Choledocholithiasis is one of the main causes for Obstructive Jaundice.In this ppt presentation, I have discussed the etiology, clinical features, complications, investigations and management of Choledocholithiasis. I have also included a mindmap and 2 algorithms for Choledocholithiasis. I hope you will find it very useful and interesting.
Obstructive jaundice is one of the important surgical topics. In this playlist I have discussed the introduction, choledocholithiasis, Carcinoma Pancreas and biliary atresia. If you watch all these videos together you will become confident in Managing obstructive jaundice.
Obstructive jaundice is one of the important surgical topics. In this playlist I have discussed the introduction, choledocholithiasis, Carcinoma Pancreas and biliary atresia. If you watch all these videos together you will become confident in Managing obstructive jaundice.
SIGMOID VOLVULUS- GENERALISED ABDOMINAL PAIN
#surgicaleducator #generalisedabdominalpain #sigmoidvolvuus #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Sigmoid Volvulus- a didactic lecture.
• It is one of the life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Sigmoid volvulus.
• I have also included a mind map, diagnostic algorithm and a treatment algorithm for Sigmoid Volvulus.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
In this ppt I have discussed the different causes for obstructive jaundice, anatomy of biliary tract, physiology of jaundice, labs in obstructive jaundice and an algorithm to diagnose obstructive jaundice.
SIGMOID VOLVULUS- GENERALISED ABDOMINAL PAIN
#surgicaleducator #generalisedabdominalpain #sigmoidvolvuus #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Sigmoid Volvulus- a didactic lecture.
• It is one of the life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Sigmoid volvulus.
• I have also included a mind map, diagnostic algorithm and a treatment algorithm for Sigmoid Volvulus.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
In this ppt I have discussed the different causes for obstructive jaundice, anatomy of biliary tract, physiology of jaundice, labs in obstructive jaundice and an algorithm to diagnose obstructive jaundice.
Dear Viewers,
Greetings from “ Surgical Educator”
Today I have uploaded a video on one of the congenital causes for obstructive jaundice- Biliary Atresia. In this episode, I am discussing about the etiology, types, clinical features, investigations, treatment and surgical outcome of Biliary Atresia. I hope you will enjoy the video. You can watch all my surgical teaching video casts in the following link: surgicaleducator.blogspot.com.
Today I have uploaded a video on one more cause for Obstructive Jaundice- Pancreatic Carcinoma. Only cancer in head of pancreas cause Obstructive Jaundice. I have talked about cancer in body and tail of pancreas as well. I have discussed the risk factors, pathology, clinical features, investigations, treatment and complications of pancreatic carcinoma. I have included a mind map and two algorithms. I hope you will enjoy this video. You can watch all my surgical teaching video casts in the following link.
Surgicaleducator.blogspot.com
Thank you for your support.
Dear Viewers,
Greetings from " Surgical Educator"
Today in this video I am going to talk on one more cause for Lower GI hemorrhage- Colorectal Carcinoma. I talk on the various causes for Lower GI hemorrhage, Etiopathogenesis, clinical features, investigations, staging, treatment and followup of Colorectal carcinoma. I have also included a mindmap, a diagnostic algorithm and a treatment algorithm. Hope you will enjoy the video. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
FISSURE-IN-ANO – Lower GI Hemorrhage
Dear Viewers,
Greetings from “Surgical Educator”
Today in this episode, I have talked about yet another cause for lower GI haemorrhage- “Fissure-in-Ano”. Unlike other causes of lower GI haemorrhage, fissure-in-ano present with painful bleeding per rectum. I am talking on etiology, types, clinical features and treatment of fissure-in-ano. I have also included a mind map, a diagnostic algorithm and a treatment algorithm. You can watch this video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
LOWER GI HEMORRHAGE- PLAYLIST OF 6 VIDEOS
Dear Viewers,
Greetings from “Surgical Educator”.
I have made a playlist for Lower GI Hemorrhage which consists of six videos on various causes of Lower GI Hemorrhage. They are Introduction, diverticular disease, haemorrhoids, fissure-in-ano, colorectal carcinoma and inflammatory bowel disease. If you watch all these videos together you will become confident to tackle the clinical problem of Lower GI Hemorrhage. You can watch these videos in the following link: https://www.youtube.com/playlist…
Thank you for watching the videos.
Case based format encourages active learning and demonstrates how to apply theoretical concepts to surgical practice. I am going to create and upload series of videos based on case scenarios apart from my usual didactic teaching videos.
Like the playlist in YouTube, in this presentation I have combined three of my presentation into one for the benefit of medical students and surgical trainees. The first presentation regading introduction to breast pathologies, second regarding benign breast lesions and the third one is regarding Carcinoma Breast. Hope you will enjoy this.
In this PPT I am talking about post-operative fever on POD#6. The commonest cause for fever during this post-op time is DVT(Walking). This is a preventable complication and if you take adequate precaution before surgery you can completely avoid this problem. i am discusing how to diagnose, manage and prevent this complication. you can watch all my teaching videocasts in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Obstructive jaundice is a condition characterized by the accumulation of bilirubin in the blood due to an obstruction in the bile ducts. The bile ducts are responsible for transporting bile, a yellowish-green fluid produced by the liver, to the intestines to aid in digestion. When the flow of bile is hindered or blocked, bilirubin, which is a waste product of red blood cells, cannot be properly eliminated from the body, leading to its accumulation in the bloodstream.
The most common cause of obstructive jaundice is the presence of a blockage in the bile ducts, usually caused by gallstones, tumors, or strictures (narrowing) of the ducts. This blockage prevents bile from flowing freely, resulting in its buildup in the liver and subsequently in the blood. As a result, individuals with obstructive jaundice may exhibit yellowing of the skin, eyes, and mucous membranes, which is the hallmark symptom of jaundice.
In this presentation I am talking about the overview of So-Hum meditation- the universal mantra.
I have discussed the meaning, how to do it, it's advantages and an advanced visualisation technique.
This is a small handbook on individual surgical disease and its management . I have discussed about Acute Appendicitis and then step by step I explain both open and laparoscopic appendicectomy in this book.
The operative surgery part is very useful for surgical trainees.
POWER OF YOUTUBE IN MEDICAL EDUCATION- Surgical Educator Channel
#powerofyoutube #surgicaleducator #babysurgeon #usmle
Website Link: www.surgicaleducator.com
Dear viewers,
• Greetings from “Surgical Educator’
• In this episode, I am talking about the Power of YouTube in medical education
• I will be discussing the various benefits of using YouTube in medical education. YouTube is definitely revolutionize the way in which we are teaching our students.
• You can enjoy all my videos in the following links:
•
/ surgicaleducator surgicaleducator.com
• Thank you for watching the video.
All my videos are problem-based, because patients are coming to us with problems and not with a diagnosis.
• I have made modules for each surgical problem which consists of
many of my YouTube videos and my PPT slides
• I request you all to watch all the videos in a playlist together, so
that you will become confident in dealing with these problems.
• Links to the Playlists based on the Surgical Problems:
• Module 1: Scrotal Swellings:
https://www.youtube.com/playlist?list...
uXwt0JH0YG8m4JmzgAli9jj
https://www.slideshare.net/babysurgeo...
• Module 2: Groin Swellings:
https://www.youtube.com/playlist?list...
uVaDboG_ddw2S6xInNnB80D
https://www.slideshare.net/babysurgeo...
• Module 3: Abdominal Pain:
https://www.youtube.com/playlist?list...
uUcXb96A3tFpTrWOVa2F7j1
https://www.slideshare.net/babysurgeo...
case-based-learning-82091549
• Module 4: Abdominal Lumps:
https://youtube.com/playlist?list=PLx...
uWBKVnBkhdE4XkW-xEoiIwB
• Module 5: Obstructive Jaundice:
https://www.youtube.com/playlist?list...
uX6MsQnsCTGl8YDFN1TYiQm
https://www.slideshare.net/babysurgeo...
127314632
• Module 6: Upper GI Hemorrhage:
https://www.youtube.com/playlist?list...
uUtV67AdUQYEUKdhX9vL576
https://www.slideshare.net/babysurgeo...
227888333
• Module 7: Lower GI Hemorrhage:
https://www.youtube.com/playlist?list...
https://www.slideshare.net/babysurgeo...
• Module 8: Thyroid Pathologies:
https://www.youtube.com/playlist?list...
uWg55odQfB_7JT0NYIP8ELp
https://www.slideshare.net/babysurgeo...
benign-diseases-and-carcinoma-thyroid
• Module 9: Breast Pathologies:
https://www.youtube.com/playlist?list...
uVTLcGtam1kFBzjY4NAf7MZ
https://www.slideshare.net/babysurgeo...
diseases-and-carcinoma-breast
• Module 10: Peripheral Arterial Diseases:
https://www.youtube.com/playlist?list...
6VIbQR4g8MdOi0z
https://www.slideshare.net/babysurgeo...
106254612
• Module 11: Venous Diseases:
https://www.youtube.com/playlist?list...
uVf1aYodgILbxVpC-fkdqNo
https://www.slideshare.net/babysurgeo...
127314847
• Module 12: Dysphagia:
https://www.youtube.com/playlist?list...
4DlU1Lp
# Dear Viewers/Friends/Colleagues,
# Greetings from Surgical Educator YouTube channel
# I am sharing an E-book where you can find out the hyperlinks for all my surgery teaching videos and their PPTs
# In this E-book you will learn the purpose of my YouTube channel Surgical Educator, core clinical problems you should master, how to utilize the channel effectively, statistics and analytics for the channel, all the teaching modules with hyperlinks to all my teaching videos and their PPTs and other learning resources created by me like the android app for the channel and other E-books.
In this presentation, I discussed the various liver swellings- both cystic and solid swellings. Cystic lumps are Pyogenic liver abscess, Amebic liver abscess and hydatid cyst. Benign solid swellings are Hepatic adenoma, Focal nodular hyperplasia and Hemangioma. The malignant solid swelings are secondary carcinoma of the liver, primary Hepatocellular carcinoma and Hepatoblastoma.
In this presentation, I have shown how to do open anterior resection both high and low varieties in a step-by-step manner with clear pictures as if reading an atlas of operative surgery.
The surgical causes for jaundice in children- both in neonates and infants- are Biliary atresia, Choledochal cyst, Biliary hypoplasia, Inspissated bile syndrome, and spontaneous perforation of CBD. How to Diagnose & Treat all these causes.
I am sharing a 10 paged e-book that consists of the hyperlinks to all my surgery teaching videos and to all the PPTs used for these videos from SlideShare. You can watch these videos problem based and can become competent to deal with it. You can read this to cover the whole undergraduate curriculum.
In this presentation I discussed 5 scrotal swellings case scenarios with my MBBS students. I have shared these case scenarios prior to the PBL class and asked the students to come prepared to the class. In the class i tested the knowledge gaind by the students by watching my didactic YouTube videos on the subject by asking so many questions. So this online class was highly interactive based on flip class model.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- 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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
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.
4. Classical Clinical
Vignette
A 40-year-old female presents with a 24 hour history of right upper
quadrant (RUQ) and epigastric pain, associated with nausea and
vomiting. She has had similar pain in the past, particularly after
eating fatty foods. According to her family, over the last few hours,
the patient has become slightly confused. Past medical history is
negative.
O/E: She is moderately tender in the RUQ to deep palpation. She has
slight scleral icterus. She has noted dark- coloured urine. The
remainder of her abdominal exam is negative.
Vitals: BP-90/60 mms of Hg; PR-110/mt; RR-16/mt;T:102*F
5. Classical Clinical Vignette
Laboratory examination:
TWBC- 15,000/μL(4 to 11,000/μL),
Total bilirubin-4mgm/dl(0.1 to 1.2mgm/dl) Direct bili- 3mgm/dl
ALP- 350μ/L (33-131μ/L); GGT- 330μ/L (8-88μ/L)
AST- 300μ/L(5-35μ/L); ALT- 280μ/L(7-56μ/L)
Sr Amylase- 100μ/L( 30-110μ/L)
Urine is positive for bilirubin
CHOLEDOCHOLITHIASIS
WITH CHOLANGITIS
6. Choledocholithiasis-Etiology
It is stones in the CBD and biliary tree.
Primary—Rare 5%—brown pigment stones. They are formed in
CBD and biliary tree itself, and are multiple, often sludge like,
commonly pigment or mixed type, extends into hepatic ducts.
Causes: Biliary stasis, biliary dyskinesia, caroli’s disease,
choledochal cyst, clonorchiasis, ascariasis Etc
Secondary—Common 95%—black pigment stones/cholesterol
stones. It is seen in 15% of gallstone disease; 75% are cholesterol
stones, 25% are pigment stones.
8. Clinical Features
50% asymptomatic
Biliary colic because of CBD obstruction by stone-
pain in RHC & epigastrium
Intermittent chills, fever, or jaundice
accompanies biliary colic Charcot’s triad
Ascending cholangitis
Suppurative cholangitis Reynold’s pentad
Persistent pain, fever, jaundice, shock & AMS
Painful jaundice with dark color urine, clay
colored stool and pururitus.
Features of Ac Pancreatitis in distal CBD stone
impaction
9. Clinical Features
Patient may be icteric and toxic, with high fever and chills, or may
appear to be perfectly healthy.
A palpable gallbladder is unusual in patients with obstructive
jaundice from common duct stone because the obstruction is
transient and partial, and scarring of the gallbladder renders it
inelastic and non distensible.
Courvoisier’s Law: “ In a jaundiced patient if GB is palpably
enlarged it is not due to Gall stone”
Tenderness in the right upper quadrant is not often as marked as in
acute cholecystitis, DU perforation or Ac Pancreatitis
Tender enlarged liver +
10. Differential diagnosis
Obstructive jaundice due to other causes:
Carcinoma of head of pancreas
Periampullary carcinoma
Carcinoma of biliary tree- cholangiocarcinoma
Biliary stricture- Scelerosing cholangitis
Intrahepatic cholestasis from drugs, pregnancy, chronic active
hepatitis, or primary biliary cirrhosis may be difficult to distinguish
from extrahepatic obstruction. ERCP would be appropriate to make
the distinction.
11. COMPLICATIONS
Liver dysfunction and biliary
cirrhosis.
White bile formation and liver
failure.
Suppurative cholangitis.
Liver abscess.
Septicaemia.
Pancreatitis if CBD stone is near
sphincter of Oddi blocking drainage of
bile and pancreatic duct.
12. Investigations- Labs
In cholangitis, leukocytosis of 15,000/mL is usual, and values above
20,000/mL are common.
T bilirubin level usually remains under 10 mg/dL, and most are in
the range of 2-4 mg/dL. The direct fraction exceeds the indirect, but
the latter becomes elevated in most cases.
Bilirubin levels do not ordinarily reach the high values seen in
malignant tumors because the obstruction is usually incomplete and
transient. In fact, fluctuating jaundice is so characteristic of
choledocholithiasis.
Serum alkaline phosphatase & GGT levels usually rises
Mild increases in AST and ALT are often seen
13. Investigations-Imaging
AXR & USG abdomen- ineffective to pick up CBD stones
USG abdomen may indicate dilated CBD >1cm
CECT- can pick up CBD stone
MRCP- best non-invasive diagnostic investigation
ERCP- Gold standard- diagnostic & therapeutic
EUS- can pick up CBD stone and can take biopsy if there is a mass
15. TREATMENT
In absence of cholangitis:
ERCP, Sphincterotomy, CBD stone removal by dormia basket or
balloon followed by Lap cholecystectomy.
Lap cholecystectomy with Lap CBD exploration
In presence of cholangitis:
ERCP with sphincterotomy and stone extraction or stent placement-
decompression
PTBD- Percutaneous transhepatic biliary drainage in ERCP failed
cases
Surgical treatment: Only when above two procedures not possible.
Decompression of CBD with T tube.
17. TREATMENT
Open cholecystectomy, intra op cholangiogram, choledocholithotomy
with T tube placement.
Remove T tube—10 to 14 days after T tube cholangiogram
Missed/retained/residual stones (< 2 years):
If T tube present Percutaneous stone extraction via T tube tract
after 4-6 weeks (Burhenne technique) using choledochoscope
If T tube absent ERCP stone removal
Recurrent stones (> 2 years):
ERCP—first approach
If duct dilated > 2 cm—choledochoduodenostomy or transduodenal
sphincteroplasty