gall bladder disease dr suleiman jastaniah,frcs (ed),facs,associted prof.umm-alqura university

GALL BLADDER DISEASE

Dr Suleiman Jastaniah,FRCS (Ed),FACS,Associted Prof.Umm-

Alqura university.

ANATOMY:

PHYSIOLOGY : -Concentrate bile by absorption of water and sodium. -CCK-------Gall.b.emptying. -Vagal stimulation.

DIAGNOSIS : *Plain Abdominal X-Ray. *Oral cholecystography : >Radio-opaque dye >It is +ve if it shows : a. Filling defect b.Non functioning G.B

*U/S*CT SCAN

GALL STONE : >Common problem all over the world . >Mixed. >Cholestrol. >Pigmented.

CLINICAL MANIFISTATIONS :.GALLBLADDER STONE : 1.Asymptomatic. 2.Biliary Colic. 3.A.Cholecystitis> *Gangrene. *Perforation. *Empyema. 4.Ch.Cholecystitis.

5.Mucocele. 6.Intestinal obstruction. Gallstone Ileus. 7.Carcinoma.

Common Bile Duct Stones :

>Obstructive Jaundice.

>A.Cholangitis.

>Acute Pancreatitis.

MANAGEMENT : 1.Open Cholecystectomy.

2.Laproscopic Cholecystectomy.

3.Cholecystostomy—ill patient.

*In Acute Cholecystitis.

C.B.D. STONE : -Primary (Denovo) -Secondary (common ).*Diagnosis : *L.F.T *PT,APPT. *U/S. *ERCP. *MRCP.>HOW do you prepare obstructive jaundice

patient?

MANAGEMENT OF C.B.D.STONES : -ERCP -Exploration of C.B.D. - Biliary enteric anastomasis. -Retained Stones : *Extraction through T-tube. *Percutanously via transhepatic route. *Dissolution by solvent. *ESWL. *Surgery.

COMPLICATIONS OF CHOLECYSTOCTOMY:

1.Bleeding.

2.C.B.D. injury.

3.Stricture.

4.Postcholecystectomy syndrome.

COMPLICATIONS ASSOCIATED WITH OBSTUCTIVE JAUNDICE :1.Cholengitis.2.Disorders of Clotting Factors.3.Renal Failure.4.Liver Failure.5.Fluid and electrolyte disorders.

Char cot's triad :

-Fever.-Jaundice.-Rt.upper quadrant pain.*Reynolds Pentad -Septic shock -Mental status changes