The document discusses the anatomy and diseases of the gallbladder and bile ducts. It provides details on:
1. The anatomy of the gallbladder, cystic duct, common bile duct, and sphincter of Oddi.
2. Common gallbladder and bile duct diseases including gallstones, cholecystitis, cholangitis, strictures, cancers, and more.
3. The symptoms, signs, investigations, and treatments for various diseases like acute cholecystitis, chronic cholecystitis, and bile duct stones.
Cholecystectomy is often the treatment for gallbladder diseases while bile duct diseases may require other interventions. A thorough understanding of the anatomy and diseases is
General GIT
• Diagnostic studies p 713
o X Ray
o Ba swallow
o Ba enema
o Endoscopies
o Fibre optic colonoscopy
o Abdominal ultrasound
o CT scan
o MRI
o Stool tests
Peptic ulcers p 747
• Definitions
• Causes
• Risk factors
• Pathophysiology
• Comparison of DU & GU, table 39.3
• Assessment and common findings
o Pain in detail others mention
• Complications (name only)
• Haemorrhage
• Obstruction
• Perforation
• Penetration
• Management
o Medical – table 39.4
o Surgical (definitions only)
Billroth 1
Billroth II
Peritonitis p 757 / Acute abdomen PCCM p 105
(T&E Periods)
• Definition
o Causes
• Assessment and common findings p 757 / clinical features PCCM p 105
o Objective data
• Nursing management
• Essential health information
Bowel obstruction p 761 (T&E Periods)
• Definition
• Causes
o Mechanical
o Non Mechanical
o Neurogenic
• Pathophysiology
• Assessment and common findings
• Physical examination
• Diagnostic studies
• Medical management
• General nursing care for abdominal surgery p 763
Inflammatory bowel disease p 768
• Definition
• Causes
o Crohns p 768
Definition
Pathophysiology
Assessment and common findings
Diagnostic studies
Management
Arresting the inflammatory process
Promoting comfort and healing
Maintaining adequate nutrition and fluid
Preventing complications
General hepatic system
• Diagnostic tests p 777
o Ultrasound
o CT
Cirrhosis of the liver p 790 PCCM p 116
• Definition
• Causes (Not types)
• Pathophysiology
• Assessment and common findings
• Clinical manifestations with patho table 41.7
• Management
• Essential health information
• General nursing care of liver cirrhosis p 795
• Complications p 797
General GIT
• Diagnostic studies p 713
o X Ray
o Ba swallow
o Ba enema
o Endoscopies
o Fibre optic colonoscopy
o Abdominal ultrasound
o CT scan
o MRI
o Stool tests
Peptic ulcers p 747
• Definitions
• Causes
• Risk factors
• Pathophysiology
• Comparison of DU & GU, table 39.3
• Assessment and common findings
o Pain in detail others mention
• Complications (name only)
• Haemorrhage
• Obstruction
• Perforation
• Penetration
• Management
o Medical – table 39.4
o Surgical (definitions only)
Billroth 1
Billroth II
Peritonitis p 757 / Acute abdomen PCCM p 105
(T&E Periods)
• Definition
o Causes
• Assessment and common findings p 757 / clinical features PCCM p 105
o Objective data
• Nursing management
• Essential health information
Bowel obstruction p 761 (T&E Periods)
• Definition
• Causes
o Mechanical
o Non Mechanical
o Neurogenic
• Pathophysiology
• Assessment and common findings
• Physical examination
• Diagnostic studies
• Medical management
• General nursing care for abdominal surgery p 763
Inflammatory bowel disease p 768
• Definition
• Causes
o Crohns p 768
Definition
Pathophysiology
Assessment and common findings
Diagnostic studies
Management
Arresting the inflammatory process
Promoting comfort and healing
Maintaining adequate nutrition and fluid
Preventing complications
General hepatic system
• Diagnostic tests p 777
o Ultrasound
o CT
Cirrhosis of the liver p 790 PCCM p 116
• Definition
• Causes (Not types)
• Pathophysiology
• Assessment and common findings
• Clinical manifestations with patho table 41.7
• Management
• Essential health information
• General nursing care of liver cirrhosis p 795
• Complications p 797
etiology ,classifications of gall stones & causes,risk factors,presentations, clinical examinations ,investigations including radiological (role of ERCP and MRCP ) and serological ,treatment including surgical and non surgical ,post cholecystectomy syndrome and its management ,Iindicatrions for cholecystectomy and cholecystotomy & when to perform ,complications of gall stones ,preventions of gall stone disease
etiology ,classifications of gall stones & causes,risk factors,presentations, clinical examinations ,investigations including radiological (role of ERCP and MRCP ) and serological ,treatment including surgical and non surgical ,post cholecystectomy syndrome and its management ,Iindicatrions for cholecystectomy and cholecystotomy & when to perform ,complications of gall stones ,preventions of gall stone disease
gall stone disease, etiology , pathogenesis , risk factors ,types of gall stones,clinical feature, diagnosis , medical and surgical treatment of gall stones , prevention of gall stones
This PPT contains all necessary detail about cholecystitis and its management and covers all aspects of this disease according to nursing point of view. Helpful for studetns.
The gall bladder is located in the junction of the right ninth costal cartilage and lateral border of the rectus abdominis.
It is a pear shaped sac lying on the inferior surface of the liver in a fossa between the right and quadrate lobes with a capacity of about 30 to 50 mL.
Formation of hard, pebble and stone like structure mainly made up of cholesterol in gall bladder is called cholelithiasis.
Know more about cholelithiasis
These presentation is related to biliary disorders. it is simple and concise presentation and provide all information about the biliary disease. i hope this presentation fulfill your requirements and should be useful.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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
- 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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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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.
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!
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
3. Surface Anatomy of Gall Bladder
Right hypochondrium
Transpyloric plane :
horizontal plane
at level of lower
border of L1
vertebral body
Mid-clavicular line
Angle between right
costal margin &
lateral border of
rectus abdominis
muscle
Normally not palpable
4. Calot’s Triangle
Boundaries :
Lateral : cystic duct, gall
bladder
Medial : common hepatic
duct
Above : inferior surface of
right lobe of liver
Contents :
Right hepatic artery
Cystic artery
Cystic lymph node of
Lund
5. Anatomy of Cystic Duct
About 3 cm long (variable),
1 to 3 mm diameter
Joins common hepatic duct
(80%) to form common bile
duct(CBD)
6. Anatomy of CBD
About 7.5 cm long, about 6 mm in
diameter
4 parts :
1.Supraduodenal : 2.5 cm long, on free
edge of lesser omentum
2.Retroduodenal : behind first part of
duodenum
3.Infraduodenal : on posterior surface or
through part of the pancreas
4.Intraduodenal : opens in second part
of
duodenum, surrounded by sphincter of
Oddi
Ends on summit of the ampulla of
Vater
7. Sphincter of Oddi
Muscular valve that
controls the flow of
digestive juices (bile and
pancreatic juice)
through the ampulla of
Vater into the
second part of the
duodenum.
8. Blood Supply of GB
Cystic artery, a branch of right hepatic artery
Rarely, cystic artery arise from common hepatic
artery
Gall bladder may also get accessory artery from
gastro-duodenal artery
9.
10. Lymphatic Drainage &
Nerve Innervation
Lymph drains into cystic lymph node of Lund
in Calot’s triangle, from there it drains into
liver hilar lymph nodes & coeliac lymph nodes
Parasympathetic from Vagus nerve (CN X)
- maintain tone & contractility
Afferent sympathetic fibres mediate pain of
biliary colic
12. At Liver :
Bile production : 97% water, 1 to 2% bile salts,
1% bile pigments, cholesterol, calcium & fatty acids
Excretion : about 40 mls/ hour (about 1 L/ 24 hours)
At Gall Bladder : 3 main functions
Reservoir for bile : during fasting
Concentration of bile : 5 to 10 times, by active
absorption of water
Mucin secretion : about 20 ml/hr
Vagus & Cholecystokinin (CCK) cause GB contraction,
sphincter of Oddi relaxation - bile excreted
16. Plain Xray Abdomen :
Only 10% of gall stones are radio-opaque
Some gall bladders may be calcified (porcelain)
Gas in bile ducts (aerobilia) – ERCP/infection
17. Ultrasonography (USG)
Most important initial imaging
Safe, painless, accurate, convenient,cost-effective & readily available
Gallstones, gall bladder,thickness of gall bladder wall & surrounding
inflammation
Biliary stones,size of ducts & sometimes
stones in common bile duct & growth in pancreas
18. CT & MRI Scans
Computed Tomography (CT) :
Useful for detecting liver & pancreas lesion
Staging of liver, bile duct, pancreatic cancers;
check for enlarged lymph nodes
Only 75% gallstones seen on CT, not for screening
Magnetic Resonance Cholangio-Pancreaticogram
(MRCP) :
Imaging of gall-bladder & bile ducts
Can show bile duct obstruction, stricture &
other intraductal abnormalities
21. Gallstones (Cholelithiasis)
About 10 to 15% of adults have gallstones but
80% are asymptomatic; females 4 : 1 male
Every year about 1 to 2% of asymptomatic cases
will develop symptoms requiring surgery
Classical teaching :
Fat
Fertile
Flatulent
Female of
Forty
22. Stone Formation
Bile salts & Lecithin
Keep cholesterol in solution
When stability is lost
due to excess cholesterol
& reduced bile salts &
lecithin gallstones form
(lithogenic bile)
24. Cholesterol stones
Contain up to 99%
pure cholesterol
Supersaturation with
cholesterol
Usually large, yellowish
Single or a few
25. Pigment stones
Stones having less than 30% cholesterol
Two types : black & brown
Black pigment stones (20 to 30% of stones) :
Associated with haemolysis, usually hereditary
spherocytosis or sickle cell disease & liver cirrhosis
26. Brown pigment stones
Rare in gall bladder; form in bile ducts &
related to bile stasis & infected bile
Also associated with foreign bodies within bile
ducts, eg. endoprosthesis (stents)
27.
28. Complications of gallstones
Biliary colic
Acute cholecystitis
Chronic cholecystitis
Acute pancreatitis
Mucocoele of GB
Empyema of GB
Perforation of GB
Obstructive jaundice
Acute cholangitis, liver abscess
Mirizzi’s syndrome
Intestinal obstruction (gallstone ileus)
Carcinoma of gallbladder
33. 1.Acute Cholecystitis & biliary colic
Mostly associated with cholelithiasis
95% gall stone found impacted in
Hartmann’s pouch or cystic duct
Types of gall stones :
mixed stones – commonest,
multifaceted
pure cholesterol stones – round, single, large
pigment stones – black/ brown, irregular,
hard
Bacteria : Usually Gram-negative aerobes,
eg. Escherichia coli, Klebsiella, Streptococcus
faecalis
Rarely : Bacteroides & Clostridia (gas in
biliary tree)
35. Pathophysiology
Stone obstruct bile outflow
Distension & ischaemia of gall
bladder
Mucosa damaged by lysolecithin
or trauma by stone
(chemical cholecystitis)
Secondary bacterial infection
(septic Cholecystitis)
Sequelae :
Stone slip back into gall bladder with
relief of obstruction & inflammation
subsides (Biliary colic)
Empyema of gall bladder
Gangrene & perforation of gall bladder
with localised abscess/ diffuse peritonitis
(mortality rate of 50%)
36. Clinical Features
Sudden onset of right hypochondrial pain
Fever, nausea, vomiting
Tenderness & guarding over right hypochondrium
Boas’s sign : area of hyperaesthesia between right
9th & 11th ribs posteriorly
Murphy’s sign : sudden holding of breath on deep
palpation of right hypochondrium
44. Treatment
Initially : conservative followed by
cholecystectomy
Nil by mouth,Naso-gastric
aspiration,
Analgesics, antibiotics,
intravenous fluids to replace &
correct electrolytes & fluids losses
Cholecystectomy
preferably laparoscopic done 2 to
3 days after initial treatment
(within 5 to 7 days of onset of
infection; otherwise delay 6
weeks)
45. 2.Chronic Cholecystitis
Shrunken, scarred, fibrotic with
thickened wall
Adhesions to surrounding
structures
Due to repeated inflammation &
mechanical irritations
Clinical features :
Chronic recurrent right
hypochondrial pain;
Nausea & vomiting, abdominal
fullness especially
precipitated by fatty foods
Flatulent dyspepsia, belching &
heartburn
Murphy’s sign may be positive
46. Management
Conservative
Chemical dissolution of stones
using Chenodeoxycholic acid or
Ursodeoxycholic acid
can be tried in elderly patients
Lithotripsy usually not done due
to poor success rate or
recurrence
Surgery - cholecystectomy
Laparoscopic cholecystectomy
treatment of choice
Open cholecystectomy through
Kocher’s (right hypochondrial)
incision
47. 3.Bile Duct Stones (Choledocholithiasis)
Charcot’s triad :
pain, jaundice (obstructive) & fever
Obstruction to outflow of bile leads
to stasis & infection
Jaundice
Ascending cholangitis
50. 5.GB Polyps
A gallbladder polyp is a small,
abnormal growth of tissue with a
stalk protruding from the lining of
the inside of the gallbladder. They
are relatively common.
95% benign, rarely cancerous
Gallbladder polyp size is often an
indication of the presence of cancer:
less than <10mm in diameter —
are typically benign don’t need
to be treated.
larger than >10mm inch in
diameter have a greater
likelihood of being or becoming
malignant.
52. Gall bladder polyp treatment
Asymtomatic
RHC pain & tenderness
Nausea
Vomiting
No treatment
Regular follow up
Cholecystectomy
Symptoms Treatment
53. 6.Gallbladder cancer ●● Very rare
Elderly women above 60 years
old
●● Similar presentation to
gallstones
●● Diagnosis by ultrasound, CT,
●● Most patients present with
advanced disease
●● Surgical resection in less than
10% palliative treatment
●● Prognosis is poor – median
survival approximately 6 months
Cholecystectomy for any gall-
bladder polyp more
than 1 cm diam.
54. 7.Cholangiocarcinoma
Uncommon malignancy
Elderly, more than 65 years old
Adenocarcinoma from extrahepatic
bile ducts
Higher risk with primary sclerosing
cholangitis, hepatolithiasis, hepatitis C,
ascending cholangitis,
choledochal cyst, Caroli’s disease
Locations :
Intrahepatic : 10 to 20%
Hilar cholangiocarcinoma or Klatskin tumours : 60%
Distal bile duct : 20 to 30%
Klatskin 60%
10-25%
20-30%
55. Cholangiocarcinoma
Clinical features :
Jaundice, abdominal pain, early satiety, cachexia
Slow-growing, local invasion & lymphadenopathy
Treatment
Mostly inoperable, 10 to 15% can have radical
resection & reconstruction of bile ducts
Whipple’s operation for distal bile duct tumours
Liver transplant
Limited role of chemotherapy/ radiotherapy
56. “ Courvoisier’s Law”
“ In the presence of obstructive jaundice, a palpable
gall bladder is usually NOT due to gall stone
obstruction of common bile duct ”
Most probably it is due to
Ca head of pancreas
Periampullary tumour
Cholangiocarcinoma
Why?
Gall bladder is usuallyfibrotic & contracted
in chronic cholecystitis with stones,
BUT there can be exceptions
62. Complications of Cholecystectomy
Bleeding
Infection, cholangitis, abscess,
septicaemia
Bile duct injury, bile leakage, duct
stricture
Retained stone
Obstructive jaundice
Acute pancreatitis
After laparoscopic
cholecystectomy :
access complications during
creation of
pneumo-peritoneum:
puncture vessel, bowel, etc.
or bile duct injury
63.
64. TOUCH creates a healing bond
in health care
The TOUCH provides the utmost needed by the sick
- Reassurance -
