of 1 degree Celsius or more) are usually seen in patients with complicated liver abscess or subdiaphragmatic abscess.
What tests should be done when gallbladder infection and gallbladder stones are suspected?
Ultrasound is the first choice for diagnosing cholecystitis and gallbladder stones, and 98% of patients can get a clear diagnosis through ultrasound. Oral cholecystography can understand both the presence or absence of stones in the gallbladder and the function of the gallbladder, and is also a commonly used examination method. If the above methods still cannot confirm the diagnosis, CT and MRI examinations can also be performed. Of course, in addition to physical examinations, necessary blood and urine tests and liver function tests are also necessary to determine the degree of inflammation and the presence of other complications.
How to cooperate with laboratory tests?
1, detailed understanding of the content of the test items and the correct collection of laboratory specimens: understand what kind of specimens should be collected for the tests you have done, and should know which tests to do, what are the requirements for collecting specimens, and what preparations should be made before the test. Generally speaking, the first urine sample should be taken early in the morning, the urine container should be clean, the volume of urine should be about 20 ml, keep the urine fresh and send it to the laboratory within half an hour, women should clean the perineum before leaving the specimen in case of menstruation. Stay stool specimens, the container should be clean and impervious to water, generally retained about 5g stool, such as abnormal stool, should be collected with pus and blood or mucus more stool.
2, carefully do the preparation before the test: some tests before the test to do some preparation, in order to correctly reflect the test results. Generally the night before the test to rest well, so that the body in the best physiological state. Check liver function, blood glucose, lipids, the night before the blood draw after nine o’clock should not eat, keep the morning blood draw for fasting state; leave urine specimens before do not drink sugar tea or eat high-protein diet and avoid strenuous exercise; do stool occult blood test, three days before the test should be abstained from animal food, otherwise it will affect the test results; some drugs will affect the test results, the test should be discontinued before, if not discontinued should tell the doctor or If you can not stop using, you should tell the doctor or suspend the test.
3, timely, comprehensive and correct treatment of laboratory results, regular follow-up: laboratory results should be promptly told the results of the doctor, and itemized analysis of the results, do not just ask whether normal or not. Some patients have only a few abnormal laboratory indicators, which should be analyzed in conjunction with the disease, and some abnormalities are caused by chance or experimental errors, which should be reviewed. Even if the test results are not normal, you should not be pessimistic and disappointed, but cooperate with the doctor for active treatment. Even if the test results are completely normal, sometimes the disease cannot be completely excluded because some biliary diseases can be asymptomatic and biochemically abnormal in the early stage.
Why should liver function tests be performed for cholecystitis and cholelithiasis?
The gallbladder and liver are adjacent to each other in anatomical position, and the bile secreted by the liver is stored in the gallbladder, and diseases of the gallbladder often affect the normal function of the liver, therefore, when suffering from cholecystitis and cholelithiasis, it is helpful to know the liver function for the diagnosis, differential diagnosis and treatment of cholecystitis and cholelithiasis.
1, help to determine the severity of cholecystitis, cholelithiasis: cholecystitis, cholelithiasis generally does not cause jaundice nor affect liver function, but in the following two cases can appear jaundice and cause liver function damage. First, acute purulent cholecystitis, gallbladder bad jaundice, when the inflammation of the gallbladder is very serious, can cause mild jaundice and elevation of serum transaminases; second, gallbladder stones fall into the common bile duct or gallbladder edema is serious, high tension, the neck of the gallbladder compression of the common bile duct, causing obstructive jaundice, then cause elevation of serum bilirubin, transaminases, alkaline phosphatase.
2.It helps to understand the liver function: patients with cholecystitis and cholelithiasis can sometimes have combined liver diseases, such as: chronic active hepatitis, cirrhosis, portal hypertension. These patients often have different degrees of liver function damage, at this time the correct estimation of the patient’s liver condition, help to take reasonable treatment measures to protect liver function and avoid further damage to liver function, such as in the drug treatment of cholecystitis and cholelithiasis, the drugs that have an impact on liver function can be used as far as possible or reduce the dose.
3, conducive to preoperative preparation, improve surgical safety: cholecystitis, cholelithiasis patients often need surgical treatment, and preoperative understanding of liver function timely correction of coagulation dysfunction caused by liver dysfunction, hypoproteinemia, etc. will greatly improve the safety of surgery, but also beneficial to the patient’s recovery after surgery.
4, help to take reasonable and safe treatment measures: cholecystitis and cholelithiasis have two methods of surgical treatment and non-surgical treatment, which should be decided according to symptoms, signs and systemic conditions and important organ functions. When liver function is severely damaged, non-surgical treatment should be used as much as possible, and litholytic drugs that damage liver function should not be used for treatment. If the patient also has liver cirrhosis and portal hypertension, a flow disconnection or shunt operation should be done before cholecystectomy, which can greatly reduce the possibility of intraoperative hemorrhage and improve the safety of the operation.
What is the significance of testing alkaline phosphatase (AKP) for cholecystitis and cholelithiasis?
Serum alkaline phosphatase levels in normal people as well as in patients with simple cholecystitis and cholelithiasis are generally maintained at normal levels, while when there is biliary obstruction, serum AKP levels rise significantly. This is because alkaline phosphatase secreted by the liver enters the bile, which contains high concentrations of alkaline phosphatase, but in the presence of a patent bile duct they all pass through the sphincter of Oddi into the intestine and do not lead to abnormal serological manifestations.
In the case of biliary obstruction, on the other hand, high concentrations of AKP cannot enter the intestine and are returned to the bloodstream by biliary hypertension, causing a significant increase in intra-serum concentrations, a change that often occurs before the patient develops significant signs of jaundice, even if the bile duct is partially obstructed. In contrast, in hepatocellular jaundice, serum AKP is only mildly elevated or unchanged.
In addition, elevated serum AKP is also seen in metastatic tumors of the liver, some occupying lesions of the liver (abscesses, amyloidosis, granulomas, etc.), and bone proliferative diseases.
What is the significance of glutamyl transpeptidase (γ-GT) for cholecystitis and cholelithiasis?
Unlike alkaline phosphatase, γ-GT is significantly elevated in both hepatocellular disease and biliary obstruction, making it impossible to distinguish obstructive jaundice from hepatocellular jaundice. However, if elevated serum AKP is also present, an abnormal γ-GT can further confirm that the lesion is from the hepatobiliary system and not from an extrahepatic organ.
How do I read the lab report?
When patients go to the hospital, they often have to undergo laboratory tests and are eager to know the results of the laboratory report to find out if they are sick and what kind of illness they have. This state of mind is understandable. In order to get the test report early, you can ask when the test report will be available and check whether it is your own when you get the test report, then read the result and treat it correctly.
The significance of laboratory tests: laboratory tests are one of the important bases for doctors to diagnose and treat diseases, and sometimes they can also be used as the main basis for diagnosis, and are an important reference for doctors to see patients. Patients should recognize the importance of laboratory results, but should not be alarmed by abnormal laboratory results.
Understand the significance of the normal value of laboratory tests.
1, to understand the normal value, in order to know abnormal, the so-called normal value, refers to the project of the majority of normal people (95%) of the data, should be reliable, but not absolutely accurate, because there are certain differences.
2, even if the same normal person, due to changes in diet and living and other internal and external environment, the normal value may also change.
3, the normal value is often not a number, but a range, such as a normal white blood cell count of 400 to 10,000 per cubic millimeter.
Correct understanding of laboratory results.
1, the normal value is on behalf of 95% of the people, there are 5% of normal people does not apply, the laboratory results are normal still may have disease, abnormal and not necessarily have disease.
2, physiological factors can affect the test results, such as mid-pregnancy white blood cells will rise, to the delivery may be higher, but the pregnant woman is not sick.
Laboratory results should be combined with the patient’s condition: doctors should first understand the disease, and then do laboratory tests, laboratory test results, and then analyze the condition, and repeatedly verify when needed, before making a judgment. Health checkups often do laboratory tests, the results are found to be abnormal, then the doctor also need to understand the situation, to see if there is a disease and what disease?
Why is it necessary to test serum amylase?
Due to the close anatomical relationship between the biliary tract and the pancreas, the two can affect each other when pathology occurs. In particular, distal obstruction of the biliary tract may cause bile to flow back into the pancreatic duct, activating pancreatic enzymes and leading to the development of acute pancreatitis. This is the pathogenesis of so-called biliary pancreatitis. Therefore, it is necessary to test the serum amylase concentration in the diagnosis of biliary tract diseases, especially acute lesions, in order to prevent missed diagnosis and result in inappropriate selection of therapeutic measures. Of course, other acute abdominal conditions (e.g., intestinal obstruction, gastrointestinal perforation, acute peritonitis, etc.) can cause elevated amylase levels, so they should also be differentiated.
What are direct bilirubin, indirect bilirubin, 1-minute bilirubin, total bilirubin, conjugated bilirubin, and free bilirubin? What kinds of bilirubin are there?
Bilirubin is divided into conjugated bilirubin and free bilirubin. The former is also known as direct bilirubin or 1-minute bilirubin, while the latter is also known as indirect bilirubin. Free bilirubin is mainly metabolized by the destruction of red blood cells, it needs to add alcohol and then diazo reagent to react when testing, this test is called indirect reaction, so free bilirubin is also called indirect bilirubin; free bilirubin enters the liver after processing and combining with other substances, and then excreted into the bile, called conjugated bilirubin, it can directly add diazo reagent to react when testing, called direct reaction, so It is also called direct bilirubin. The direct reaction is usually completed within one minute, so it is often called 1-minute bilirubin. The sum of total combined bilirubin and free bilirubin is total bilirubin.
What is the clinical significance of measuring CA19-9, CA125 and CA50?
CA19-9, CA125 and CA50 are all tumor markers, which are essentially a protein. The current experience shows that an increase in these three markers can indicate the possibility of malignant tumors in the body, and their accuracy is high, especially an increase in CA19-9 can strongly indicate the possibility of pancreatic tumors, and an increase in all three is more meaningful.
What preparation should be done before ultrasound examination of biliary tract diseases and why?
Ultrasound examination is easy to perform and painless for patients, so no special preparation is generally required. However, in order to obtain better examination results, patients should pay attention to the following points.
1.Fast for 8 hours before the examination, and do not eat fatty food one night before the examination, which can make the bile in the gallbladder full and facilitate the examination.
Patients with constipation can take laxatives the night before the examination to eliminate the accumulation of gas and feces in the intestinal cavity, because excessive accumulation of gas in the intestine can interfere with ultrasound observation.
3, barium in X-ray gastrointestinal imaging and inflation in gastrointestinal endoscopy will affect the clarity of ultrasound images, so ultrasound should be done first and then other examinations such as gastrointestinal endoscopy. If gastrointestinal imaging has been done, ultrasound examination should be done after three days. (4) Before going to bed for examination, you should loosen your clothes and pants to fully expose both sides of the quarter rib area.
What are the differences between gallbladder stones and gallbladder polyps during ultrasound examination?
Gallbladder polyps are single or multiple rounded clusters of intense light in the gallbladder cavity, which differ from gallbladder stones in that there is no sound shadow after the clusters and they do not change with the change of position. Sometimes small stones on the posterior wall of the gallbladder have unclear acoustic shadows and move in a small range, much like polyps, when the patient is asked to change position extensively, these small stones can appear as stone rolling signs, multi-directional cut and sweep, and acoustic shadows can also appear.
Is it correct to find intrahepatic bile duct stones on ultrasound? Does it have to be serious?
The intrahepatic bile ducts are better diagnosed by ultrasound because there is less interference. However, the intrahepatic bile ducts are widely branched and can be easily missed during examination. Some intrahepatic calcifications can be misdiagnosed as stones, and in patients who have undergone biliary intestinal anastomosis, gas from the intestine may enter the bile duct and be mistaken for stones, so the correct diagnosis rate is only 70%~80%.
Most of the intrahepatic bile duct stones found by ultrasound need further examination to clarify the condition, except for acute cholangitis manifestations such as high fever and jaundice, which require emergency treatment, and should be considered comprehensively with medical history, and some patients can be treated with drugs first. Some patients can be treated with medication first. Further treatment plan will be made after the diagnosis and pathology are clear, while some patients still need surgery to be cured.
What is ERCP?
ERCP stands for Endoscopic Retrograde Cholangiopancretography, also known as endoscopic retrograde cholangiopancreatography. The operation is just like gastroscopy, the specific operation is to enter the duodenum through the mouth, esophagus and stomach, find the opening of the biliopancreatic duct papilla in the second section of the duodenum, insert the contrast tube, inject the contrast agent and then take pictures from all directions to observe the bile duct and pancreatic duct.
What should I do before endoscopic retrograde cholangiopancreatography?
ERCP examination is basically like a gastroscopy. Patients should fast for 6-8 hours, give sedatives and atropine 15 minutes before the examination to reduce salivation, and spray local anesthetics in the pharynx to reduce nausea and other discomfort, except that an iodine allergy test should be performed. For those who have recently had biliary tract or pancreatitis, it is advisable to use antibiotic drugs before the examination to prevent the activation of latent bacterial infection by the contrast agent.
How should the patient cooperate after endoscopic retrograde cholangiopancreatography?
1.Because the anesthetic in the pharynx will not expire until 1~2 hours, in order to avoid accidental introduction of food into the trachea, it will take 6 hours after the examination before eating.
2. Observe whether there is abdominal pain and fever, pay attention to the color of stool, whether there is blood in stool and vomiting blood, and seek medical attention once it happens.
3. For those who have pancreatic ducts visualized during the imaging, they should enter a low-fat diet for 2~3 days after the imaging.
How to cooperate with doctors for T-tube cholangiography?
1.Eliminate concerns.
2. It is advisable to open the T-tube the day before the imaging.
3, the injection of contrast medium during the imaging will have mild distension and pain in the right upper abdomen, which is normal, but if the distension and pain are abnormal, you should tell the doctor to avoid high contrast pressure.
4.The doctor should abstain from breathing when taking the film.
5.The T-tube should be kept open after the imaging. If there is abdominal pain or fever, contact the doctor in time.
What is MRCP (Magnetic Resonance Cholangiopancreatography)?
Magnetic resonance cholangio-pancreatography (MRCP) is a new three-dimensional imaging technique that has been clinically applied in recent years, which is a promising diagnostic technique because it is simple, non-invasive and does not require contrast injection, but can obtain similar image effects as ERCP and PTC. The basic technique of MRCP is the T2 weighted pulse sequence. Therefore, stationary fluids such as bile and pancreatic fluid have high intensity signals, while the signal intensity of both substantial organs and blood flow are weak or even undetectable. Combining the above imaging features, an image with low background signal and high intensity signal of the bile duct and pancreatic duct can be obtained. This image can achieve results close to those of direct cholangiography.
What are the advantages of MRCP for biliary tract disease?
It has the following advantages.
1. Broad indications: It can be applied to almost all kinds of patients with biliary tract and pancreatic diseases (except those with contraindications to MRI, such as those with metal prostheses or pacemakers), including those with anatomical changes after surgery, those with pancreatitis and cholangitis, and those who are not suitable for ERCP or PTC for various reasons.
2, high contrast rate: even without bile duct dilatation, 100% of the intra- and extra-hepatic bile ducts can be displayed. The visualization rate of the pancreatic ducts in the head of the pancreas is 95%, and 42% in the tail of the body, and nearly 100% when the pancreatic ducts are dilated. According to the special imaging principle of MRCP, the unrevealed bile ducts and pancreatic ducts are mostly normal unless there is obvious dilatation at the proximal end to diagnose biliary stenosis.
No complications: Since MRCP is not an interventional test and no contrast agent is needed, it is as painless and free of complications as ultrasound and CT.
4. High diagnostic accuracy: MRCP can provide accurate localization and is not affected by the uneven distribution of contrast agent. In the qualitative diagnosis, it is especially suitable for the diagnosis of bile duct stones and bile duct cysts and other benign lesions with a correct rate of about 97%; in the diagnosis of malignant bile duct obstruction, it can not only accurately determine the site of obstruction, but also make a preliminary qualitative diagnosis according to the location of the tumor and the shape of the occupancy.
MRCP can show the whole picture of the biliary tract, including the lesion, the pancreatic duct and the combined flow of the biliopancreatic duct. This not only provides more information for diagnosis, but also helps to develop appropriate surgical procedures according to the length and morphology of the normal bile ducts near and distal to the lesion.
6. Conventional scan: T1 and T2 conventional scans of MR can show the upper abdominal organs, including the liver, pancreas, surrounding blood vessels and internal organs, which provides a basis for qualitative diagnosis of tumors and preoperative judgment of whether the tumor can be removed and the extent of removal.
What are the disadvantages of MRCP?
Because MRCP imaging principle does not depend on contrast injection, it reflects the static situation of bile and pancreatic ducts, so it cannot determine whether the obstruction is complete or incomplete, even if the duodenum is partially visualized, it cannot indicate whether the sphincter of Oddi is open. This makes it difficult to diagnose distal bile duct stenosis and sphincter of Oddi insufficiency.
2.The visualization of small stones in the distal bile duct is not effective, but sometimes the diagnosis can be clarified with the help of the coronal primary image of the scan.
Although the initial qualitative diagnosis of peri-potbelly tumors can be provided based on the occupancy pattern, a clear diagnosis sometimes relies on CT examination because of the poor visualization of the pancreas on MR conventional scans.
4.MRCP can never replace the role of PTC for simultaneous bile duct drainage and ERCP for simultaneous EST and stone extraction.
Is there any difference between cystic dilatation of bile ducts and bile duct cysts? What is it?
Bile duct cyst, also known as cystic dilatation of the bile duct, is also known as common bile duct cyst because most of it occurs in the common bile duct, and its development is related to congenital abnormal development, so it is also known as congenital bile duct cyst. Pathologically, it is not a true cyst, but a cystic dilatation of a considerable portion of the common bile duct to varying degrees, with a cyst wall made of fibrous connective tissue. The size of the cyst varies greatly, from a small volume of only 30 ml or even smaller to a large one that can hold more than several hundred ml. The main clinical manifestations are: recurrent abdominal pain, obstructive jaundice, and palpable mass in the right upper abdomen.
In addition to choledochal cysts, sometimes the cysts are born in intrahepatic bile ducts, and sometimes there are cysts in both intra- and extrahepatic bile ducts.
According to statistics, bile duct cysts have a high rate of malignancy and can be regarded as a kind of precancerous lesion of bile duct cancer, so those with clear diagnosis should seize the opportunity for timely surgical treatment.
Is the normal bile duct sterile?
There is a small amount of bacteria in the normal bile duct. However, as long as there is no obstruction in the bile duct, bacteria will not multiply in the bile and cause infection, and the bacteria that enter the bile duct can be excreted into the intestine with the bile.
What is “Charcot’s” triad? What is Raynaud’s pentad?
Cholangitis can cause the “Charcot’s” triad of abdominal pain, chills and fever, and jaundice. It is named after Charcot, who first described it in 1877. In most patients, abdominal pain is due to spasm of oddi′s sphincter and bile duct smooth muscle caused by stones embedded in the lower part of the common bile duct. Chills and fever are due to retrograde spread of biliary tract infection and systemic toxicity caused by retrograde flow of pathogenic bacteria and toxins into the blood. Jaundice is due to bile duct obstruction caused by stone impaction.
On the basis of the above triad, shock and psychiatric symptoms such as apathy, drowsiness and coma appear, which was first considered by Reynolds et al. in 1954 as a result of acute obstructive purulent cholangitis with severe disease and a large number of bacteria and toxins entering the circulatory system, so it is called “Reynolds’ pentad”. The presence of these symptoms reflects a critical condition that requires prompt surgical drainage of the bile duct.