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Cholelithiasis - By Sir Faisal Ghani

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Cholilithiasis ! by Sir Faisal Ghani, Lumhs !

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Cholelithiasis - By Sir Faisal Ghani

  1. 1. Gallstones FAISAL GHANI SIDDIQUI MBBS; FCPS; PGD-BIOETHICS; MCPS –HPE PROFESSOR OF SURGERY, IN CHARGE, MINIMAL INVASIVE SURGICAL CENTRE, & & IN CHARGE, BIOETHICS PROGRAMME AT LIAQUAT UNIVERSITY OF MEDICAL & HEALTH SCIENCES faisal@lumhs.edu.pk www.lumhs/faculty/surgery
  2. 2. Preamble • Why gall bladder? • Surgical anatomy & physiology of gall bladder • Why gallstones form? • How do gallstones present? • How to manage a patient with gallstones?
  3. 3. Functions of Gall Bladder • Reservoir for bile • Concentration of bile • Secretion of mucus
  4. 4. Anatomy of Gall Bladder
  5. 5. Fundus Body Neck Infundibulum Cystic duct
  6. 6. Bile Ducts • Common hepatic duct • Cystic duct • Common bile duct
  7. 7. Common Bile Duct • Supraduodenal • Retroduodenal • Infraduodenal • Intraduodenal
  8. 8. Calot’s Triangle kah-lō′
  9. 9. Moynihan’s Hump
  10. 10. Gallstones (Cholelithiasis)
  11. 11. Types of Gallstones • Cholesterol • Pigment • Mixed
  12. 12. Causes -Cholesterol Stones • Supersaturated bile –Obesity –High caloric diet –Oral contraceptives –Resection of terminal ileum
  13. 13. Causes -Pigment Stones • Hemolysis –Hereditary spherocytosis –Sickle cell disease
  14. 14. Causes -Mixed Stones –Infected bile –Foreign bodies in the CBD (stents, parasites e.g. Clonorchis sinensis)
  15. 15. Clinical Features • Asymptomatic • Pain • Complications
  16. 16. Complications • Acute cholecystitis • Mucocele • Empeyema • Choledocholithiasis • Acute pancreatitis • Intestinal obstruction
  17. 17. Treatment for Cholelithiasis
  18. 18. Treatment -Indications • Symptomatic gallstones • Complicated gallstones • Silent gallstones – Diabetics – Patients undergoing bariatric surgery
  19. 19. Procedures • Open cholecystectomy • Laparoscopic cholecystectomy
  20. 20. Laparoscopic Cholecystectomy • Supine/reversed Trendelenburg’s • General anesthesia • Preparation of abdomen / toweling • Creation of pnemoperitoneum – Closed technique (Veress’ needle) – Open technique (Hassan’s) • Additional ports

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