What symptoms should a person 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 a possibility of toxic shock, the patient should be sent to the hospital immediately, otherwise the lighter the delay, the more life-threatening.
(2) Although the biliary tract disease has been clearly diagnosed in the past, but this time the symptoms are different or develop than before, you should still 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 and recently feel worse symptoms with wasting/weakness, you should consider whether the disease has malignant changes.
If you have a history of previous biliary surgery and have recently developed epigastric pain, jaundice and fever, you should 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, for example, if a patient who has previously undergone internal biliary drainage has 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. High fever that does not subside 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) is usually seen in patients with complicated liver abscess or subdiaphragmatic abscess.
What tests should be done when gallbladder infection or gallbladder stones are suspected?
Ultrasound is the first choice for the diagnosis of cholecystitis and gallbladder stones, and 98% of patients can be diagnosed clearly by 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) Understand in detail the content of the test items and the correct collection of specimens: understand what kind of specimens should be collected for the test you are doing, and 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. Retain stool specimens, the container should be clean and impervious to water, generally retain 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 should be prepared before the test in order to correctly reflect the test results. Generally, the night before the test should be well rested, so that the body is in the best physiological state. To check liver function, blood glucose and lipids, you should stop eating after 9:00 p.m. the night before the blood draw, and keep fasting in the morning when the blood is drawn; do not drink sugar tea or eat a high-protein diet and avoid strenuous exercise before leaving the urine specimen; to do the stool occult blood test, you should abstain from eating animal food three days before the test, otherwise it will affect the test results; some drugs will affect the test results, so you should stop using them before the test, and if you cannot stop using them, you should tell your doctor or If you cannot stop using them, 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 to the doctor, and analyze the results item by item, do not just ask whether it is normal or not. Some patients have only a few abnormal laboratory indicators, which should be analyzed in the context of 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 anatomically, 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.
(1) It helps to determine the severity of cholecystitis, cholelithiasis: Cholecystitis, cholelithiasis usually does not cause jaundice nor does it affect liver function, but jaundice can occur and cause liver function impairment in the following two cases. One is the presence of acute purulent cholecystitis, gallbladder bad jaundice, when the inflammation of the gallbladder is very serious, it can cause mild jaundice and elevation of serum transaminases; the second is the gallbladder stones fall into the common bile duct or the gallbladder edema is serious, high tension, the neck of the gallbladder presses the common bile duct, causing obstructive jaundice, then cause elevation of serum bilirubin, transaminases, alkaline phosphatase, etc.
(2) It helps to understand liver function: Patients with cholecystitis and cholelithiasis can sometimes have combined liver diseases, such as: chronic active hepatitis, liver cirrhosis, and portal hypertension. These patients often have different degrees of liver function damage, at this time, the correct estimation of the patient’s liver condition can help to take reasonable therapeutic measures to protect liver function and avoid further damage to liver function, such as in the drug treatment of cholecystitis and cholelithiasis, drugs that have an impact on liver function can be used or reduced in dose as much as possible.
(3) Benefit from preoperative preparation and improve surgical safety: patients with cholecystitis and cholelithiasis often need surgical treatment, and preoperative understanding of liver function and timely correction of coagulation dysfunction and hypoproteinemia caused by poor liver function will make the surgery much safer and also benefit the patient’s recovery after surgery.
(4) Help to take reasonable and safe treatment measures: there are two methods of surgical treatment and non-surgical treatment for cholecystitis and cholelithiasis, 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?
A: Serum alkaline phosphatase levels are generally maintained at normal levels in normal people as well as in patients with simple cholecystitis and cholelithiasis, 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 glutaminyl transpeptidase (γ-GT) in cholecystitis and cholelithiasis?
A: 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?
A: 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 psychological state is understandable. In order to get the lab report early, you can ask when the report will be available and check if it is your own when you get the lab report, then read the results and treat it correctly.
The significance of laboratory tests: laboratory tests are one of the important bases for doctors to diagnose and treat diseases, 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 understand the normal value, in order to know abnormal, the so-called normal value, refers to the majority of normal people (95%) of the project data, should be reliable, but not absolutely accurate, because there are certain differences; ② even the same normal person, due to changes in diet and living and other internal and external environment, the normal value will change; ③ normal value is often not a number, but a The normal value is often not a number but a range, such as a normal white blood cell count of 400~10000 per cubic millimeter.
The correct understanding of the test results: ① normal value is representative of 95% of the population, and does not apply to the 5% of normal people, the test results may still be normal and not necessarily sick; ② physiological factors can affect the test results, for example, the white blood cells will rise in mid-pregnancy, and may be higher at the time of delivery, 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 if necessary, repeatedly verify, 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?
It is important to find out what the reason for abnormal test results is: there are many factors for abnormal test results, which can be both sick and not sick: (1) to find out the root cause, do not be afraid of sickness and not to make further examination; (2) to recall whether the preparation before the test is correct, and to exclude all kinds of factors that may lead to abnormal results; (3) clear abnormal results can be confirmed by further other tests.
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 lesions occur. In particular, distal obstruction of the bile duct 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 diagnoses and result in inappropriate selection of therapeutic measures. Of course, other acute abdominal conditions (such as 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, and the latter is also known as indirect bilirubin. Free bilirubin is mainly metabolized by the destruction of red blood cells, and it needs to add alcohol and then diazo reagent to react in the test, 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 in the test, 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 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) fasting for 8 hours before the examination and not eating fatty food the night before the examination, which can make the bile in the gallbladder full and facilitate the examination; (2) 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 gastrointestinal endoscopy Therefore, ultrasound examination should be done first and then other examinations, such as gastrointestinal endoscopy, should be done. If gastrointestinal imaging has been done, ultrasound examination should be done three days later. (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 in ultrasound examination?
Gallbladder polyp is a single or multiple rounded intense light clusters in the cavity of gallbladder, it is different from gallbladder stone because there is no sound shadow after the intense light clusters, and it does not change with the change of body 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 the 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 does ERCP mean?
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 image of 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 is necessary to wait 6 hours after the examination before eating, and there will still be discomfort in the pharynx for 1-2 days afterwards.
2. pay attention to the presence of abdominal pain, fever, stool color, blood in the stool, vomiting blood, and seek medical attention once it occurs.
3. For those whose pancreatic ducts are visualized during imaging, they should enter a low-fat diet for 2~3 days after imaging.
How to cooperate with doctors for T-tube cholangiography?
1, to 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, should follow the instructions to abstain from breathing during the film.
5.After the imaging, the T-tube should be kept open. 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 image technology that has been clinically applied in recent years. The basic technique of MRCP is a 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 visualization rate: even without bile duct dilatation, 100% of the intra- and extra-hepatic bile ducts can be visualized. 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 in the proximal end to diagnose biliary strictures.
(3) No complications: Since MRCP is not an interventional examination and no contrast agent is needed, it is painless and free of complications like ultrasound and CT.
(4) High diagnostic accuracy: MRCP provides accurate localization and is not affected by the uneven distribution of contrast agents. In the qualitative diagnosis, it is especially suitable for the diagnosis of biliary stones and bile duct cysts and other benign lesions with a correct rate of about 97%; in the diagnosis of malignant biliary 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 morphology of the occupancy.
(5) It can show the whole picture of biliary tract: MRCP can show the whole picture of biliary tract including lesions, pancreatic duct and biliopancreatic duct merging. This not only provides more information for diagnosis, but also helps to formulate appropriate surgical procedures according to the length and morphology of the normal bile ducts in the proximal and distal parts of the lesion.
(6) Conventional scans: T1 and T2 conventional scans of MR can show the upper abdominal organs, including the liver, pancreas, and surrounding blood vessels and internal organs, providing 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 or not. This poses difficulties for the diagnosis of distal biliary 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 original image of the coronal plane of the scan.
3. Although the initial qualitative diagnosis of peri-potbelly tumors can be provided based on the occupying morphology, a definitive diagnosis sometimes relies on CT examination because of the poor visualization of the pancreas on conventional MR scans.
4, MRCP can never replace the role of PTC which can simultaneously perform biliary drainage and the role of ERCP which can simultaneously perform EST and lithotripsy.