Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Duodenal biliary drainage is a little-used procedure
that sometimes can be helpful in diagnosing gallstones.
How is duodenal biliary drainage done?
For duodenal biliary drainage, a
thin plastic or rubber tube with several holes at its tip is passed through a patient's anesthetized nostril,
down the back of the throat, through the esophagus and stomach, and into the duodenum where the bile and pancreatic ducts enter the
small intestine. This is
accomplished with the help of fluoroscopy,
a type of X-ray. Once the tube is in
place, a synthetic hormone related to cholecystokinin is injected intravenously.
The hormone causes the gallbladder to contract and squeeze out its concentrated
bile into the duodenum. The bile then is sucked up through the tube and examined
for the presence of cholesterol and pigment particles under a microscope.
A modification of duodenal biliary drainage involves
collection of bile through an endoscope at the time of an upper gastrointestinal
endoscopy -- either by EGD (esophagogastroduodenoscopy) or by
ERCP (endoscopic retrograde cholangio-pancreatography).
Why might duodenal biliary drainage be done?
Gallstones begin as microscopic particles of cholesterol
or pigment that grow in size. Once the particles grow large enough to become
gallstones, they can obstruct the bile ducts and cause problems. It is clear
that some people who develop the symptoms and complications of
gallstones -- biliary colic, cholecystitis,
or pancreatitis
-- have only these microscopic particles in their gallbladders, particles too small to obstruct the bile ducts.
There are two possible
explanations for how obstruction might be occurring in this situation. The first is that a small gallstone obstructed the bile ducts but finally passed through the
bile ducts into the intestine. The second is that the particles passing through the bile ducts "irritate" the ducts, causing spasm of the muscle within the walls of the ducts (which obstructs the duct) or causing inflammation of the duct so that the wall of the duct swells (which also obstructs the duct).
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause symptoms.
Pancreatitis is a rare disease in which the pancreas becomes inflamed, occurring when digestive enzymes are activated and begin attacking the pancreas causing damage to the gland. There are two types of pancreatitis, acute and chronic. Most commonly caused by alcohol or gallstones, it can lead to bleeding in the gland, serious tissue damage, infection, and cysts. Enzymes and toxins may then enter the bloodstream and seriously injure organs, such as the heart, lungs, and kidney.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Choledochal cysts are cysts of the bile ducts. There are several different types of choledochal cysts. These cysts are congenital, however, their cause is not known. Symptoms of choledochal cysts in infants include an enlarged liver and jaundice. In older people, the cysts cause abdominal pain, jaundice, cholangitis, gallstones, and pancreatitis. Treatment for choledochal cysts is surgery.
*Pancreatitis facts Medically Edited by:
Charles P. Davis, MD, PhD
Pancreatitis is inflammation of the pancreas, the organ that secretes
digestive enzymes into the gastrointestinal tract; it also synthesizes and
secretes insulin and
glucagon.
Pancreatitis may be caused by
gallstones (by blocking the pancreatic duct
outlet), chronic alcohol use, trauma, medications, infections, tumors, and
genetic abnormalities.
Acute pancreatitis with upper
abdominal pain that is often severe and
constant over several days, and may be accompanied by
fever,
nausea,
vomiting,
tachycardia, and abdominal swelling; severe cases can develop
dehydration,
low
blood pressure, shock, organ failure, and death.
Acute pancreatitis is diagnosed preliminarily by the patient's history,
physical exam and the levels of amylase and lipase in the blood (elevated in
pancreatitis patients); other t...
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