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Cholelithiasis   final year lecture
 

Cholelithiasis final year lecture

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    Cholelithiasis   final year lecture Cholelithiasis final year lecture Presentation Transcript

    • GALLSTONES
    • • 20% are Cholesterol Stones. • 5% are Pigment Stones. • 75% are Mixed… … … • In Asia  80% Pigment Stones. • In Europe  80% Cholesterol Stones.
    • Risk Factors • BIG 4..? 1. Female. 2. Forty. 3. Fertile. 4. Fatty.
    • Risk Factors • Pregnancy. • OCP. • Hemolytic Anemia. • Cirrhosis. • Infection. • IBD/Terminal Ileal Resection. • TPN. • Hyperlipidemia.
    • Pathogenesis • Excess secretion of Cholesterol in Bile. • Excess Mucous Production. • Non-Functioning Gallbladder. • Stasis in Gallbladder.
    • Pathological Effects 1. Silent Gallstones. 2. Obstruction of the Cystic Duct. 3. Movement of Stone into CBD. 4. Ulceration of Stone through Gallbladder Wall.
    • Clinical Presentation 1. Biliary Colic. 2. Acute Cholecystitis. 3. Chronic Cholecystitis. 4. Gallstone Pancreatitis. 5. Obstructive Jaundice. 6. Acute Cholangitis. 7. Gallstone Ileus. 8. Mucocele / Empyema of the Gallbladder.
    • 1. Biliary Colic • Episodic Pain in RHC / Epigastrium. • Pain Radiates to Lower Pole of Right Scapula. • Sweaty, Nauseous, Vomiting Patient. • Intermittent Jaundice with Pale Stool & Dark Urine.
    • • Differential Diagnosis: – Renal Colic. – Intestinal Obstruction. – Angina. • Pain Episode may Resolve when Stone is Passed into CBD / Falls Back into the Gallbladder.
    • 2. Acute Cholecystitis • Sever, Constant & Localized RHC Pain. • Fever / Toxaemia / Rigors / Leucocytosis. • Tenderness in RHC / Murphy’s Sign. • Palpable Gallbladder. • Complications; – Empyema. – Perforation. – Obstructive Jaundice. – Acalculous Cholecystitis.
    • Murphy’s Sign
    • Chronic Cholecystitis • Repeated Inflammation resulting in Fibrosis & Thickening of Gallbladder. • Longstanding Dyspepsia with Episodic Cholecystitis. • Differential Diagnosis: – Peptic Ulcer. – Hiatus Hernia. – Angina.
    • Gallstone Pancreatitis • Due to Transient Blocking of Ampulla of Vater by Stone. • Especially when Stones are Small & Numerous.
    • Obstructive Jaundice • Acute Onset. • History of Pain. • Non-Palpable Gallbladder. • Courvoisier’s Law..?????
    • Acute Cholangitis CAUSE … ? • Infection of Bile In the Biliary Tree… • Charcot’s Triad … ? 1. Pain. 2. Fever. 3. Jaundice.
    • • Predisposing Factors; – Stone in CBD. – Biliary Stricture. – Post – ERCP. – Post – Biliary Reconstructive Procedure. • Antibiotics & Resuscitation followed by Decompression of Biliary Tree.
    • Gallstone Ileus • Gallstones may Erode into Duodenum / Colon. • Gallstone lodge at Level of Meckel’s Diverticulum / Ileocaecal Valve.
    • • Present as Acute Abdomen. • Treat by; – Drip & Suck. – Urgent Laparatomy. Cholecysto-Enteric Fistula LEFT UNTIL ACUTE EPISODE IS OVER.
    • Investigations (for Gallstones) • Ultrasound. • LFTs. • ERCP / MRCP. • AXR. • CT Scan
    • Ultrasound Pictures
    • Ultrasound
    • ERCP
    • MRCP
    • CT SCAN
    • Treatment • Conservative Management for Acute Cholecystectomy. • Laparoscopic Cholecystectomy. • Open Cholecystectomy. • Cholecystostomy. • Medical Treatment; – Chenodeoxycholic Acid.
    • Acute Cholecystitis • Principles of Management: – Admission to Hospital. – Pain Relief. – NPO. – IV Fluids. – Broad Spectrum Antibiotics. – Elective / Emergency Cholecystectomy.
    • Laparoscopic Cholecystectomy • Preoperatively; – U/S + LFT + Clotting Screen. – Exclude Peptic Ulcer & Hiatal Hernia. – Encourage Weight Loss & Smoking Cessation. – Consent. • Ports; – 3 or 4 Ports.
    • • Closure. • Postoperatively; – Orally Allowed when fully recovered. – Home in 24hrs when Pain-Free. • Complications;
    • THANK YOU . . . !