Causes of Hemobilia All/Except -

Ans. is 'd' ie Hepatitis (Ref. Sabiston, 18/e pl515 (17/e, p 1561, 16/e, p 1056); Maingot's 10/e, p 300)Hemobilia is defined as bleeding into the biliary tree from an abnormal communication between a blood vessel and bile duct.Causes of hemobilia:Trauma (most common)iatrogenic trauma is the most common cause(includes interventional radiological procedures, percutaneous liver biopsy, percutaneous transhepatic bil- iary drainage, operations on gallbladder and bile duct)blunt trauma is more common cause than penetrating traumaGall stonesVascular pathologies - aneurysms, angiodysplasias, hemangiomas.Uncommon causesMalignant tumors of liver, biliary tree, gall bladder, pancreas parasitic infection heaptic abscess cholangitisClinical presentationClassical triad consists ofUpper abdominal pain (biliary colic)Obstructive jaundice (obstruction by blood clots)Upper gastrointestinal haemorrhageHematemesismelenaDiagnosisDiagnosis of hemobilia is typically made on upper endoscopy with findings of bleeding from the ampulla of vater.Arterial angiography is the investigation of choice as it will reveal the source of bleeding in about 90% of cases.ManagementIn majority of cases, transarterial embolization (TAE) is curative.Surgery is indicated when TAE has failed, it consists of:ligation of bleeding vessels