Gallstones:
Most common biliary pathology
Asymptomatic in majority of cases (>80%)
Approx. 1–2% of asymptomatic patients develop symptoms requiring cholecystectomy per year.
Gastric Cancer - Deifinition , epidemiology , histological types and molecular genetics and WHO update
Reference - WHO Classificiation of tumors of Digestive system
Rosai and Ackermann
Gallstones:
Most common biliary pathology
Asymptomatic in majority of cases (>80%)
Approx. 1–2% of asymptomatic patients develop symptoms requiring cholecystectomy per year.
Gastric Cancer - Deifinition , epidemiology , histological types and molecular genetics and WHO update
Reference - WHO Classificiation of tumors of Digestive system
Rosai and Ackermann
A quick review of the various benign pathologic conditions of Gallbladder,intended primarily for the Undergraduate students; Based on Bailey & Love's Short Practise of Surgery latest edition.
Complicated diverticular disease
Diverticulitis is the most usual clinical complication of
diverticular disease, affecting 10–25% of patients with
diverticular.
The process by which diverticulitis arises has been likened to that of appendicitis, with a diverticulum becoming obstructed by inspissated stool in its neck.
This faecalith abrades the mucosa of the sac, causing inflammation and expansion of usual bacterial flora, with
diminished venous outflow and localised ischaemia.
Bacteria may breach the mucosa and extend the process
through the full wall thickness, ultimately leading to
perforation.
Acalculous Cholecystitis.pptx Acalculous cholecystitis is defined as cholecys...nlormainterns
Acalculous cholecystitis is defined as cholecystitis that occurs without a gallstone.
This typically occurs in critically ill patients due to a combination of factors (e.g. bile stasis and hypoperfusion).
Acalculous cholecystitis often goes unrecognized initially, because of intubation and sedation. This can lead to a high rate of progression to gallbladder necrosis (50%) and perforation (10%).The term “necrotizing cholecystitis” has been proposed for this disease, to emphasize its potentially malignant course
science has an evolving nature. what happened today may not be tomorrow, what is not today may happen tomorrow.
No one is complete so reading and thinking may open the door to the hidden ground.
A concise revision on the pathology and current management of liver hepatic cysts and abscesses. Being a copy of seminar presentation I for the HepatoPancreaticoBiliary Unit of the Division of General Surgery, Ahmadu Belllo University Teaching Hospital, Zaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. OUTLINE
• Objectives
• Definition of cholecystitis
• Classification of cholecystitis
• Carcinoma of gallbladder
• Summary
• References
2
3. OBJECTIVES
To study and understand:
• What is cholecystitis?
• Classification of cholecystitis
• Pathogenesis, morphology, clinical features of
different groups of cholecystitis.
• Carcinoma of gallbladder
3
4. DEFINITION
What is cholecystitis?
Inflammation of the gallbladder is called
cholecystitis.
• In Malaysia, the diseases of gastrointestinal
system are getting chronic by days, making
them as one of the top 10 most prevalent
causes of death.
4
7. DEFINITION
Acute inflammation of gallbladder that contains
stones and is precipitated by obstruction of the
gallbladder neck or cystic duct.
• The most common major complication of
gallstones.
• The most common reason for emergency
cholecystectomy.
Neck
7
8. PATHOGENESIS
8
• Acute CALCULOUS cholecystitis results from
chemical irritation and inflammation of the
obstructed gallbladder.
• The action of mucosal phospholipases
hydrolyzes luminal lecithins (phospholipids) to
toxic LYSOLECITHINS.
• The normally protective glycoprotein mucus
layer is disrupted, exposing the mucosal
epithelium to the direct DETERGENT action of
bile salts.
9. 9
• Prostaglandins released within the wall of the
distended gallbladder contribute to mucosal
and mural inflammation.
• Gallbladder dysmotility develops
distention and increased intraluminal
pressure
compromise blood flow to the mucosa.
ischemia
10. MORPHOLOGY
In acute cholecystitis
basically,
• Gallbladder is usually
enlarged and tense
• Characterized as a bright
red or blotchy, violaceous to
green-black discolouration.
• Imparted by subserosal
haemorrhages.
• Serosal covering is layered
by:
▫ Fibrin
▫ Definite suppurative
10
11. In acute calculous cholecystitis,
• Obstructing stones are usually present in the
neck of the gallbladder or cystic duct.
• The gallbladder lumen may contain one or more
stones, filled with cloudy or turbid bile which
may contain large amounts of fibrin, pus and
haemorrhage.
11
12. • Empyema of gallbladder – the contained
exudate is virtually pure pus.
• In mild cases, the wall is thickened, edematous
and hyperemic.
• Gangrenous cholecystitis – severe,
gallbladder turns into green-black necrotic
organ, with small-to-large perforations.
• Acute emphysematous cholecystitis –
invasion of gas-forming organisms i.e., clostridia
and coliforms.
12
13. CLINICAL FEATURES
Patients usually, not always,
experienced previous episodes of
pain.
May appear with remarkable
suddenness & constitute an
acute surgical emergency.
Or may present with mild
symptoms without medical
intervention.
Attacks usually subside in 7-10
days.
25% of patients progressively
develop more severe symptoms
– immediate surgical
intervention.
Recurrence is common after
13
15. Acute inflammation of
gallbladder that has no
relation with gallstones.
• 5%-12% of gallbladders
removal contain no
gallstones.
• Mostly happen in seriously
ill patients.
DEFINITION
15
Preoperative condition with
inflamed gallbladder
16. RISK FACTORS
(1) Sepsis with hypotension and multisystem organ
failure;
(2) Immunosuppression
(3) Major trauma and burns
(4) Diabetes mellitus
(5) Infections
(Salmanellosis & Cholera), Parasitic infestation
16
Subserosal perforation in diabetic
patient with acute
emphysematous cholecystitis.
17. PATHOGENESIS
Results from ischemia of cystic artery
Contributing factors:
- Inflammation & edema of the wall that compromise blood flow
- Gallbladder stasis
-Accumulation of microcrystals of cholesterol (biliary sludge)
-Viscous bile
-Gallbladder mucus
Cystic duct obstruction in the absence of frank stone formation
17
18. MORPHOLOGY
• There are no specific morphologic differences
between acute acalculous and calculous
cholecystitis, except for the absence of
macroscopic stones in acalculous form.
18
19. CLINICAL FEATURES
• The symptoms are more
insidious – underlying
conditions.
• Higher proportion of patients –
no symptoms referable to
gallbladder.
• Incidence of gangrene and
perforation is higher than in
calculous cholecystitis.
• Rarely, acute acalculous occurs
due to primary bacterial infection
(e.g., Salmonella typhi,
staphylococci).
• Less painful acute acalculous –
systemic vasculitis, severe
atherosclerotic ischemic disease
in elderly, AIDS patients & biliary
tract infection.
19
Gangrenous gallbladder
with empyema
Perforation
(hole/piercing)
at the apex of
gallbladder
20. MANAGEMENT FOR ACUTE
CHOLECYSTITIS
• Initial treatment management is conservative, consisting of nil
by mouth, IV fluids, opiate analgesia and IV antibiotics
(cephalosporins, fluoroquinolones or
piperacillin/tazobactam).
• Cholecystectomy cures acute cholecystitis and relieves
biliary pain. It is usually delayed for a few days to allow the
symptoms to settle.
• Surgery may be delayed when patients have an underlying
severe chronic disorder (eg, cardiopulmonary) that increases
the surgical risks. In such patients, cholecystectomy is
deferred until medical therapy stabilizes the comorbid
disorders or until cholecystitis resolves.
▫ If cholecystitis resolves, cholecystectomy may be done ≥ 6
wk later. Delayed surgery carries the risk of recurrent biliary
complications.
20
22. CHRONIC CHOLECYSTITIS
• In most cases, it develops without any history if
acute attacks, but in some cases, it happens as
a sequel to repeated bouts of acute
cholecystitis.
• Almost associated with gallstones but they do
not have direct role in development of pain or
inflammation.
▫ Symptoms and morphologic alterations similar to
those seen in calculous form.
• Since it is associated with cholelithiasis in more
than 90% of cases, the patient populations are the
same as those for gallstones.
22
23. MORPHOLOGY – GROSS
• The serosa - smooth and glistening but maybe dulled by subserosal
fibrosis.
• Dense fibrous adhesions.
• Wall - thickened with opaque gray-white appearance.
• In uncomplicated cases – lumen contains fairly clear, green-yellow,
mucoid bile and stones.
• Mucosa is preserved.
23
Notice thickness of galldladder wall, abundant polyhedric stones
and small papillary tumor in the cystic duct.
24. Morphology – histologic examination
• In the mildest cases, only
scattered lymphocytes,
plasma cells and
macrophages are found in
the mucosa & subserosal
fibrous tissue.
• In advanced cases, there is
marked subepithelial &
subserosal fibrosis, with
mononuclear cell infiltration.
• Buried crypts of epithelium
due to reactive proliferation
of mucosa & fusion of
mucosal folds.
• Outpouchings of mucosal
epithelium through the wall –
24
Enlarged mucosal folds of the
gallbladder and infiltrate of foamy
histiocytes, very little inflammation,
found in the muscular wall and
serosal fat.
25. 25
The gallbladder mucosa is
infiltrated by inflammatory cells
Outpouching of the mucosa
through the wall forms
Rokitansky-Aschoff sinus
(contains bile).
26. CLINICAL FEATURES
• Has no striking manifestations of acute forms.
• Usually characterized by recurrent attacks of
steady epigastric or right upper quadrant
pain.
• Nausea, vomiting and intolerance for fatty foods.
26
28. EPIDEMIOLOGY
More common
in women
Occurs in 7th
decade of life
Mexico & Chile
– high
incidence of
gallstone
disease
In US, most
common in
Hispanics and
Native
Americans
Although
uncommon, it
is the most
frequent
malignant
tumor of biliary
tract
28
29. PATHOGENESIS
• Gallbladder cancer arises in the
setting of chronic
inflammation. In the vast
majority of patients (>75%), the
source of this chronic
inflammation is
cholesterol gallstones.
• The presence of gallstones
increases the risk of gallbladder
cancer 4- to 5-fold.
• Other unusual causes are
associated with gallbladder
cancer, including primary
sclerosing cholangitis, ulcerative
colitis, liver flukes,
chronic Salmonella typhi and
paratyphi infections, and
Helicobacter infection.
29
30. MORPHOLOGY
Cancer may exhibit exophytic or infiltrating
growth patterns.
• The infiltrating pattern is more common and
usually appears as a poorly defined area of
thickening and induration of the gallbladder wall.
• Deep ulceration can cause direct penetration of
gallbladder wall or fistula formation to adjacent
viscera where neoplasm grow.
• These tumors are scirrhous and very firm.
30
31. • The exophytic pattern grows into the lumen as an
irregular, cauliflower-like mass but also invades the
underlying wall.
• Luminal portion may be necrotic, hemorrhagic
and ulcerated.
• Most common sites: fundus & neck; 20% involve
lateral walls.
31
The opened gallbladder contains a large, exophytic tumor
that virtually fills the lumen
32. • Most are adenocarcinomas – may be papillary or
poorly differentiated.
• About 5% are squamous cell carcinomas.
• Neuroendocrine tumors, which is rare, also occur.
• By the time this cancer is discovered, most have invaded
the liver or spread to the bile ducts or portal hepatic
lymph nodes.
32
Papillary pattern
33. CLINICAL FEATURES
• Onset is insidious and indistinguishable from those
associated with cholelithiasis (e.g., abdominal pain,
jaundice, anorexia and nausea and vomiting).
• Early detection may be possible in patients with
palpable gallbladder & acute cholecystitis before
extension of tumor into adjacent structures.
• Or when carcinoma is found during
cholecystectomy.
33
34. PROGNOSIS
• Outlook by stage
• Sadly, for most people cancer
of the gallbladder does not
have a very good outlook.
• By the time it is diagnosed, it is
often in the later stages and
treatment is unlikely to cure
it.
• 1 out of 10 (10%) will live for
more than 5 years.
34
Although overall prognosis is improving, many patients with
gallbladder cancer continue to have advanced disease at the
time of their diagnosis, and subsequent poor survival rates.
May 2009 issue of the Archives of Surgery.
35. SUMMARY
• Cholecystitis is the inflammation of the
gallbladder, almost always associated with
gallstones.
• Divided into acute (calculous & acalculous) and
chronic.
• Carcinoma of gallbladder is a rare disease in
which malignant (cancer) cells form in the
tissues of the gallbladder.
• Although carcinoma of gallbladder is a rare
disease, it has a bad prognosis.
35