![[PBL] 총수담관담석증 CBD stones-1](http://images.happyhaksul.com/thumb/498/497939-0001.gif)
![[PBL] 총수담관담석증 CBD stones-2](http://images.happyhaksul.com/thumb/498/497939-0002.gif)
![[PBL] 총수담관담석증 CBD stones-3](http://images.happyhaksul.com/thumb/498/497939-0003.gif)
![[PBL] 총수담관담석증 CBD stones-4](http://images.happyhaksul.com/thumb/498/497939-0004.gif)
![[PBL] 총수담관담석증 CBD stones-5](http://images.happyhaksul.com/thumb/498/497939-0005.gif)
![[PBL] 총수담관담석증 CBD stones-6](http://images.happyhaksul.com/thumb/498/497939-0006.gif)
분야
hwp1. Gall stones pathophysiology
2. Clinical Manifestation
3. Diagnosis
1. Pathophysiology
2. Clinical Manifestation
3. Complications
4. Diagnosis
: unconjugated bilirubin이 증가하는 상태
- hemolytic disorders
- liver cirrhosis(hypersplenism)
- ineffective erythropoiesis
- Gilbert's syndrome
- cystic fibrosis
- ileal diseases, ileal resection, or ileal bypass
- old age
(2) Brown pigment stone: soft, clay-like consistency / especially prominent in Asians
◆ predisposing factor
- chronically infected bile stasis 상태에서 세균에 의해 phospholipid와 conjugated bilirubin이
fatty acid와 unconjugated bilirubin으로 분해
- biliary stricture, sclerosing cholangitis
- biliary parasitic infestation
- oriental cholangiohepatitis
- choledochal cyst(caroli's disease), cholecystectomy
2. Clinical Manifestation
1) biliary colic(RUQ)
- fatty meal, large or normal meal, menstrual cycle에 의해 precipitating 가능
- consistent steady ache, radiation to Rt. scapula, shoulder
- benign suddenly and persist for 30min~5hours (5시간 넘으면 acute cholecystitis 의심)
2) nausea, vomiting
3) mile elevation of serum bilirubin and/or ALP: CBD stone을 의미
4) fever & chill: cholecystitis, cholangitis, pancreatitis 등의 complication을 의미
