Fwd: Jaundice

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---------- Forwarded message ----------
From: UCD Graduate '09 None <ucdgrad09@gmail.com&gt;
Date: 2009/2/25
Subject: Jaundice
To: ucdgrad09@gmail.com

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  • Fwd: Jaundice

    1. 5. <ul><li>Pre-hepatic </li></ul><ul><li>Hepatic </li></ul><ul><li>Post hepatic ( surgical/obstructive ) </li></ul>
    2. 6. <ul><li>Causes: </li></ul><ul><li>Lumen </li></ul><ul><li>Wall </li></ul><ul><li>Outside wall </li></ul>
    3. 7. <ul><li>Investigations: </li></ul><ul><li>Laboratory tests </li></ul><ul><li>Imaging investigations </li></ul><ul><li>Special tests </li></ul>
    4. 8. <ul><li>Laboratory Tests: </li></ul><ul><li>Liver biochemical tests: bilirubin </li></ul><ul><li>alk phosphatase </li></ul><ul><li>GGT </li></ul><ul><li>AST </li></ul><ul><li>ALT </li></ul><ul><li>Serology </li></ul><ul><li>Autoantibody screen </li></ul><ul><li>Tumour markers </li></ul><ul><li>Coagulation screen </li></ul>
    5. 9. <ul><li>Imaging investigations: </li></ul><ul><li>Ultrasound </li></ul><ul><li>EUS </li></ul><ul><li>CT scan </li></ul><ul><li>ERCP </li></ul><ul><li>MRCP </li></ul><ul><li>PTC </li></ul>
    6. 18. <ul><li>Types of Gallstone: </li></ul><ul><li>Cholesterol </li></ul><ul><li>Mixed </li></ul><ul><li>Pigment </li></ul>
    7. 19. Appearance of gallstones
    8. 20. Appearance of gallstones
    9. 21. <ul><li>Pathogenesis of Gallstones: </li></ul><ul><li>Lithogenic Bile </li></ul><ul><li>Stasis </li></ul><ul><li>Nucleating Factors </li></ul>
    10. 22. <ul><li>Lithogenic Bile: </li></ul><ul><li>Cholesterol Synthesis in Liver </li></ul><ul><li>Cholesterol/Bile Salt ratio </li></ul><ul><li>7 alpha hydoxylase </li></ul><ul><li>HMG co-enzyme reductase </li></ul>
    11. 23. Components of bile
    12. 24. <ul><li>Stasis: </li></ul><ul><li>Vagotomy </li></ul><ul><li>Pregnancy </li></ul>
    13. 25. <ul><li>Nucleating Factors: </li></ul><ul><li>Mucus Glycoproteins </li></ul><ul><li>Desquamated Epithelia </li></ul><ul><li>Foreign Bodies </li></ul>
    14. 26. Cholesterol gallstone pathogenesis
    15. 27. <ul><li>Clinical Presentations: </li></ul><ul><li>Silent 70% </li></ul><ul><li>Mechanical Impaction </li></ul><ul><li>Cystic Duct Biliary Colic </li></ul><ul><li>CBD Jaundice </li></ul><ul><li>Cholangitis </li></ul><ul><li>Inflammation </li></ul><ul><li>Acute Cholecystitis </li></ul><ul><li>Chronic Cholecystitis </li></ul><ul><li>Acute Pancreatitis </li></ul><ul><li>Ulceration/Fistula Formation </li></ul><ul><li>Carcinoma </li></ul>
    16. 28. <ul><li>Investigation of Gallstones: </li></ul><ul><li>Ultrasound </li></ul><ul><li>Oral Cholecystogram </li></ul><ul><li>Cholangiography </li></ul><ul><li>Endoscopic Retrograde </li></ul><ul><li>Peroperative </li></ul><ul><li>MRCP </li></ul><ul><li>HIDA Scan </li></ul>
    17. 29. Gallstones and biliary sludge
    18. 30. Several noninvasive imaging modalities currently available
    19. 31. Endoscopic retrograde cholangiopancreatography
    20. 32. Endoscopic retrograde cholangiopancreatography
    21. 33. Per-operative cholangiopancreatography
    22. 34. <ul><li>Management: </li></ul><ul><li>Asymptomatic </li></ul><ul><li>Symptomatic </li></ul>
    23. 35. Endoscopic view of sphincterotomy and basket extraction (a)
    24. 36. Endoscopic view of sphincterotomy and basket extraction (b)
    25. 37. Endoscopic view of sphincterotomy and basket extraction (c)
    26. 38. Balloon dilation of the papilla and stone extraction (d)
    27. 39. Operating room setup for laparoscopic cholecystectomy
    28. 40. Laparoscopic cholecystectomies and pneumoperitoneum
    29. 41. 4 laparoscopic ports during laparoscopic cholecystectomy

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