Chronic Choledocolithiasis

1. Chronic Choledocolithiasis:-
Complaints:-
-Dry Skin
-Fever
-Pain in right Hypochandriac
Anamnesis Morbi:-
-Chronic pain
-1 Week
-Analgesics
Anamnesis Vitae:-
-Fatty Food
-Fried Food
-Alcohol
Physical Examination:-
Visual inspection
-Jauinduce
Palpation:-
Pain in right hypocondrium
-Vilar’s triad : pain , Fever , Jaundice
-Reynol’s pentad : Pain , Fever , Jaundice . Hypotension , Mental confusion
Percussion:-
No change

2. Auscultation:-
No change
Labaratory test:-
-Leukocytosis with left shift formula
-Biochimical blood analysis: Increase bilarubin
Increase alanine
Increase phosphates amylase
Instrumintal Examination:-
#X-Ray : we inject the contstract media by 3 ways:-
1 – Exteriory by tabltes and injection intravenously
- We give patient contrast media
- Then liver discharge contrast media to common bile duct
- Then we can see right and left hepatic bile duct and common bile duct
2-Intragrade (Anterograde) : we use injection or tube with contstractmedia and inject it in common bile
duct with contstractmedia.
3-Retrograde: we use catheter with fibrogastroscope and fullfate common bile duct with
contstractmedia
#Ultra Sound : Frequency : 2,25 – 3,5 MGz
-Diameter of common 0.4 to 1,0 CM
-Cholethiasis : we see stone in Gallblader
-Cholecytitis : *increase of Gallblader wall.
*Change in Gallblader form.
*Concretion.
-Choledocolithiasis: *stone in common bile duct
*Deformation and deylation in common bile duct

3. **What the mechanisim of jaundice? :
When the stone blocked common bile duct the Bilarubin is going to intestent and then it’s going to the
blood and by the blood its absorb to the skin and sclera.**
**What the reason of Mental confusion ? :
Hight level Bilarubin in blood , affect to brain.**
**What the Reason of Hypotenstion ? :
Becouse of Bilarubin its affect to Liver and then to the Heart.**
Chronic Choledocolithiasis:- Ulcer Disease of Deudnum
Complaints -Dry Skin
-Fever
-Pain in right Hypochandriac
Chronic pain in right hypocondrium
-Nausia
-Vomiting
-Heartburn
Anamnesis morbi -Chronic pain
-1 Week
-Analgesics
-Chronic pain
-1 Mounth
-Anti Acid
Anamnsis vitae -Fatty Food
-Fried Food
-Alcohol
-Excessive Food
-Alcohol intake
-Previous history of surgery
abdominal
Labaratory Test -Leukocytosis with left shift formula
-Biochimical blood analysis:
Increase bilarubin
Increase alanine
Increase phosphates amylase
-Leukocytosis with left shift
formula
-Biochemical : Increase creatinine
-Blood Serology : anti bodies to
helico.bacter
-General urine analysis :
Protienuria , Cylnders, erythrosits
-PH Meter : Increase acidity
Treatment:-
-Plan hospitalization to surgery Department.
-Plan Operation.
-Cholesistomy
-Bileductomy
-Relax