Gallbladder and Biliary Tract Diseases

Gallbladder and Biliary Tract Diseases......Page 2
Preface......Page 9
Contents......Page 11
Contributors......Page 14
I— Introduction......Page 18
1— General Morphology of Gallbladder Ganglia......Page 19
3— Chemical Coding of Gallbladder Neurons......Page 20
1— Electrical Properties of Gallbladder Neurons......Page 23
A— Vagal Preganglionic Input to Gallbladder Ganglia......Page 25
B— Sympathetic Postganglionic Input to Gallbladder Ganglia......Page 26
C— Sensory Axon Reflexes in Gallbladder Ganglia......Page 27
D— The Sphincter of Oddi......Page 28
A— Cholecystokinin......Page 29
B— Prostaglandin E[sub(2)]......Page 30
V— Concluding Remarks......Page 31
References......Page 33
I— Introduction......Page 38
II— Gallbladder Morphology......Page 39
A— NaCl Transport: Na[sup(+)]/H[sup(+)] and Cl[sup(-)]/HCO[sup(-)][sub(3)] Exchange......Page 40
B— Other Electrolyte Transporters......Page 41
C— Water Transport......Page 42
E— Electrolyte and Water Transport during Gallstone Formation......Page 43
F— Absorption versus Secretion......Page 46
IV— Biliary Lipids......Page 47
VI— Amino Acids and Sugars......Page 48
VII— Mucins......Page 49
VIII— Proteins......Page 50
IX— Arachidonic Acid Metabolites......Page 51
References......Page 52
II— General Features of the Smooth Muscle......Page 56
III— Physiological Mechanisms of Gallbladder Smooth Muscle Contraction and Relaxation......Page 57
A— Contraction......Page 58
B— Relaxation......Page 64
A— Excess Cholesterol in Bile......Page 65
B— Innervation, Inflammation, and Biliary Bile Salt Composition......Page 68
References......Page 70
A— The Hepatocyte......Page 81
B— Structural Lipid......Page 83
A— Bile Salts......Page 86
B— Phospholipids......Page 87
C— Cholesterol......Page 89
1— Vesicular Secretion......Page 91
2— Micellar Extraction of Phospholipids......Page 93
4— Selectivity of Biliary Phospholipid Secretion......Page 94
C— Cholesterol Secretion into Bile......Page 95
A— Cholestasis......Page 96
B— Inherited Diseases of Bile Secretory Function......Page 98
1— Microdomains......Page 99
2— Vesicle Formation......Page 100
VII— Conclusion......Page 101
References......Page 102
II— Anatomy......Page 115
IV— Experimental Models of Biliary Secretion......Page 116
B— Isolated Bile Duct Cells......Page 117
D— Isolated Bile Duct Unit......Page 118
1— Ion Transporters......Page 121
2— Ion Channels......Page 124
C— Bile Acid Transport/Cholehepatic Circulation......Page 126
D— Glucose Transport......Page 127
1— Secretin......Page 128
B. Neural......Page 130
2— Neuropeptidergic Nerve System......Page 131
References......Page 134
I— Epidemiology......Page 142
A— Age......Page 143
D— Oral Contraceptives and Estrogen Replacement Therapy......Page 145
G— Rapid Weight Loss......Page 146
J— Gallbladder Stasis......Page 147
A— Cholesterol Metabolism......Page 148
B— Biliary Lipids and the Physical Chemistry of Bile......Page 150
D— Role of the Gallbladder in Gallstone Formation......Page 152
E— Nucleation of Cholesterol Monohydrate Crystals......Page 153
F— Gallbladder Motility......Page 154
References......Page 155
A— General......Page 162
B— Noncholesterol Content in Cholesterol Gallstones......Page 163
D— Brown Pigment Gallstones......Page 164
E— Sludge......Page 165
B— Noncholesterol Components in Cholesterol Stones......Page 166
C— Black Pigment Stones......Page 167
1— Bilirubinate......Page 168
4— Metals......Page 169
6— Protein......Page 170
2— Fatty Acid Salts......Page 171
References......Page 172
A— Biology of Cholesterol......Page 180
C— Esterification, Storage, and Lipoprotein Secretion......Page 181
D— Lipoprotein Cholesterol Uptake......Page 183
B— Bile Salt Synthesis......Page 184
A— Inborn Errors of Cholesterol Synthesis......Page 187
B— Inborn Errors of Bile Acid Synthesis......Page 189
V— Cholesterol and Bile Salt Homeostasis in Health and Disease......Page 190
B— De Novo Synthesis......Page 191
C— Uptake, Hydrolysis, and Reacylation......Page 193
References......Page 194
I— Introduction......Page 199
A— Cholesterol Monohydrate......Page 200
C— Additional Crystal Forms in Bile......Page 202
IV— Solubilization of Cholesterol in Bile......Page 203
A— Equilibrium Phase Diagram......Page 204
B— Metastable Equilibrium......Page 205
B— Direct Light Microscopy......Page 206
E— Measurement of Crystal Mass......Page 207
A— Origins of Biliary Cholesterol......Page 208
B— Pathways of Cholesterol Crystallization......Page 209
B— Bile Salt Species......Page 213
VIII— Crystal Growth and Stone Formation......Page 214
IX— Conclusion......Page 215
References......Page 216
II— General Properties of Mucins......Page 224
III— Gallbladder Mucin and the Pathogenesis of Gallstone Disease......Page 225
C— Mucin Forms a Gel Layer in Which Cholesterol Crystals Nucleate......Page 226
D— Role of Mucin in Nucleation and Growth of Cholesterol Crystals......Page 227
1— MUC1......Page 228
3— MUC3......Page 230
B— Identification of Gallbladder Mucin Genes......Page 231
C— Structural Organization of the Major Gallbladder Mucin, MUC5B......Page 232
VI— Expression of Mucin Genes in Gallstone Disease......Page 235
A— Prostaglandins......Page 236
VIII— Regulation of Mucin Gene Expression in the Gallbladder......Page 237
References......Page 238
II— Origin of Protein......Page 247
III— Definition of Nucleation......Page 248
IV— Inhibitors of Crystallization......Page 249
V— Crystallization-Promoting Proteins......Page 250
VI— Relevance of Proteins to Crystallization in Native Bile......Page 252
VII— Possible Mechanism by Which Proteins Affect Crystallization......Page 253
B— Lectin-Binding Inhibitory Glycoproteins......Page 254
X— Role of Proteins in Gallstone Growth......Page 255
XI— Concluding Remarks......Page 256
References......Page 257
III— Control of Gallbladder Motility......Page 262
A— Neural Control......Page 263
C— Other Peptides and Neurotransmitters......Page 264
IV— Role of the Gallbladder in the Enterohepatic Circulation of Bile Acids......Page 265
B— Ultrasonography......Page 266
C— Cholescintigraphy......Page 267
D— Duodenal PerfusionTechniques......Page 268
B— Gallbladder Filling and Storage......Page 269
D— Mixing Function of the Gallbladder......Page 270
1— Intraindividual Variation......Page 271
3— Techniques Used for Assessing Gallbladder Motor Functions......Page 272
4— Expression of Results......Page 273
VIII— Gallbladder Motor Functions: Concepts and Methods......Page 274
A— Techniques......Page 275
B— Methods......Page 276
References......Page 277
D— Nerve Innervation—Intrinsic......Page 286
G— Neural Regulation of Postprandial Gallbladder Motility......Page 287
H— Endocrine Regulation of Postprandial Gallbladder Motility......Page 288
1— Prostaglandins......Page 289
4— Pituitary Adenylate Cyclase Activating Polypeptide......Page 290
A— Introduction......Page 291
D— The Role of CCK in Gallbladder Dysmotility Associated with Gallstones......Page 292
F— Prostaglandins and Gallstone Pathogenesis in Humans......Page 293
H— Molecular Mechanisms Underlying Gallbladder Dysmotility and Cholesterol Gallstone Pathogenesis......Page 294
References......Page 295
I— Introduction......Page 307
II— Effect of Octreotide Treatment on the Prevalence/Incidence of Gallbladder Stones......Page 308
B— Bile Lipid Composition and Physical Chemistry......Page 309
B— Large Bowel Transit......Page 310
C— Relationship between Large Bowel Transit Time and the Percentage of DCA in Serum/Bile......Page 311
V— Is the Percentage of DCA in Serum a Valid Marker for the Percentage of DCA in Bile?......Page 312
B— Effect of Increasing the Percentage of DCA in Bile on Biliary Cholesterol Secretion......Page 313
E— Effect of DCA Feeding on Biliary Cholesterol Saturation......Page 314
A— Review of Published Literature......Page 315
B— Roles of Cecal Anaerobes, Bile Acid-Metabolizing Enzymes, and Intracolonic pH in the Formation an.........Page 316
VIII— Reversal of Transit-Induced Abnormalities in DCA Metabolism with Intestinal Prokinetics......Page 318
References......Page 319
I— Introduction: The Structure of Gallstones......Page 326
A— Free and Bound Calcium......Page 328
B— Determinants of Ionized and Total Calcium Concentrations in Bile......Page 329
C— Measurement of Calcium in Bile......Page 331
B— The Formation Constant (K'f) of Soluble Calcium Complexes......Page 333
1— Bile Salts and Simple and Mixed Micelles......Page 334
4— Bilirubinates......Page 336
5— Fatty Acylates......Page 337
IV— Kinetics of Calcium Salt and Cholesterol Precipitation and Biomineralization Theory......Page 338
A— Biomineralization......Page 339
C— Biomineralization of Cholesterol......Page 340
2— Function......Page 341
1— Preparations of APF and CBP from Bile and Gallstones......Page 342
2— Characteristics of APF and CBP......Page 344
3— Sources of APF/CBP in Bile......Page 346
2— Functions of APF......Page 347
3— Functions of CBP......Page 349
G— Biomineralization Functions of Other Proteins and Biliary Lipids......Page 350
A— Summary of Current Concepts......Page 352
B— Limitations of Current Concepts......Page 353
C— Initiation of Mineral Nucleation and Precipitation......Page 354
References......Page 355
I— Introduction......Page 370
A— Cholesterol Solubility......Page 371
C— Gallbladder Mucin......Page 372
III— Pigment Gallstones......Page 373
V— High-Risk Populations......Page 374
B— Rapid Weight Loss......Page 375
D— Pregnancy and Sex Steroid Hormones......Page 376
G— Diabetes Mellitus......Page 377
A— Participation in a Regular Exercise Program......Page 378
B— Lowering of the Rate of Weight Reduction......Page 379
E— Ursodeoxycholic Acid......Page 380
G— Inhibitors of Cholesterol Synthesis......Page 382
H— Cholecystokinin......Page 383
References......Page 384
II— Prevalence......Page 396
III— Genetics......Page 397
IV— Pathogenesis......Page 398
V— Clinical Variability......Page 399
VII— Diagnosis......Page 400
C— Ultrasound......Page 401
E— Liver Histology......Page 402
G— Magnetic Resonance Imaging......Page 403
VIII— Pathology......Page 404
IX— Bile Acid Metabolism and Fat Malabsorption......Page 405
A— Nutrition......Page 407
C— Biliary Complications......Page 408
E— Liver Transplantation......Page 409
XI— Gene Therapy......Page 410
References......Page 411
B— Helical Computed Tomography......Page 416
C— Magnetic Resonance Imaging......Page 417
1— Ultrasound......Page 418
2— Computed Tomography......Page 419
1— Ultrasound of Cholecystitis......Page 420
2— Computed Tomography of Cholecystitis......Page 428
3— Magnetic Resonance Imaging of Cholecystitis......Page 430
1— Ultrasound of Choledocholithiasis......Page 431
A— Noncontrast Computed Tomography......Page 433
B— Computed Tomography Following Cholangiographic Contrast Agents......Page 434
3— Magnetic Resonance Imaging/Magnetic Resonance Cholangiopancreatography of Choledocholithiasis......Page 437
References......Page 441
II— Technique......Page 446
III— Evaluation for Gallstones......Page 447
IV— Neoplastic Lesions of the Biliary Tree......Page 449
References......Page 452
III— Prevalence......Page 455
IV— Incidence......Page 456
VI— Natural History......Page 457
VII— Treatment......Page 459
References......Page 460
II— Definition......Page 462
III— Diagnosis......Page 463
A— Transabdominal Ultrasound and Computed Tomography......Page 464
IV— Prevalence, Epidemiology, and Risk Factors......Page 465
D— Biliary Stasis......Page 466
V— Pathogenesis......Page 467
VI— Natural History......Page 468
A— Acalculous Biliary Pain......Page 469
D— Cholangitis and Pancreatitis......Page 470
C— Endoscopic Papillotomy......Page 471
References......Page 473
I— Introduction......Page 478
A— The Clinical Presentation of Biliary Colic......Page 479
C— Causes of Biliary Colic......Page 480
A— Pathogenesis of Acute Cholecystitis......Page 481
1— Mediators of Gallbladder Inflammation......Page 484
IV— Signs, Symptoms, and Laboratory Abnormalities Accompanying Acute Cholecystitis......Page 485
A— Confirmation of the Diagnosis of Acute Cholecystitis......Page 487
A— Acute Acalculous Cholecystitis......Page 488
D— Perforated Gallbladder......Page 489
E— Salmonella Cholecystitis......Page 490
1— Delayed Treatment versus Early Cholecystectomy......Page 491
b— Timing of Laparoscopic Cholecystectomy and Factors that Influence the Rate of Conversion......Page 493
C— Alternatives to Medical and Surgical Treatment of Acute Cholecystitis......Page 494
References......Page 495
II— History......Page 498
1— Age......Page 499
6— Other Comorbid Conditions......Page 500
B— Patient Information......Page 501
1— Video and Camera Equipment......Page 502
1— Access......Page 503
4— The Procedure......Page 504
7— Postoperative Course......Page 505
2— Vascular Complications......Page 506
5— Hernia......Page 507
2— Gallbladder Perforation, Bile Leak, Hematoma, and Abscess......Page 508
4— Others......Page 509
A— Alternatives......Page 510
B— Day-Case Surgery and Cost-Effectiveness......Page 511
1— Training......Page 512
VIII— Conclusion......Page 513
References......Page 514
II— Management of Asymptomatic Stones......Page 527
A— Oral Dissolution Therapy with Bile Acids......Page 528
References......Page 529
I— Introduction......Page 532
II— Physical Properties of Shock Waves......Page 533
B— Influence of Chemical Composition, Radiological Stone Features, and Stone Structure......Page 536
C— Influence of Stone Volume and Number of Stones......Page 537
A— Success Rate......Page 538
B— Morbidity and Mortality......Page 541
C— Stone Recurrence......Page 542
V— Extracorporeal Shock-Wave Lithotripsy of Bile Duct Stones......Page 543
References......Page 546
I— Historical Overview......Page 551
III— The Discovery of Methyl Tert-Butyl Ether and Gallbladder Catheterization......Page 552
IV— The Procedure of Percutaneous Topical Gallstone Dissolution......Page 553
A— Problems Relating to Solvent Delivery......Page 554
B— Patient and Gallstone Selection......Page 555
C— Postdissolution Imaging......Page 556
B— Solvent Delivery Systems......Page 557
C— Computed Tomography (CT) for Gallstone Selection and a Predictive CT Index......Page 559
D— Percutaneous Gallbladder Endoscopy......Page 561
VIII— New Solvents......Page 562
IX— Endoscopic Retrograde Gallbladder Cannulation......Page 563
X— Gallstone Recurrence after Topical Dissolution......Page 564
References......Page 565
II— Classification and Pathogenesis......Page 570
IV— Diagnosis......Page 571
V— Management......Page 573
1— Difficult Bile Duct Stones......Page 574
2— Complications......Page 576
3— Alternative Endoscopic Techniques......Page 577
1— Open Exploration of the Common Bile Duct......Page 578
C— Percutaneous Management......Page 579
1— Laparoscopic Cholecystectomy......Page 580
2— Gallstone Pancreatitis......Page 584
4— Postcholecystectomy without T Tube......Page 585
6— Cholangitis......Page 586
References......Page 587
1— Ischemia......Page 595
2— Infection......Page 596
3— Chemical Injury......Page 597
4— Obstruction......Page 598
1— The Clinical Setting......Page 599
4— Chemotherapy......Page 600
8— Outpatient Presentation......Page 601
11— Pediatric Cholecystitis......Page 602
1— Clinical Presentation in HIV-Positive Individuals......Page 603
1— Ultrasound......Page 604
3— Morphine-Augmented HIDA Scintigraphy......Page 605
5— CT Scanning......Page 606
1— General Measures......Page 607
F— Complications......Page 608
2— Emphysematous Cholecystitis......Page 609
A— Introduction......Page 610
E— Adenomyomatosis......Page 611
H— Investigations......Page 612
4— Ultrasound with CCK Stimulation......Page 613
References......Page 614
II— Epidemiology......Page 627
IV— Pathology......Page 628
V— Histology......Page 630
VIII— Clinical Presentation......Page 631
IX— Therapeutic Surgery......Page 634
XI— Stage II......Page 635
Xl— Adjuvant Therapy......Page 636
References......Page 638
II— Biliary Tract Embryology......Page 640
B— Pathophysiology......Page 641
D— Evaluation......Page 642
E— Treatment......Page 645
F— Outcomes......Page 646
B— Pathophysiology......Page 647
C— Clinical Presentation......Page 648
E— Treatment......Page 650
F— Outcomes......Page 652
G— Choledochocele......Page 653
H— Caroli's Disease......Page 654
References......Page 655
A— Inflammatory Bowel Disease......Page 660
III— Prevalence......Page 662
B— Signs and Symptoms......Page 663
E— Laboratory Tests......Page 664
A— Histopathology and Staging......Page 665
B— Hepatic Atrophy......Page 666
A— Diagnostic Criteria......Page 667
C— Small-Duct Disease with Normal Cholangiography......Page 668
VII— Natural History......Page 669
VIII— Complications......Page 670
A— Cholangiocarcinoma......Page 671
D— Hepatic Osteodystrophy......Page 673
I— Ascending Cholangitis......Page 674
X— Prognostic Models......Page 675
A— Cholestatic Diseases......Page 676
A— Autoimmune and Nonautoimmune Factors......Page 677
B— Immunogenetic Susceptibility......Page 678
D— Biliary Epithelial and Endothelial Cells as Immunological Targets......Page 679
F— Role of CD66a or Biliary Glycoprotein in Inflammation or Fibrogenesis......Page 680
G— Pathophysiological Consequences of Biliary Obstruction and Cholestasis......Page 681
I— Postulated Mechanism of PSC Pathogenesis......Page 682
1— Biliary Tract Surgery to Alleviate Obstruction......Page 683
Colchicine......Page 684
Ursodeoxycholic Acid......Page 685
6— Orthotopic Liver Transplantation......Page 686
Recurrence of Primary Sclerosing Cholangitis after Orthotopic Liver Transplantation......Page 687
1— Cholangiocarcinoma......Page 688
6— Pruritus......Page 689
References......Page 690
II— Vanishing Bile Duct Syndrome/Ductopenia/Paucity of Bile Ducts......Page 705
III— Vanishing Bile Duct Syndrome in Liver Transplantation......Page 708
D— Risk Factors for Chronic Rejection......Page 711
E— Treatment of Chronic Rejection......Page 712
VI— Adult Idiopathic Ductopenia......Page 713
VIII— Ductopenia in Infancy and Childhood......Page 715
X— Paraneoplastic Bile Duct Paucity......Page 717
XI— Primary Biliary Cirrhosis......Page 718
References......Page 719
II— Incidence......Page 724
III— Etiology and Associated Diseases......Page 725
IV— Pathology......Page 726
C— Radiological Evaluation......Page 727
D— Biopsy/Cytology......Page 731
VI— Staging, Classification, and Preoperative Assessment......Page 732
VII— Surgical Resection......Page 733
VIII— Palliative Therapy......Page 737
B— Operative Palliation......Page 738
A— Surgical Resection......Page 741
B— Palliative Therapy......Page 744
X— Adjuvant Therapy......Page 746
References......Page 748
II— Pathology......Page 754
III— Epidemiology and Pathogenesis......Page 755
C— Radiological Imaging......Page 756
D— Endoscopy/Cholangiography......Page 758
A— Staging......Page 761
B— Local Excision......Page 762
C— Pancreaticoduodenectomy......Page 765
VI— Survival......Page 766
References......Page 768
B— Pathogenesis......Page 771
C— Etiology......Page 774
1— Laboratory Investigations......Page 776
2— Radiological Investigations......Page 777
G— Differential Diagnosis......Page 778
H— Microbiology of Acute Cholangitis......Page 779
2— Antibiotic Therapy......Page 780
Endoscopic Drainage......Page 784
Percutaneous Transhepatic Biliary Drainage......Page 785
J— Complications......Page 786
1— Antibiotic Prophylaxis for Biliary Surgery......Page 787
2— Antibiotic Prophylaxis for Endoscopic and Percutaneous Biliary Drainage......Page 788
4— Recurrent Cholangitis and Maintenance Antibiotic Therapy......Page 789
A — Introduction......Page 790
C— Pathogenesis......Page 791
F— Investigations......Page 792
1— Overview......Page 793
2— Endoscopic and Percutaneous Therapy......Page 794
3— Surgical Therapy......Page 795
3— Clinical Features......Page 797
B— Liver Fluke Cholangitis......Page 798
2— Opisthorchis Viverrini......Page 799
A— Epidemiology......Page 800
D— Investigations......Page 801
Acknowledgments......Page 803
References......Page 804
II— Historical Aspects......Page 820
III— Classification of Injuries......Page 821
IV— Mechanisms of Injury and Strategies of Prevention......Page 822
V— Surgical Management......Page 825
VI— Role of Interventional Radiology......Page 830
VII— Endoscopic Techniques......Page 831
IX— Legal Aspects......Page 834
References......Page 836
III— Diagnosis of Biliary Strictures......Page 840
IV— Causes of Biliary Strictures......Page 841
B— Percutaneous Transhepatic Therapy......Page 842
C— Endoscopy......Page 843
2— Management of Distal Obstruction......Page 844
3— Management of Hilar Malignant Biliary Obstruction......Page 849
1— Postoperative Biliary Stricture......Page 850
Pathogenesis......Page 851
Operative Management......Page 852
Management of Postoperative Biliary Strictures: A Summary......Page 853
Etiology......Page 854
Management......Page 855
Clinical Presentation......Page 857
Management......Page 858
2— Diagnosis......Page 860
3— Management......Page 861
Nonoperative Management......Page 862
References......Page 864
B......Page 872
C......Page 873
E......Page 874
G......Page 875
M......Page 876
S......Page 877
W......Page 878