iwal reza ahdi

Anat omy
Gal l s t ones( Chol el i t hi asi s)
 4F: Fat Fertile Female of Forty

 Pathogenesis:
1.Metabolic Factor.
2.Stasis of bile.
3.Infective.
 Types of Gallstones: Three types
A.cholesterol stones: composed of cholesterol
solitary, smooth surface
oval/round shape
pale-yellow coloured
Pigment stones: consist of Ca-
bilirubinate

Black /Dark brown

Associated with raised bilirubin production-haemolysis
Small, multiple, soft putty-like-masses.

Mixed stones: Composed of :

Cholesterol.
Bile pigments. In varying proportions

Calcium
EFFECTS AND COMPLICATIONS
OF GALLSTONES
In the gall bladder

silent stone perforation

Ac. Cholecystitis empyema
Chr. Cholecystitis mucocele
Gangrene carcinoma

In the bile duct:

obstructive jaundice
cholangitis
Acute pancreatitis

In the intestine:

Acute intestinal obstruction [gallstone ileus]

CHOLECYSTITIS:
It is an inflammatory condition of the gall bladder.
1. Acute
2. Chronic
(a) Secondary chronic cholecystitis
(b) Primary chronic cholecystitis

ACUTE CHOLECYSTITIS: 90% associated calculi

PATHOLOGY

. Obstruction or stasis
. Chemical irritation
. Bacterial Infection
Cl i ni cal f eat ur es:
Dyspept i c sympt oms.
Ri ght subcost al pai n
Pyr exi a
Jaundi c e

I nvest i gat i on:

Rout i ne bl ood
ECG
USG( upper abdomen)
X- Ray of t he abdomen
chol esci nt i gr aphy

Tr eat ment :
c ons e r vat i ve t r e at ment f ol l o wed by c hol e c ys t e c t omy
Nasogast r i c aspi r at i on and I V f l ui d
admi ni s t r at i on
Anal gesi c s
Br oad spect r u m ant i bi ot i c s

sur gi cal t r eat ment : Chol ecyst ect omy

Chronic
Two variety:Cholecystitis
secondary chronic cholecystitis
primary chronic cholecystitis

Clinical features: vague and insidious in onset

Intolerance to fatty food

Belching
epigastric distension Nausea
and vomiting.
Pain usually follows meal
Investigations:
Blood routine
Oral cholecystography
USG

Treatment:
Cholecystectomy is the definitive treatment
THANK YOU