Gallbladder and bile duct tumors can cause extrahepatic biliary obstruction. Symptoms may be completely absent, but are often constitutionally or reflect a biliary obstruction. The diagnosis is based on the representation of the bile ducts with ultrasonic plus CT, MRCP or ERCP. The prognosis is poor. A mechanical biliary drainage can often relieve the itching and prevent recurrent cholangitis.

(See also Overview biliary function.)

Gallbladder and bile duct tumors can cause extrahepatic biliary obstruction. Symptoms may be completely absent, but are often constitutionally or reflect a biliary obstruction. The diagnosis is based on the representation of the bile ducts with ultrasonic plus CT, MRCP or ERCP. The prognosis is poor. A mechanical biliary drainage can often relieve the itching and prevent recurrent cholangitis. (See also Overview biliary function.) Cholangiocarcinoma and other bile duct tumors are rare (1-2 / 100,000). Benign tumors of the biliary tract are very rare. Cholangiocarcinomas occur in the majority in the extrahepatic bile ducts on: 60-70% in the hilar region (so-called Klatskin tumor.), About 25% in the distal junctions and the rest in the liver. Risk factors are PSC, advanced age, liver fluke infestation and Choledochal. Gallbladder cancer is rare (2.5 / 100,000). More often, it is in North American Indians, in patients with large gallstones (> 3 cm), and in patients with severe gallbladder calcification due to chronic cholecystitis (porcelain gallbladder). Almost all (70 to 90%) of the patients also have gallstones. The median survival time is three months. Healing is possible if the cancer (eg. As by chance during a cholecystectomy) is detected early. Gallbladder polyps are usually asymptomatic benign Schleimhautaussackungen that protrude into the lumen of the gallbladder. Most have a diameter <10 mm and are made of cholesterol ester and Triglyzeridet. They are found in about 5% of people during an ultrasound examination. Other less common, benign polyps are adenomas and inflammatory polyps. Small gallbladder polyps are incidental findings that do not require treatment. Symptoms and discomfort for most patients with cholangiocarcinoma, the disease is manifested by the appearance of itching and a painless obstructive jaundice, typically aged between 50 and 70 years. Early perihilar tumors cause only vague abdominal pain, anorexia and weight loss. Other signs may include fatigue, a acholischer chair, a palpable abdominal mass, hepatomegaly or gallbladder be (Courvoisier's sign with distal cholangiocarcinoma). The pain may be similar also constant and progressively as biliary colic (as an expression of the closure) or. Sepsis (as a result of acute cholangitis), although uncommon, can be triggered by an ERCP. Manifestations of gallbladder carcinoma range from the accidental discovery at a cholecystectomy, which was carried out to alleviate biliary pain, cholelithiasis through to advanced disease with chronic pain, weight loss and a palpable tumor in the abdomen or obstructive jaundice. Most gallbladder polyps do not cause symptoms. Diagnostic sonography (sometimes endoscopically), followed by CT cholangiography or MRCP ERCP Sometimes the suspicion of the existence of a cholangiocarcinoma and gallbladder cancer is unclear at extrahepatic closure. The laboratory tests reflect the degree of cholestasis. In patients with primary sclerosing cholangitis serum carcinoembryonic antigen (CEA) and CA 19-9 are determined on a regular basis to detect a cholangiocarcinoma. The diagnosis is based on ultrasound (or endoscopic ultrasound) followed by CT Chlolangiographie or magnetic resonance cholangiopancreatography (MRCP) (Imaging tests of the liver and gall bladder). A CT is sometimes performed, they can give more information than ultrasound, particularly in gallbladder carcinomas. If these methods do not provide a reliable result, an ERCP is required. ERCP may represent not only the tumor, but can make a cytological diagnosis with brush smears, so sometimes an ultrasound or CT-guided needle biopsy is unnecessary. A contrast-enhanced computed tomography can be used for staging. An open laparotomy is performed to determine the extent of the tumor, which then determines the further therapeutic procedure. In therapy cholangiocarcinoma, stenting (or other bypass procedure) or occasionally resection in gallbladder carcinoma usually symptomatic treatment In cholangiocarcinoma relieves a stent liner or a surgically applied bypass the itching, jaundice, and perhaps the fatigue. Hilar cholangiocarcinoma, the show in the imaging further spread are powered by a stent through PTC or ERCP. Cholangiocarcinoma in the distal transition endoscopically powered by ERCP with a stent. There is suspicion of a localized cholangiocarcinoma, surgical exploration determines a possible resectability by a hilar resection or Pancreaticoduodenectomy by Whipple. However, a successful resection is often impossible. A liver transplant is not indicated because of the high recurrence rate. An efficacy of adjuvant chemotherapy and radiotherapy in cholangiocarcinoma is not proven. The majority of the gall bladder carcinomas are treated symptomatically. Important points bile duct cancer (cholangiocarcinoma mostly or gallbladder carcinoma) is unusual. A carcinoma should be considered in patients with unexplained extrahepatic bile duct obstruction or abdominal mass considered. The diagnosis of cancer is made by imaging, starting with ultrasound followed by CT cholangiography or MRCP. The treatment of cancer is symptomatic (e.g., by setting the stent, or by bypassing the obstruction in cholangiocarcinoma.); occasionally resection is justified.

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