Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 14 2021

Secondary Billiary Cholangitis

  • Snapshot
    • A 46-year-old obese woman presents to her gastrointestinal doctor for colicky right upper quadrant pain and pruritus. She denies having any weight loss, fevers, or chills. She does report having pruritus worse at night, as well as fatigue and light-colored stool. Labs show elevated alkaline phosphatase. A right upper quadrant ultrasound shows intrahepatic dilation of bile ducts and stones in the gallbladder. She is scheduled for a consultation with general surgery and started on ursodeoxycholic acid and cholestyramine.
  • Introduction
    • Overview
      • secondary biliary cholangitis resulting from longstanding extrahepatic biliary obstruction
  • Epidemiology
    • Risk factors
      • obstructive lesions
        • gallstones
        • biliary strictures
        • malignancy
          • pancreatic cancer
        • inflammation
          • pancreatitis
    • Pathogenesis
      • extrahepatic obstruction of the bile ducts causes ↑ pressure in the intrahepatic ducts
        • this causes injury in the biliary tree, including fibrosis
  • Presentation
    • Symptoms
      • common symptoms
        • fatigue
        • pruritus
          • worse at night
        • dark urine
        • light-colored stool
        • right upper quadrant pain
    • Physical exam
      • inspection
        • jaundice
        • hepatosplenomegaly
        • may have xanthomas or xanthelasma
  • Imaging
    • Ultrasound
      • indication
        • to assess for hepatobiliary disease, including the etiology of extrahepatic obstruction
      • views
        • right upper quadrant
      • findings
        • gallstones
        • intrahepatic vs extrahepatic ductal dilation
  • Studies
    • Serum labs
      • liver function tests showing cholestasis pattern
        • ↑ direct bilirubin
        • ↑ alkaline phosphatase
      • ↑ cholesterol
  • Differential
    • Primary biliary cholangitis
      • key distinguishing factor
        • + autoantibodies (anti-mitochondrial antibody)
    • Hemochromatosis
      • key distinguishing factor
        • triad of cirrhosis, diabetes, and bronze skin pigmentation
    • Wilson disease
      • key distinguishing factors
        • patients typically present before age 40
        • cirrhosis, neurologic disease, psychiatric disease, and Kayser-Fleischer rings in the eyes
  • Treatment
    • Management approach
      • treat underlying condition
        • i.e., cholecystectomy for cholelithiasis
    • Medical
      • ursodeoxycholic acid
        • indications
          • all patients
      • cholestyramine
        • indications
          • severe pruritus refractory to other therapies
  • Complications
    • Ascending cholangitis
1 of 0
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options