The document discusses various interventional procedures for the hepatobiliary system. It describes tumor embolization and ablation techniques used for oncologic procedures in the liver. It also discusses vascular interventions like TIPS and biopsies. For biliary interventions it outlines percutaneous and endoscopic techniques like cholangiography, drainage and cholecystostomy. It provides details on chemoembolization and radioembolization for treating liver cancer. It also provides an overview of the TIPS procedure and indications for biliary interventions like ERCP, PTC and percutaneous cholecystostomy.
Hepatocellular carcinoma—role of interventional radiologist Dr. Muhammad Bin ...Dr. Muhammad Bin Zulfiqar
In these presentation we will discuss the merits, demrits and outcomes of various interventional radiology modalities for the treatment of hepatocellular carcinoma
This presentation include biliary anatomy ,indication, contraindication post op care of percutaneus transhepatic biliary drainage with important technique. and advantage and disadvantage of different technique. This is important for radiologist, radiographers, intervention radiologist radiology resident. Thanks
Imaging assessment of malignant focal and diffuse liver lesions from Ultrasound to Mri with overview of interventional modalities and diagnostic snippets,
Hepatocellular carcinoma—role of interventional radiologist Dr. Muhammad Bin ...Dr. Muhammad Bin Zulfiqar
In these presentation we will discuss the merits, demrits and outcomes of various interventional radiology modalities for the treatment of hepatocellular carcinoma
This presentation include biliary anatomy ,indication, contraindication post op care of percutaneus transhepatic biliary drainage with important technique. and advantage and disadvantage of different technique. This is important for radiologist, radiographers, intervention radiologist radiology resident. Thanks
Imaging assessment of malignant focal and diffuse liver lesions from Ultrasound to Mri with overview of interventional modalities and diagnostic snippets,
Radiological investigation of billiary tact 01Kajal Jha
The name biliary tract is used to refer to all of the ducts, structures and organs involved in the production, storage and secretion of bile.
Bile canaliculi >> Canals of Hering >> intrahepatic bile ductule (in portal tracts / triads) >> interlobular bile ducts >> left and right hepatic ducts >>
These merge to form the common hepatic duct
This exits the liver and joins with the cystic duct from gall bladder
Together these form the common bile duct which joins the pancreatic duct
These pass through the ampulla of Vater and enter the duodenum
Comments Excellent paper. It’s obvious that you put quite a bit of .docxdrandy1
Comments: Excellent paper. It’s obvious that you put quite a bit of work into this. Unfortunately, your paper needs adequate citations in the body of the text to meet our standards on plagiarism. You need to cite each textbook from your bibliography whenever you quote or use some information from the textbook or other resource. For example, writing (Jones 285) after the quote or information used means that you got it from the book whose author was Jones and the info came from page 285.
Laparoscopic cholecystectomy is a procedure in which laparoscopic techniques remove the gallbladder. It is the standard of care for symptomatic gallbladder disease, of which most are performed for symptomatic cholelithiasis. Other indications include acute cholecystitis, biliary dyskinesia, and gallstone pancreatitis.
Describe the reasons a patient might have the selected surgical procedure
The typical reason a cholecystectomy is a treatment of choice is inflammatory changes of gallbladder or blockage of bile flow by gallstones. Symptomatic cholelithiasis is the most common reason where gallstones in the gallbladder are blocking the bile flow and cause inflammation. The patient usually complains of episodic epigastric pain and right upper quadrant pain that radiates to the right shoulder. This pain is found to occur several hours after heavy meals and the patient experiences nausea, vomiting, bloating, fever, and right upper quadrant tenderness. Another condition is acute cholecystitis, where inflammation and symptoms are more prominent. The patient may have a fever, constant pain, positive Murphy's sign, or leukocytosis. Acute cholecystitis may be caused by calculous biliary tract disease with confirmed gallstones in the abdominal US. Acute acalculous cholecystitis usually occurs in critically ill patients, those with prolonged total parenteral nutrition, and some immunosuppressed patients. Patients with episodes of right upper quadrant pain (which are ‘classic' for biliary pain without evidence of cholelithiasis of US or ERCP) may also be referred for laparoscopic cholecystectomy. Gallstone pancreatitis (when small stones pass through the cystic duct) confirmed by cholangiography is another indication for laparoscopic cholecystectomy.
Describe the reasons a patient might be disqualified for this surgery and the options for the patient if any
A patient might be excluded for laparoscopic cholecystectomy due to acute general conditions that are a contraindication for any surgery such as an acute cardiac failure, uncontrolled hypertension, acute renal failure, pneumonia, etc. The condition should be treated by a primary care provider or specialist and the patient should be stable prior surgery. Additional contraindications may include the inability to tolerate general anesthesia, significant portal hypertension, uncorrectable coagulopathy, and multiple prior operations.
List the diagnostic tests and lab work that an attending surgeon might order and desc.
Comments Excellent paper. It’s obvious that you put quite a bit of .docxcargillfilberto
Comments: Excellent paper. It’s obvious that you put quite a bit of work into this. Unfortunately, your paper needs adequate citations in the body of the text to meet our standards on plagiarism. You need to cite each textbook from your bibliography whenever you quote or use some information from the textbook or other resource. For example, writing (Jones 285) after the quote or information used means that you got it from the book whose author was Jones and the info came from page 285.
Laparoscopic cholecystectomy is a procedure in which laparoscopic techniques remove the gallbladder. It is the standard of care for symptomatic gallbladder disease, of which most are performed for symptomatic cholelithiasis. Other indications include acute cholecystitis, biliary dyskinesia, and gallstone pancreatitis.
Describe the reasons a patient might have the selected surgical procedure
The typical reason a cholecystectomy is a treatment of choice is inflammatory changes of gallbladder or blockage of bile flow by gallstones. Symptomatic cholelithiasis is the most common reason where gallstones in the gallbladder are blocking the bile flow and cause inflammation. The patient usually complains of episodic epigastric pain and right upper quadrant pain that radiates to the right shoulder. This pain is found to occur several hours after heavy meals and the patient experiences nausea, vomiting, bloating, fever, and right upper quadrant tenderness. Another condition is acute cholecystitis, where inflammation and symptoms are more prominent. The patient may have a fever, constant pain, positive Murphy's sign, or leukocytosis. Acute cholecystitis may be caused by calculous biliary tract disease with confirmed gallstones in the abdominal US. Acute acalculous cholecystitis usually occurs in critically ill patients, those with prolonged total parenteral nutrition, and some immunosuppressed patients. Patients with episodes of right upper quadrant pain (which are ‘classic' for biliary pain without evidence of cholelithiasis of US or ERCP) may also be referred for laparoscopic cholecystectomy. Gallstone pancreatitis (when small stones pass through the cystic duct) confirmed by cholangiography is another indication for laparoscopic cholecystectomy.
Describe the reasons a patient might be disqualified for this surgery and the options for the patient if any
A patient might be excluded for laparoscopic cholecystectomy due to acute general conditions that are a contraindication for any surgery such as an acute cardiac failure, uncontrolled hypertension, acute renal failure, pneumonia, etc. The condition should be treated by a primary care provider or specialist and the patient should be stable prior surgery. Additional contraindications may include the inability to tolerate general anesthesia, significant portal hypertension, uncorrectable coagulopathy, and multiple prior operations.
List the diagnostic tests and lab work that an attending surgeon might order and desc.
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
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
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.
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. 1.Oncologic therapeutic
procedures :
Tumor Embolization : Method that promotes
tumor destruction by embolization of its
suppliers vessels.
◦ Hepatic radioembolization
Tumor Ablations : Percutaneous local tumor
destruction by using a device to cause cell
death.
6. Liver CancerTreatments
Tumors need a blood supply, which they actively
generate, to feed themselves and grow.
In treating cancer patients, interventional
radiologists attack the cancer tumor from inside
the body without medicating or affecting other
parts of the body by using embolization and
radiofrequency heat.
7. Chemoembolization delivers a high dose
of cancer-killing drug (chemotherapy)
directly to the organ while depriving the
tumor of its blood supply by blocking, or
embolizing, the arteries feeding the tumor.
8. In treating cancer patients, interventional
radiologists use embolization to cut off the
blood supply to the tumor (embolization),
deliver radiation to a tumor
(radioembolization), or combine this technique
with chemotherapy to deliver the cancer drug
directly to the tumor (chemoembolization).
9. Chemoembolization is a minimally
invasive treatment for liver cancer that
can be used when there is too much
tumor to treat with radiofrequency
ablation (RFA), when the tumor is in a
location that cannot be treated with RFA,
or in combination with RFA or other
treatments.
10. Using imaging for guidance, a tiny catheter
up the femoral artery in the groin into
the blood vessels supplying the liver
tumor.
11. Chemoembolization
The embolic agents keep the
chemotherapy drug in the tumor by
blocking the flow to other areas of the
body.This allows for a higher dose of
chemotherapy drug to be used, because
less of the drug is able to circulate to the
healthy cells in the body.
12. Chemoembolization is a palliative, not a
curative, treatment. It can be extremely
effective in treating primary liver cancers,
especially when combined with other
therapies.
13. Catheter is placed via a transfemoral approach with
tip within the selected hepatic artery
14. SIR-Sphere size is small enough to gain entry into
tumor nodules but too large to pass through the end
capillary bed into the venous circulation
Tumor vessels 25μm -75μm
End arterioles 8 μm
SIR-Spheres mean diameter 35 μm
15.
16.
17.
18.
19.
20. Yttrium-90 Radioembolization
Radioembolization is very similar to
chemoembolization but with the use of
radioactive microspheres.This therapy is
used to treat both primary and metastatic
liver tumors.
21. This treatment incorporates the
radioactive isotopeYttrium-90 into the
embolic spheres to deliver radiation
directly to the tumor. Each sphere is
about the size of five red blood cells in
width.
22. These beads are injected through a
catheter from the groin into the liver
artery supplying the tumor.The beads
become lodged within the tumor vessels
where they exert their local radiation that
causes cell death
23. This technique allows for a higher, local
dose of radiation to be used, without
subjecting healthy tissue in the body to
the radiation.
24. Radioembolization is a palliative, not a
curative, treatment-but patients benefit by
extending their lives and improving their
quality of life. It is a relatively new therapy
that has been effective in treating primary
and metastatic liver cancers. It is
performed as an outpatient treatment.
25. TIPS
Portal hypertension condition in which the
normal flow of blood through the liver is
slowed or blocked by scarring (cirrhosis) or
other damage (e.g. hepatitis). Patients with
the condition are at risk of internal bleeding
or other life-threatening complications.
Transjugular intrahepatic portosystemic
shunt (TIPS) formation is a minimally-
invasive treatment to alleviate this impaired
blood flow.
26. Indications
1. Prevention of variceal bleeding
2. Acute bleeding of esophageal varices that is
refractory to medical therapies
3. Esophageal variceal rebleeding
4. Bleeding from gastric varices
5. Prevention of bleeding from portal
hypertensive gastropathy
6. Ascites due to cirrhosis
7. Budd-Chiari syndrome
8. Veno-occlusive diseases
28. Relative contraindications
1. Hepatoma
2. Obstruction of all hepatic veins
3. Portal vein thrombosis
4. Thrombocytopenia of less than
20,000/cm(3)
5. Severe coagulopathy
6. Moderate pulmonary hypertension
29. TIPS
• A catheter is placed in the right
jugular vein
• The catheter is threaded through
the superior and inferior vena cava
to the hepatic vein
• Wall of the hepatic vein is
punctured and the needle is
directed across an approximate 2
inch gap to the portal vein
• Successful passage into the portal
vein is determined by the pattern
of dye injected through the
catheter
30. TIPS
• A guide wire is
threaded through
the needle to
maintain the
passage between
the hepatic and
portal veins
31. TIPS
• A balloon may be used
across the passage to
widen the holes in the
vessel walls and the
passage through the
liver tissue
34. There is a 5-15% incidence of retained stones
after cholecystectomy
Associated with increased risk of recurrent
biliary obstruction, pancreatitis, and cholangitis.
Benign/malignant strictures.
35.
36. ERCP
The diagnostic procedure of choice for
abnormalities of the biliary and pancreatic
ducts offers options of intervention:
Stone extraction
Sphincterotomy
Placement of stents
37. A side viewing endoscope is advanced
into the descending duodenum the papilla
ofVater is identified and cannulated
contrast is injected to visualize the
pancreatic duct and biliary duct systems
38. Causes for ERCP failure include:
Upper GI stricture/stenosis
Complete ductal obstruction limiting
retrograde filling
Postsurgical biliary-enteric fistula
Technical failure
MRCP is an effective alternative when
ERCP is unsuccessful
39.
40.
41. PercutaneousTranshepatic
Cholangiography
Old reliable
Accurate technique for defining the site of
obstruction
Provides option of tissue biopsy and/or
intervention with drain or stent
Has been largely replaced by non-invasive
techniques
42. Indications
Failed ERCP / ERCP not feasible (e.g.
patients with gastrojejunostomy)
Biliary system delineation in presence of
intra and extrahepatic biliary calculi
To identify obstructive cause of jaundice; and
differentiate from medically treatable cause
Anatomic evaluation of complications of
ERCP
Delineating bile leaks
44. Technique
◦ Standard technique:Thin needle puncture in
ninth or tenth intercostal space
◦ Contrast injected during slow withdrawal of
the needle under fluoroscopic guidance
◦ When duct placement confirmed, additional
injection
◦ Films taken in AP, right and left oblique
45.
46. Surgical resection offers potential for cure
but is rarely possible
Palliation alternatives:
1. Surgical bypass
2. Percutaneous drainage
3. Endoscopic or percutaneous stent
placement
47. Three types of drains:External – does not
cross obstruction, drains percutaneously
Internal-external – bile in obstructed
segment enters through the side holes of the
catheter and emerges beyond the
obstruction; the external segment can be
capped
Internal – drains only into enteric system
48.
49. Percutaneous cholecystostomy
Image-guided placement of drainage
catheter into gallbladder lumen.This
minimally invasive procedure can aid
stabilization of a patient to enable a more
measured surgical approach with time for
therapeutic planning.
50. Indications
poor surgical candidate/high risk patients
with acute calculous or acalculous
cholecystitis.
unexplained sepsis in critically ill patients
(Diagnostic for cholecystitis as etiology of
sepsis if clinical improvement after
cholecystostomy).
access to or drainage of biliary tree
following failed ERCP and PTC.
51. Contraindications
Absolute contraindications
usually none
Relative contraindications
bleeding diathesis: all attempts should be
made to correct coagulopathy.
ascites
gallbladder tumor that might be seeded
gallbladder packed with calculi preventing
catheter insertion