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Other indicators include raised indicators of ampulla of vater (pancreatic duct obstruction) such as lipases and amylases. In prolonged cases the international normalized ratio (INR) may change due to a decrease in vitamin K absorption. (It is the decreased bile flow which reduces fat breakdown and therefore absorption of fat soluble vitamins).
The ampulla of Vater is the site of tumors, often with a threatening prognosis and difficult surgical treatment. The silver-colored stool is a combination of the white stool of obstructive jaundice combined with black stool of melena or bleeding. It was first described in the British Medical Journal by Dr. H. Ogilvie in 1955. [4]
The sphincter of Oddi is a muscular valve that controls the opening to the ampulla. The region can be directly visualized with the endoscopic camera while various procedures are performed. A plastic catheter or cannula is inserted through the ampulla, and radiocontrast is injected into the bile ducts and/or pancreatic duct.
The bile duct is some 6–8 cm long, and normally up to 8 mm in diameter. [4]Its proximal supraduodenal part is situated within the free edge of the lesser omentum.Its middle retroduodenal part is oriented inferiorly and right-ward, and is situated posterior to the first part of the duodenum, and anterior to the inferior vena cava.
Cancerous tumours arising from the CBD, the ampulla, or the portion of the duodenum near the ampulla can result in distal CBD obstruction. When the masses are incapable of being surgically removed, CDD can be performed. In some cases where the growing tumour occludes the new pathway, CDD will only provide palliative relief.
Courvoisier's principle (known as Courvoisier's sign or Courvoisier–Terrier's sign, or Courvoisier syndrome) states that a painless palpably enlarged gallbladder accompanied with mild jaundice is unlikely to be caused by gallstones. Usually, the term is used to describe the physical examination finding of the right-upper quadrant of the abdomen.
This inflammation of the gallbladder is known as cholecystitis and is a common indication for surgical removal of the gallbladder, or cholecystectomy. [ 12 ] Occasionally gallstones may become lodged in the common bile duct and obstruct the flow of bile from the gallbladder to the small intestine– this condition is known as ...
A gallstone is a stone formed within the gallbladder from precipitated bile components. [2] The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones, [5] and choledocholithiasis refers to the presence of migrated gallstones within bile ducts.