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home - Biliary - Gallstone Disease - Microlithiasis Written by Dr Sebastian Zeki
Knowledge


Knows the physiology and biochemistry of bile and the pathogenesis
of gallstones

Is familiar with the normal anatomy and the anatomical variations of
the biliary tree

Recognises the symptoms and signs of the potential complications of
galllstone disease including biliary colic acute cholecystitis jaundice
due to calculous bile duct obstruction cholangitis and carcinoma

Knows the various techniques of diagnostic imaging including
ultrasound CT MRI ERCP EUS radionuclide techniques

Knows the various treatment options the indications for operative and
non-operative management and the risks of each

Knows the current national guidelines for use of ERCP and the risks
of the technique

Knows the ways in which gallbladder polyps are diagnosed and
managed

Knows that gallbladder and sphincter of Oddi dysfunction (SOD) may
account for otherwise unexplained abdominal pain

Recognises different types of SOD how they may present and how
they are investigated

Skills
Can select the most appropriate diagnostic and therapeutic
techniques for each clinical situation

Recognises possibility of diagnostic uncertainty in biliary dysmotility
and shows thoughtful judgement in each individual situation

Behaviours
Makes appropriate assessment stratifies urgency and plans
management of patients who have complications of gallstones

Microlithiasis

C)From ampulla after sincalide stimulation B) C) Cholesterol microlithiasis= choles-terol monohydrate crystalsBilirubinate microlithiasis have amorphous reddish-brown bilirubinate granules in their gallbladder. Cholesterol crystals exhibit birefrin-gence Test is +ve if any cholesterol crys-tals or amorphous red brick biliru-binate granules are seen. Endoscopic ultrasonographyThe sensitivity of EUS combined with bile microscopy in detecting microcrystals is 92% in patients with a negative USS.Because it is invasive, EUS is generally reserved for patients with biliary colic or suspected complications of gallstones (such as pancreatitis) who have a negative transabdominal ultrasound. Microlithiasis causes everything that gallstones causeAccounts for 5% of category 4 patients Bile microscopy This has a sensitivity of 65-90%.Look for microcrystals in gallbladder bile specifically. Method of Collection The bile is incubated and centrifuged After super-natant discarded, liquid analyzed with polarizing microscope; A)Percutaneous puncture of the gallbladder under ultrasound or fluoroscopic guidance B)During ERCP either through selective gallbladder cannulation or bile aspiration bile from the common bile duct after stimulating gallbladder contraction by an infusion of the CCK analogue sincalide Microlithiasis Written by Dr Sebastian Zeki

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