.

2.  Anatomy revision
 10 complications
 Pathogenesis
 Symptoms
 Signs
 Management

4. 1) Acute cholecystitis
2) Chronic cholecystitis
3) Obstructive jaundice
4) Cholangitis
5) Acute pancreatitis
6) Mucocele
7) Empyema
8) Gallstone ileus
9) Gallbladder perforation
10) Gallbladder carcinoma

5.  Cholecyst- Gallbladder
 -itis Inflammation
 -ectomy Removal
 Acalculus vs calculus
 Inflammation of GB wall
 Obstruction of cystic duct
 Oedema, mucosal ulceration, fibro purulent
exudate

7.  Symptoms
 RUQ/epigastric pain
 Fever
 Nausea & vomiting, anorexia
 Signs
 Tender RUQ, guarding, rebound
 Murphy’s positive
 ↑WCC, ↑CRP, mildly ↑LFTs

8.  Imaging
 USS/CT – thickened GB wall, pericholecystic
fluid, stones, distended GB
 Management
 Admission
 IV rehydration & NBM/clear fluids
 Analgesia
 Antibiotics
 Cholecystectomy

9.  Gallstones invariably
 Repeated attacks  fibrosis
 Insidious onset vs several attacks
 Common histological finding after
cholecystectomy
 Asymptomatic vs pain
 Management = conservative vs surgical

10.  Blockage of biliary tree (CBD or hepatic duct)
 Intra-luminal vs extra-luminal
 Mirizzi Syndrome
 Local oedema
 Courvoisier’s Law – jaundice, pain, non-palpable
gallbladder
 Management
 USS +/- MRCP
 ERCP
 Cholecystectomy

14.  Cholang- Bile ducts
 -itis Inflammation/infection
 Biliary tree infection in presence of obstruction
(stones, stricture)
 Signs & Symptoms
 Unwell jaundiced patient!
 Charcot’s Triad = fever, pain, jaundice

15.  Management
 Resuscitation
 IV antibiotics
 Biliary tree decompression
 ERCP, radiological or surgical intervention
 Definitive management of cause of
obstruction

16.  Inflammatory process due to local enzymatic
effects
 Causes:
 GET SMASHED
 Gallstones
 Ethanol
 Trauma (ERCP)

18.  Signs & Symptoms
 Epigastric pain radiating to back
 Tender, rigid abdomen, vomiting,
dehydrated
 Raised amylase, history of jaundice or recent
ERCP, or previous RUQ pains
 Management
 Resuscitation, analgesia, removal of cause &
prevention of future episodes

19.  Endoscopic Retrograde Cholangio-
Pancreatography
 Imaging of biliary tree +/- therapeutic removal
of stones +/- stent insertion +/-
sphincterotomy

20.  Impaction of stone in GB neck or cystic duct
when GB empty of bile
 Mucous is secreted into GB from epithelium
 No inflammation so GB swells to many times
its normal size
 Signs & Symptoms
 Pain
 Tender RUQ mass

22.  Impaction of stone in GB neck or cystic duct
with superadded infection of bile
 Water absorbed so bile concentrated
 Pus present
 Due to:
 Acute cholecystitis
 Infection of mucocele

23.  Signs
 Palpable tender gallbladder
 Septic patient
 Management
 Early cholecystectomy (prevents perforation)
 Radiologically-guided percutaneous
drainage (temporary measure)

24.  Fistula between gallbladder & bowel
 Stone travels through bowel & embedded in
narrow point of bowel causing bowel obstruction
 Usually ileo-caecal valve (small bowel)
 Signs & Symptoms
 Previous RUQ pain, small bowel obstruction
 X-ray – distended small bowel loops (opacity in
RIF), air in biliary tree
 Rigler’s triad: SBO; pneumobilia; GS in RIF
 Management
 Laparotomy, resuscitation, milk stone back and
remove via cut into healthy section of bowel

27.  Inflammation causes necrosis of GB wall
causing perforation
 Following empyema or acute cholecystitis
 Biliary peritonitis
 Significant mortality (60%)

28.  Rare
 4 Female:1 Male
 95% of cases associated with gallstones
 Incidental finding during cholecystectomy, or
presents with similar picture to chronic
cholecystitis.
 Management
 Radical resection including liver segments

30. Questions?