7. etiology
2 ACALCULOUS
Cholesterosis(strawberry gall
bladder)
Cholesterol polyposis of gall bladder
Cholecystitis glandularis proliferans
Diverticulosis of gall bladder
Typhoid of gall bladder
12. Abdominal pain
• SITE - RIGHT HYPOCHONDRIUM
• TYPE - COLICKY
• ONSET – SUDDEN
• DURATION – MORE THAN 12 hrs
• RADIATION
BACK
SHOULDER
RIGHT HYPOCHONDRIUM
LEFT HYPOCHONDRIUM
30. GALL BLADDER RADIONUCLIDE SCAN
ORAL CHOLECYSTOGRAM
PERCUTANEOUS TRANSHEPATIC
CHOLANGIOGRAPHY (PTC)
ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREATOGRAPHY (ERCP)
MAGNETIC RESONANCE
CHOLANGIOPANCREATOGRAPHY (MRCP
31. HIDA SCAN
HIDA IS HEPATIC IMINODIACETIC ACID
due to edema of cystic duct HIDA
Does not enter in gall bladder hence
nonvisualization of gall bladder is
diagnostic of acute cholecystitis
Its imortance lies in diagnostic of
acalculous cholecystitis
38. • Naspgastric tube:
ryle’s tube admistration immediately
continued 3 to 5 days.aspirating HCL
decreases the secretion of bile.spasm of
bladder may come down
intravenous fluid:
in the beginning 5 % dexrose saline
may be started but subsquently fluid may be
changed according to electrolyte balance of
paitent
Analgesic +anticholinergic given to reduce
spasm
39. Antibiotic
broad spectrum to cotrol
inflammation.combination of
ampicillin+clindamycin+ and
aminoglycoside is good.
40. • Conservative treatment stopped
and early cholecystectomy
advised
1)pain and tenderness spread across the
abdomen
2)gall bladder increases in size
3)Pulse rate continuse to rise
4)In very elderly patient
41. Surgical Treatment
1.Attack within 48-72 h of diagnosis
2.Deterioration in patient’s general condition
3.Complications are present
Perforation
Peritonitis
Acute obstructive suppurative cholangitis
Acute pancreatitis
43. • Two method in cholecystectomy:
duct first method:
the cystic duct and artery are
first dissected and divided
fundus first method:
in which dissection is started
from fundus and gradually proceed
toward cystic duct
44. Operative problems
1)CBD and right hepatic artery
injury during the operation of
fundus first method
2)Slipped of clip or ligature may
lead to profuse bleeding
45. 3)Biliary leakage from some unknown
duct which may lead to syndrome
known as waltman-walter syndrome
this syndrome is menifested by
chest pain or upper abdominal
pain,low BP,tachycardia.it mimics
coronory thrombosis,pulmonary
embolism.this condition is fatal so
immediately reexplored the
abdomen
46. Postoperative treatment
1)Drainage is removed after 48 hours or it
may be kept for longer period
2)Gastric aspiration and IV fluid is
continued until the peristalsis of
intestine is come back
