Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

600 Gallbladder Cancers Gallstone Disease

Special Tests

■Ultrasound

➣gallstones and gallbladder mass

■CT

➣mass in the gallbladder or liver, may occlude bile ducts

■ERCP

➣cutoff of the cystic duct

➣stricture of the common duct

differential diagnosis

n/a

management

What to Do First

■suspect diagnosis

■ERCP for support of diagnosis

General Measures

■assess patient’s ability to undergo attempted resection

specific therapy

■surgery

■poor response to chemo or radiation

■stenting via ERCP if biliary obstruction

follow-up

■serial visits with physical examination, liver chemistries

complications and prognosis

■depends on whether or not incidental

■if incidental (10%): surgery curative

■remaining 90%: 5% 5-yr survival

Gallstone Disease....................................

AIJAZ AHMED, MD

history & physical

History

■types of gallstones: cholesterol/mixed stones (90%) and pigmented

(10%)