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Predisposing factors
1. Obesity
2. Female sex hormones – estrogen & OCPs
3. Increasing age
4. Pregnancy
5. Drugs- octreoti...
LITHOGENIC BILE
• Increase cholesterol-
obesity,diet
• Decrease bile acids-
OCPs,genetic
factors,PBC,ileal
disease,ileal r...
Types of Gall stones
1. Cholesterol stones – radiating crystal like appearance
2. Mixed stones- Most common type of stones...
Pigment stones
Black pigment stones
• Most common
• Formed in gall bladder
• Made of Calcium
bilirubinate,phosphate,bicarb...
Clinical features
• More common in females
• Fat,fertile,forty,flatulent
• 10% Gallstones are RADIO-OPAQUE
• Asymptomatic ...
• MURPHY’s SIGN
Patient winces in pain
with catch of breath
when inflamed gall
bladder strikes
palpating fingers on
inspir...
Complications of Gall stones
In Gall Bladder-
• Acute cholecystitis
• Chronic cholecystitis
• Empyema of gall bladder
• Mu...
Management
Investigations
• USG abdomen – posterior acoustic
shadowing
• Plain X RAY abdomen
• LFT- Increased conjugated b...
D/D of radio-opaque shadow on x-ray
• Renal stone
• Calcified 12th rib tip
• Phlebolith
• Faecolith
• Calcified lymph node...
Treatment
• Medical therapy-
• GALL STONE DISSOLUTION
• Ursodeoxycholic acid (UDCA) – with a functioning
Gall bladder with...
Surgical therapy
• Laparoscopic
cholecystectomy is ideal.
• Open cholecystectomy is
done if patient unfit for
laparoscopy ...
Cholelithiasis
Cholelithiasis
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Cholelithiasis

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surgery ppt on cholelithiasis
gall stones
causes
pathogenesis
clinical features
management

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Cholelithiasis

  1. 1. Predisposing factors 1. Obesity 2. Female sex hormones – estrogen & OCPs 3. Increasing age 4. Pregnancy 5. Drugs- octreotide, clofibrate 6. High fat diet 7. Diabetes mellitus
  2. 2. LITHOGENIC BILE • Increase cholesterol- obesity,diet • Decrease bile acids- OCPs,genetic factors,PBC,ileal disease,ileal resection • Increase bilirubin- Hemolytic Anemia NUCLEATION • Excess pronucleating factors-e.g. mucin • Decreased anti- nucleating factors- e.g. Apolipoproteins STASIS OR HYPOMOTILITY OF GALL BLADDER • OCPs • Vagotomy • Fasting • Pregnancy • Prolonged parenteral nutrition
  3. 3. Types of Gall stones 1. Cholesterol stones – radiating crystal like appearance 2. Mixed stones- Most common type of stones; contains cholesterol, calcium salts of phosphates and carbonates, palmitate ,proteins and are multiple faceted. 3. Pigment stones- small, black or greenish black, multiple and often sludge like
  4. 4. Pigment stones Black pigment stones • Most common • Formed in gall bladder • Made of Calcium bilirubinate,phosphate,bicarbona te • Common in hemolytic disorders,cirrhosis • Multiple , small & hard in consistency Brown pigment stones • Rarely form in gall bladder • Formed in bile duct • Related to bile stasis & infected bile • E.coli, Bacteroides
  5. 5. Clinical features • More common in females • Fat,fertile,forty,flatulent • 10% Gallstones are RADIO-OPAQUE • Asymptomatic in 10 to 20% cases • Symptoms- • Biliary colic- Right hypochondrium & epigastrium, radiating to chest,back & shoulder, severe , on & off, spasmodic, occurs within hours after meal,usually self limiting and recurring,precipitated by fatty meal. • vomiting • Fever • Increased WBCs
  6. 6. • MURPHY’s SIGN Patient winces in pain with catch of breath when inflamed gall bladder strikes palpating fingers on inspiration
  7. 7. Complications of Gall stones In Gall Bladder- • Acute cholecystitis • Chronic cholecystitis • Empyema of gall bladder • Mucocele gall bladder • Perforation – leading to biliary peritonitis • Gangrene of gall bladder • Carcinoma In Bile duct- • Obstructive jaundice • Cholangitis • Acute pancreatitis In Intestine- • Acute intestinal obstruction
  8. 8. Management Investigations • USG abdomen – posterior acoustic shadowing • Plain X RAY abdomen • LFT- Increased conjugated bilirubin Increased Alkaline Phosphate, GGT, 5’-Nucleotidase • TLC
  9. 9. D/D of radio-opaque shadow on x-ray • Renal stone • Calcified 12th rib tip • Phlebolith • Faecolith • Calcified lymph node • Renal cell Ca - calcification • Calcified Adrenal tumor
  10. 10. Treatment • Medical therapy- • GALL STONE DISSOLUTION • Ursodeoxycholic acid (UDCA) – with a functioning Gall bladder with stone less than 10 mm • 10-15 mg/kg/day • Pigment stones are non responsive to medical therapy
  11. 11. Surgical therapy • Laparoscopic cholecystectomy is ideal. • Open cholecystectomy is done if patient unfit for laparoscopy through Right Sub-costal(KOCHERS’s) incision.
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surgery ppt on cholelithiasis gall stones causes pathogenesis clinical features management

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