#collected

1. Cholecystitis
Dr. Md. Monirul Islam
MBBS, BCS, MS (Ortho)
Consultant (Ortho-Surgery)
250 beded Sadar Hospital , Jhenaidah

11. Ethiology of cholecystitis
• Infection: E. coli, Salmonella
typhy, Streptococcus,
Staphylococcus, Klebsiella, B.
pyogeaneus.
• Parasites: Lambliosis,
amoebiasis, ascaridosis,
opisthorchosis and other.

31. Diagnostic:
For diagnostic, stones in Gall Bladder
we administrate:
• Biochemistry of bile
• Ultrasound examination
• Cholecystographia (X-ray)
• СТ
• Laparoscopy

33. Ultrasound examination:
• Thickness wall of Gallbladder  4mm,
• Increase volume of Gallbladder,
• Symptom Murphy +,
• Stones Gallbladder,
• Deformation and commissures,
• Hypotonic dyskinesia.

37. (Left anterior oblique)

51. Endoscopic retrograde
cholangiopancreatoscopy (ERCP)

53. Nonsurgical Management
• Diet therapy: low-fat diet, fat-soluble
vitamins, bile salts
• Drug therapy: opioid analgesia with
meperidine hydrochloride,
antispasmodic or anticholinergic
drugs, antiemetic

56. Antibacterial therapy
- Ampicillin 0,5 g x 4 times during 7 days,
- Ofloxacin 0,25 g x 2 times during 7 days,
- Doxicyclin 0,1 g x 2 times during 5 days,
- Furazolidone 0,1 g x 3 times during 10
days.

57. Symptomatic therapy cholelitiasis
for bile colic:
• Sol. No-spani 2%-2,0 I/M
• Sol. Baralgini 5,0 I/V
• Sol. Atropini sulfatis 0,1%-1,0 I/C
• Sol. Analgini 50%-2,0 I/M

58. Classification of cholagogues
• Choleretics are not recommended at the
cholecystitis.
• Cholekinetics are recommended at the
dyskinesia which is developed on
hypotonic type.
• Cholespasmolytics are recommended at
the dyskinesia which is developed on
hypertonic type.

59. Treatment of dyskinesia
• Cholekinetics: corn stigmas, olive oil, xylite, sorbite
20-25 g on 100 ml of warm water, MgSO4 33% - 30ml
+ Berberini bisulfatis and 2 raw eggs use for blind
catheterization . Blind cateterization: A patient uses
cholekinetic in the morning and lays on the right side
on the hot water bag on 2 hours. A frequency of this
procedure - 1 time in a week.
• At the asthenovegetative syndrome are
recommended small doses of tranquilizers. Its relaxe
gallbladder.

60. Treatment
1. Ursodesoxycholic acid (10 mg/kg)
“UrsoFalk”
2. Henodesoxycholic acid
(10-15 mg/kg 6-12
monthes)
“Henofalk”
“Henochol”
3. Henodesoxycholic +
Ursodesoxycholic acids
“LitoFalk”

61. Lithotripsy