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Cholelithiasis Finalyearlecture 140511003220 Phpapp01 PDF
Cholelithiasis Finalyearlecture 140511003220 Phpapp01 PDF
•• In
20%
Asiaare
Cholesterol
80% PigmentStones.
Stones.
• 5% are Pigment Stones.
• In Europe 80% Cholesterol Stones.
• 75% are Mixed… … …
Risk Factors
• BIG 4..?
1. Female.
2. Forty.
3. Fertile.
4. Fatty.
Risk Factors
• Pregnancy.
• OCP.
• Hemolytic Anemia.
• Cirrhosis.
• Infection.
• IBD/Terminal Ileal Resection.
• TPN.
• Hyperlipidemia.
Pathogenesis
• Excess secretion of Cholesterol in Bile.
• Excess Mucous Production.
• Non-Functioning Gallbladder.
• Stasis in Gallbladder.
Pathological Effects
1. Silent Gallstones.
2. Obstruction of the Cystic Duct.
3. Movement of Stone into CBD.
4. Ulceration of Stone through Gallbladder
Wall.
Clinical Presentation
1. Biliary Colic.
2. Acute Cholecystitis.
3. Chronic Cholecystitis.
4. Gallstone Pancreatitis.
5. Obstructive Jaundice.
6. Acute Cholangitis.
7. Gallstone Ileus.
8. Mucocele / Empyema of the Gallbladder.
1. Biliary Colic
• Episodic Pain in RHC / Epigastrium.
• Pain Radiates to Lower Pole of Right Scapula.
• Sweaty, Nauseous, Vomiting Patient.
• Intermittent Jaundice with Pale Stool & Dark Urine.
• Differential Diagnosis:
– Renal Colic.
– Intestinal Obstruction.
– Angina.
• Differential Diagnosis:
– Peptic Ulcer.
– Hiatus Hernia.
– Angina.
Gallstone Pancreatitis
• Due to Transient Blocking of Ampulla of Vater by
Stone.
• Courvoisier’s Law..?????
Acute Cholangitis
•CAUSE … ? Triad … ?
Charcot’s
• Infection
1. Pain. of Bile In the Biliary Tree…
2. Fever.
3. Jaundice.
• Predisposing Factors;
– Stone in CBD.
– Biliary Stricture.
– Post – ERCP.
– Post – Biliary Reconstructive Procedure.
• Treat by;
– Drip & Suck.
– Urgent Laparatomy.
Cholecysto-Enteric Fistula LEFT UNTIL ACUTE EPISODE IS OVER.
Investigations (for Gallstones)
• Ultrasound.
• LFTs.
• ERCP / MRCP.
• AXR.
• CT Scan
Ultrasound Pictures
Ultrasound
ERCP
MRCP
CT SCAN
Treatment
• Conservative Management for Acute
Cholecystectomy.
• Laparoscopic Cholecystectomy.
• Open Cholecystectomy.
• Cholecystostomy.
• Medical Treatment;
– Chenodeoxycholic Acid.
Acute Cholecystitis
• Principles of Management:
– Admission to Hospital.
– Pain Relief.
– NPO.
– IV Fluids.
– Broad Spectrum Antibiotics.
– Elective / Emergency Cholecystectomy.
Laparoscopic Cholecystectomy
• Preoperatively;
– U/S + LFT + Clotting Screen.
– Exclude Peptic Ulcer & Hiatal Hernia.
– Encourage Weight Loss & Smoking Cessation.
– Consent.
• Ports;
– 3 or 4 Ports.
• Closure.
• Postoperatively;
– Orally Allowed when fully recovered.
– Home in 24hrs when Pain-Free.
• Complications;
THANK YOU . . . !