7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

1/42

OCZXJ CBAFJC\SXLXLSOCZXJ CBAFJC\SXLXLSHT HLFL^ S-TO@^OFHT HLFL^ S-TO@^OF

KS& KOLS& ILCS"ZSO,& IKOS&KS& KOLS& ILCS"ZSO,& IKOS&

Hl~f- Lm Fo~tasca~lc sztgjt|&Hl~f- Lm Fo~tasca~lc sztgjt|&Ijffaw lm Tadaxlc ) Fo~- Cafa+Tjcxof Sztgjt|"eatjo zmly-,Ijffaw lm Tadaxlc ) Fo~- Cafa+Tjcxof Sztgjt|"eatjo zmly-,

CAMSZFXOMX GJM- SZTGJAMCAMSZFXOMX GJM- SZTGJAM

FO^TASCA^LSX ) CAFA^TACXAFAGLSXFO^TASCA^LSX ) CAFA^TACXAFAGLSX

BAM SZTGJAM MAYO KJHLCOF CJMXTJBAM SZTGJAM MAYO KJHLCOF CJMXTJBAM SZTGJAM GAHTJ@ KJKATLOF BAS^LXOFBAM SZTGJAM GAHTJ@ KJKATLOF BAS^LXOF

BAM- OSS ^TAI GTOMX KJH- CAFFJGJBAM- OSS ^TAI GTOMX KJH- CAFFJGJ

BAM-SZTGJAM @@- BAS^LXOFBAM-SZTGJAM @@- BAS^LXOF

JR+OSSX- ^TAI F-X-K-GJM- BAS^LXOFJR+OSSX- ^TAI F-X-K-GJM- BAS^LXOF

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

2/42

OMOXAK\ AI GLXOMOXAK\ AI GLX

IATJGZXIATJGZXKLHGZXKLHGZX

BLMHGZXBLMHGZX

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

HT HLFL^ S-TO@T HLFL^ S-TO@

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

3/42

^OXBA^B\SLAFAG\^OXBA^B\SLAFAG\

ADSXTZCXLAMADSXTZCXLAM

SXOSLSSXOSLS

HLSXJMXLAMHLSXJMXLAM

LMCTJOSJ LM LMXTOFZKLMOF ^TJSSZTJLMCTJOSJ LM LMXTOFZKLMOF ^TJSSZTJ

SXLKZFOXLAM AI LMIFOKOXAT\SXLKZFOXLAM AI LMIFOKOXAT\

KJHLOXATSKJHLOXATSCAKKJMSOFS DJCAKJ YLTZFJMXCAKKJMSOFS DJCAKJ YLTZFJMX

LMIJCXLAMLMIJCXLAM

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX HT HLFL^ S-TO@^OFT HLFL^ S-TO@^OF

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

4/42

YLSCJTOF ^OLMYLSCJTOF ^OLM

HZFF& CTOK^\ AT OCBLMG ^OLM-HZFF& CTOK^\ AT OCBLMG ^OLM-

GJAKJXTLC IATCJS SZCB OSGJAKJXTLC IATCJS SZCB OS

HLSXJMXLAM& SXTJXCBLMG&HLSXJMXLAM& SXTJXCBLMG&XTOCXLAM& CAMXTOCXLAM )XTOCXLAM& CAMXTOCXLAM )CJTXOLM CBJKLCOFS GLYJ TLSJCJTXOLM CBJKLCOFS GLYJ TLSJXA ^OLM-XA ^OLM-

OFWO\S IJFX LM KLHFLMJ-OFWO\S IJFX LM KLHFLMJ-

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX HT HLFL^ S-TO@T HLFL^ S-TO@

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

5/42

HJILMLXLAMHJILMLXLAM

Lmifokkoxlam ai goff dfohhjt lsLmifokkoxlam ai goff dfohhjt ls

coffjhcoffjh

OCZXJ CBAFJC\SXLXLS -OCZXJ CBAFJC\SXLXLS -

HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

6/42

HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

7/42

HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

8/42

LMCLHJMCJMCLHJMCJCAKKAM LM IJTXLFJCAKKAM LM IJTXLFJ

IOXX\IOXX\

ODAYJ IATX\ODAYJ IATX\

IJKOFJSIJKOFJS

HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

9/42

OJXLAFAG\OJXLAFAG\

? COFCZFAZSCOFCZFAZS AdsxtzcxAdsxtzcx c|sxlcc|sxlc hzcxhzcx

4 OCOFCZFAZSOCOFCZFAZS Cbafjsxjtasls"sxtowdjtt| goff dfohhjtCbafjsxjtasls"sxtowdjtt| goff dfohhjt,, Cbafjsxjtaf ~af|~asls ai goff dfohhjtCbafjsxjtaf ~af|~asls ai goff dfohhjt Cbafjc|sxlxls gfomhzfotls ~taflijtomsCbafjc|sxlxls gfomhzfotls ~taflijtoms HlyjtxlczHlyjtxlczfasls ai goff dfohhjtfasls ai goff dfohhjt X|~balh ai goff dfohhjtX|~balh ai goff dfohhjt

HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

10/42

DOCXJTLOF LMIJCXLAMDOCXJTLOF LMIJCXLAM

J+caflJ+cafl EfjdsljffoEfjdsljffo

S-iojcoflsS-iojcofls

SofkamjffoSofkamjffo

Cfasxtlhlo OmojtadjsCfasxtlhlo Omojtadjs

HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

11/42

SJYJTJ LFFMJSSSJYJTJ LFFMJSS

LfjzsLfjzs Sj~slsSj~sls

Sjyjtj dztms!lm`ztljsSjyjtj dztms!lm`ztljs

SxotyoxlamSxotyoxlam

Kzfxl~fj dfaah xtomsizslamsKzfxl~fj dfaah xtomsizslams

COTCLMAKOCOTCLMAKO

HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

12/42

^OXBAFAG\^OXBAFAG\

LMIFOKKOXLAMLMIFOKKOXLAM

FACOFLPOXLAMFACOFLPOXLAM LfjzsLfjzs Kayjkjmx ai akjmxzkKayjkjmx ai akjmxzk

Faa~s ai lmxjsxlmjFaa~s ai lmxjsxlmjTJSAFZXLAMTJSAFZXLAM

JK^\JKOJK^\JKO

KZCACJFJKZCACJFJ

^JTIATOXLAM^JTIATOXLAM GJMJTOFLPJH ^JTLXAMLXLSGJMJTOFLPJH ^JTLXAMLXLS

FACOF ODSCJSSFACOF ODSCJSSILSXZFOILSXZFO

HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

13/42

CFLMLCOF IJOXZTJSCFLMLCOF IJOXZTJS

^OLM^OLM

SLXJSLXJ + TLGBX B\^ACBAMHTLZK+ TLGBX B\^ACBAMHTLZKX\^JX\^J ++ CAFLCE\CAFLCE\AMSJXAMSJX SZHHJMSZHHJMHZTOXLAMHZTOXLAM KATJ XBOM ?4 btsKATJ XBOM ?4 btsTOHLOXLAMTOHLOXLAM

DOCEDOCE SBAZFHJTSBAZFHJT TLGBX B\^ACBAMHTLZKTLGBX B\^ACBAMHTLZK FJIX B\^ACBAMHTLZKFJIX B\^ACBAMHTLZK

HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

14/42

^TJCL^LXOXLMG IOCXATS^TJCL^LXOXLMG IOCXATS Ioxx| IaahIoxx| Iaah

KayjkjmxKayjkjmx DtjoxblmgDtjoxblmg

TJFLJYLMG IOCXATSTJFLJYLMG IOCXATS

OmofgjslcsOmofgjslcs

IJYJTIJYJT

MOZSJO!YAKLXLMGMOZSJO!YAKLXLMGHLSXJMXLAM!CAMSXL^OXLAMHLSXJMXLAM!CAMSXL^OXLAM

@OZMHLCJ@OZMHLCJHT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

15/42

SLGMSSLGMSGJMJTOFGJMJTOF

XOCB\COTHLOXOCB\COTHLO

^\TJRLO^\TJRLO

FACOFFACOF XJMHJTMJSS + TX B\^ACBAMHTLZKXJMHJTMJSS + TX B\^ACBAMHTLZK

TLGLHLX\ + TX B\^ACBAMHTLZKTLGLHLX\ + TX B\^ACBAMHTLZK

KZT^B\KZT^B\S SLGMS SLGM

KOSSKOSS

HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

16/42

LMYJSXLGOXLAMSLMYJSXLGOXLAMS

DFAAH CAK^FJXJ ^LCXZTJDFAAH CAK^FJXJ ^LCXZTJ FJZCAC\XASLSFJZCAC\XASLS

ZTLMJZTLMJ

DLFLTZDLMDLFLTZDLM^FOLM R+TO\ ODHAKJM^FOLM R+TO\ ODHAKJM

Tohlaa~oqzj goff sxamjsTohlaa~oqzj goff sxamjs

ZFXTOSAMAGTO^B\ZFXTOSAMAGTO^B\ Hlfoxoxlam ai dlfflot| xtjjHlfoxoxlam ai dlfflot| xtjj SxamjsSxamjs

IfzlhIfzlhHT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

17/42

GOFF DFOHHJT TOHLAMZCFLHJ SCOMGOFF DFOHHJT TOHLAMZCFLHJ SCOM

ATOF CBAFJC\SXAGTOKATOF CBAFJC\SXAGTOK

^JTCZXOMJAZS XTOMSBJ^OXLC^JTCZXOMJAZS XTOMSBJ^OXLC

CBAFOMGLAGTO^B\ "^XC,CBAFOMGLAGTO^B\ "^XC,

JMHASCA^LC TJXTAGTOHJJMHASCA^LC TJXTAGTOHJ

CBAFOMGLA^OMCTJOXAGTO^B\ "JTC^,CBAFOMGLA^OMCTJOXAGTO^B\ "JTC^,

KOGMJXLC TJSAMOMCJKOGMJXLC TJSAMOMCJ

CBAFOMGLA^OMCTJOXAGTO^B\ "KTC^,CBAFOMGLA^OMCTJOXAGTO^B\ "KTC^,HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

18/42

ODHAKLMOF ZFXTOSAZMH SBAWLMG GOFF SXAMJSODHAKLMOF ZFXTOSAZMH SBAWLMG GOFF SXAMJSHT HLFL^ S-TO@T HLFL^ S-TO@CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

19/42

HLIIJTJMXLOF HLOGMASLSHLIIJTJMXLOF HLOGMASLSCAKKAMCAKKAM

OCZXJ ^OMCTJOXLXLSOCZXJ ^OMCTJOXLXLS

^JTIATOXJH HZAHJMOF ZFCJT^JTIATOXJH HZAHJMOF ZFCJT

^JTIATOXJH ^J^XLC ZFCJT^JTIATOXJH ^J^XLC ZFCJT

O^^JMHLCLXLSO^^JMHLCLXLS

TOTJTOTJ

OCZXJ ^\JFAMJ^BTLXLSOCZXJ ^\JFAMJ^BTLXLSBJ^OXLXLSBJ^OXLXLS

K\ACOTHLOF LMIOTCXLAMK\ACOTHLOF LMIOTCXLAM

^MJZKAMLXLS^MJZKAMLXLS HT HLFL^ S-TO@T HLFL^ S-TO@CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

20/42

CAK^FLCOXLAMSCAK^FLCOXLAMS

JK^\JKOJK^\JKO

^JTIATOXLAM^JTIATOXLAM

^JTLXAMLXLS^JTLXAMLXLS

ODSCJSSODSCJSSILSXZFOILSXZFO

KZCACJFJKZCACJFJ

OCZXJ ^OMCTJOXLXLSOCZXJ ^OMCTJOXLXLSGOFF SXAMJ LFJZSGOFF SXAMJ LFJZS

ADSXTZCXLYJ @OZMHLCJADSXTZCXLYJ @OZMHLCJ

HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

21/42

HjilmlxlamsHjilmlxlams

S|k~xakoxlcS|k~xakoxlc

cbafjflxbloslscbafjflxblosls

Wor!womlmg ~asx~tomhlof j~lgosxtlc!TZ_Wor!womlmg ~asx~tomhlof j~lgosxtlc!TZ_

~olm hzj xa xtomsljmx c|sxlc hzcx adsxtzcxlam~olm hzj xa xtomsljmx c|sxlc hzcx adsxtzcxlamd| sxamj& ma ijyjt!WDC& matkof FIXd| sxamj& ma ijyjt!WDC& matkof FIX

OczxjOczxj

cbafjc|sxlxlscbafjc|sxlxls

Oczxj GD lmifokkoxlam hzj xa c|sxlc hzcxOczxj GD lmifokkoxlam hzj xa c|sxlc hzcx

adsxtzcxlam- ^jtslsxjmx TZ_ ~olm %!+ ijyjt&adsxtzcxlam- ^jtslsxjmx TZ_ ~olm %!+ ijyjt&WDC& FIX& %Kzt~b| WDC& FIX& %Kzt~b| s ; lms~ltoxat| ottjsxs ; lms~ltoxat| ottjsx

HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

22/42

Cbtamlc cbafjc|sxlxls +Tjczttjmx dazxs ai caflc!oczxjCbtamlc cbafjc|sxlxls +Tjczttjmx dazxs ai caflc!oczxjcbaf| fjohlmg xa cbtamlc GD woff lmifokk!ildtasls- Macbaf| fjohlmg xa cbtamlc GD woff lmifokk!ildtasls- Ma

ijyjt!WDC-ijyjt!WDC-

Ocofczfazs cbafjc|sxlxls +GD lmifokkoxlam hzj xa dlflot|Ocofczfazs cbafjc|sxlxls +GD lmifokkoxlam hzj xa dlflot|sxosls":* ai xlkj, omh max sxamjs"* ai ~xs,& com fjoh xa sj~xlc sbace

HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

23/42

Cosj ?Cosj ?

89|a I w TZ_ ~olm r8bt& oixjt o ioxx|89|a I w TZ_ ~olm r8bt& oixjt o ioxx|kjof& tohloxlmg xa xbj T sco~zfo& ofsa wkjof& tohloxlmg xa xbj T sco~zfo& ofsa w

mozsjo- ^x ls ~olm+itjj maw-mozsjo- ^x ls ~olm+itjj maw-

Ma ~tlat j~lsahjsMa ~tlat j~lsahjsKlmlkof TZ_ xjmhjtmjss& ma Kzt~b|sKlmlkof TZ_ xjmhjtmjss& ma Kzt~b|s

WDC 2& FIX matkofWDC 2& FIX matkof

TZ_ Z!S tjyjofs cbafjflxblosls wlxbazx GDTZ_ Z!S tjyjofs cbafjflxblosls wlxbazx GDwoff xblcejmlmg at ~jtlcbafjc|sxlc ifzlhwoff xblcejmlmg at ~jtlcbafjc|sxlc ifzlh

Hlogmasls0 1Hlogmasls0 1HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

24/42

Cosj ?Cosj ?

hjmaxjshjmaxjsgoffsxamjsgoffsxamjs

hjmaxjs xbjhjmaxjs xbjocazsxlcocazsxlcsbohaw hzj xasbohaw hzj xaodsjmcj aiodsjmcj ai

tjifjcxjh sazmhtjifjcxjh sazmhwoyjs djblmhwoyjs djblmhxbj goffsxamjxbj goffsxamj

HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

25/42

S|k~xakoxlc cbafjflxbloslsS|k~xakoxlc cbafjflxblosls

oeo dlflot| caflcoeo dlflot| caflcXbj ~olm acczts hzj xa o sxamjXbj ~olm acczts hzj xa o sxamj

adsxtzcxlmg xbj c|sxlc hzcx& cozslmg woffadsxtzcxlmg xbj c|sxlc hzcx& cozslmg woff

xjmslam5 ~olm tjsafyjs wbjm sxamj ~ossjsxjmslam5 ~olm tjsafyjs wbjm sxamj ~ossjs^olm zszoff| fosxs ?+: bts& totjf| = 48bts^olm zszoff| fosxs ?+: bts& totjf| = 48bts

Zfxtosazmh tjyjofs jylhjmcj ox xbj ctlkjZfxtosazmh tjyjofs jylhjmcj ox xbj ctlkj

scjmj ai xbj flejf| jxlafag|0 goffsxamjsscjmj ai xbj flejf| jxlafag|0 goffsxamjsJrok& WDC& omh FIX matkof lm xbls cosjJrok& WDC& omh FIX matkof lm xbls cosj

Xtjoxkjmx0 Fo~otasca~lcXtjoxkjmx0 Fo~otasca~lc

cbafjc|sxjcxak|cbafjc|sxjcxak| HT HLFL^ S-TO@T HLFL^ S-TO@CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

26/42

S~jcxtzk ai Goffsxamj HlsjosjS~jcxtzk ai Goffsxamj Hlsjosj

Cbafjflxblosls

Os|k~xakoxlc

cbafjflxblosls

S|k~xakoxlc

cbafjflxblosls

Cbtamlc

cofczfazs

cbafjc|sxlxls

Oczxj

cofczfazs

cbafjc|sxlxls

S|k~xakoxlcS|k~xakoxlc

cbafjflxbloslscbafjflxblosls

com dj o bjtofhcom dj o bjtofh

xa0xa0 om oxxoce aiom oxxoce ai

oczxjoczxj

cbafjc|sxlxlscbafjc|sxlxls

at amgalmgat amgalmgcbtamlccbtamlc

cbafjc|sxlxlscbafjc|sxlxls

Ko| ofsa tjsafyjKo| ofsa tjsafyj

HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

27/42

Cosj 4Cosj 4

Sokj cosj& jrcj~x ~x bos bohSokj cosj& jrcj~x ~x bos boh

kzfxl~fj ~tlat oxxoces ai slklfot TZ_kzfxl~fj ~tlat oxxoces ai slklfot TZ_

~olm~olm

Ma ijyjt at WDCMa ijyjt at WDC

Zfxtosazmh tjyjofs goffsxamjs&Zfxtosazmh tjyjofs goffsxamjs&

xblcejmjh GD woff& ma ~jtlcbafjc|sxlcxblcejmjh GD woff& ma ~jtlcbafjc|sxlc

ifzlhifzlh

Hlogmasls0 1Hlogmasls0 1HT HLFL^ S-TO@T HLFL^ S-TO@

CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

28/42

Cbtamlc cofczfazs cbafjc|sxlxlsCbtamlc cofczfazs cbafjc|sxlxls

Tjczttjmx lmifokkoxat| ~tacjss hzjTjczttjmx lmifokkoxat| ~tacjss hzj

xa tjczttjmx c|sxlc hzcx adsxtzcxlam&xa tjczttjmx c|sxlc hzcx adsxtzcxlam&

* ai xbj xlkj hzj xa goffsxamjs* ai xbj xlkj hzj xa goffsxamjs

Ayjtxlkj& fjohs xa scottlmg!woffAyjtxlkj& fjohs xa scottlmg!woff

xblcejmlmgxblcejmlmg

Xtjoxkjmx0 fo~otasca~lcXtjoxkjmx0 fo~otasca~lc

cbafjc|sxjcxak|cbafjc|sxjcxak|

HT HLFL^ S-TO@T HLFL^ S-TO@CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

29/42

Cosj 3Cosj 3

Sokj ~x& maw = 48bts ai TZ_ ~olmSokj ~x& maw = 48bts ai TZ_ ~olmtohloxlmg xa xbj T sco~zfo& sxotxjh oixjttohloxlmg xa xbj T sco~zfo& sxotxjh oixjt

ioxx| kjof& o!w mozsjo& yaklxlmg& ijyjtioxx| kjof& o!w mozsjo& yaklxlmg& ijyjt

Jrok0 ^of~odfj& xjmhjt goffdfohhjt&Jrok0 ^of~odfj& xjmhjt goffdfohhjt&

gzothlmg& %Kzt~b|s ; lms~ltoxat| ottjsxgzothlmg& %Kzt~b|s ; lms~ltoxat| ottjsx

WDC ?3& KlfhWDC ?3& Klfh FIXFIX

Z!S0 goffsxamjs& woff xblcejmlmg "=8kk,&Z!S0 goffsxamjs& woff xblcejmlmg "=8kk,&

GD hlsxjmslam& ~jtlcbafjc|sxlc ifzlh&GD hlsxjmslam& ~jtlcbafjc|sxlc ifzlh&samagto~blc Kzt~b|s slgm "yjt| s~jclilc,samagto~blc Kzt~b|s slgm "yjt| s~jclilc,

Hlogmasls0 1Hlogmasls0 1

HT HLFL^ S-TO@T HLFL^ S-TO@CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

30/42

Cosj 3Cosj 3

Cztyjh ottawCztyjh ottaw Xwa skoff sxamjs oxXwa skoff sxamjs oxGD mjceGD mjce

Sxtolgbx ottawSxtolgbx ottaw Xblcejmjh GD woffXblcejmjh GD woff

~jtlcbafjc|sxlc ifzlh~jtlcbafjc|sxlc ifzlh

; hote flmlmg; hote flmlmg

azxslhj xbj woffazxslhj xbj woff

HT HLFL^ S-TO@T HLFL^ S-TO@CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

31/42

Cosj 3Cosj 3

hjmaxjs xbjhjmaxjs xbj

GD woffGD woff

xblcejmlmgxblcejmlmg

hjmaxjs xbjhjmaxjs xbj

ifzlh otazmh xbjifzlh otazmh xbj

GDGD

GD ofsa o~~jotsGD ofsa o~~jots

hlsxjmhjhhlsxjmhjh

HT HLFL^ S-TO@T HLFL^ S-TO@CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

32/42

Oczxj cofczfazs cbafjc|sxlxlsOczxj cofczfazs cbafjc|sxlxls

^jtslsxjmx c|sxlc hzcx adsxtzcxlam^jtslsxjmx c|sxlc hzcx adsxtzcxlam fjohs xafjohs xaGD hlsxjmslam& woff lmifokkoxlam )jhjkoGD hlsxjmslam& woff lmifokkoxlam )jhjko

Com fjoh xa0jk~|jko& gomgtjmj& tz~xztjCom fjoh xa0jk~|jko& gomgtjmj& tz~xztj

^olm zsz- ~jtslsxs =48bts ) o!w^olm zsz- ~jtslsxs =48bts ) o!wM!Y!IjyjtM!Y!Ijyjt

^of~odfj!xjmhjt at jyjm^of~odfj!xjmhjt at jyjm ylsldfjylsldfj TZ_ kossTZ_ koss

MzcfjotMzcfjot BLHOBLHO scom sbaws mamilflmg ai GDscom sbaws mamilflmg ai GD Li Z!S mam+hlogmasxlc& adxolmLi Z!S mam+hlogmasxlc& adxolm BLHOBLHO

XrXr0 M^A& LYI& Odr "GMT ) jmxjtacacczs,0 M^A& LYI& Odr "GMT ) jmxjtacacczs,

S 0 Cbafjc sxjcxak zsz wlxblm 82btsSg0 Cbafjc|sxjcxak| zsz wlxblm 82btsHT HLFL^ S-TO@T HLFL^ S-TO@

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

33/42

Cosj 8Cosj 8

27|a K ctlxlcoff| lff& am famg+xjtk27|a K ctlxlcoff| lff& am famg+xjtk

X^M w TZ_ ~olm& ijyjt&X^M w TZ_ ~olm& ijyjt& WDCWDC

Zfxtosazmh0 GD woff xblcejmlmg&Zfxtosazmh0 GD woff xblcejmlmg&

~jtlcbafjc|sxlc ifzlh&~jtlcbafjc|sxlc ifzlh& ma goffsxamjsma goffsxamjs

Hlogmasls0 1Hlogmasls0 1

HT HLFL^ S-TO@T HLFL^ S-TO@CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

34/42

Oczxj ocofczfazs cbafjc|sxlxlsOczxj ocofczfazs cbafjc|sxlxls

Lm :+?>* ai cosjs ai oczxj cbafjc|sxlxlsLm :+?>* ai cosjs ai oczxj cbafjc|sxlxlsSjjm lm ctlxlcoff| lff ~xs at ~tafamgjh X^MSjjm lm ctlxlcoff| lff ~xs at ~tafamgjh X^M

Katj flejf| xa ~tagtjss xa gomgtjmj&Katj flejf| xa ~tagtjss xa gomgtjmj&

jk~|jko& ~jtiatoxlam hzj xa lscbjklojk~|jko& ~jtiatoxlam hzj xa lscbjkloCozsjh d| goffdfohhjt sxosls itak foce aiCozsjh d| goffdfohhjt sxosls itak foce ai

jmxjtof sxlkzfoxlam d| cbafjc|sxaelmlmjmxjtof sxlkzfoxlam d| cbafjc|sxaelmlm

XrXr0 Jkjtgjmx cbafjc|sxjcxak|0 Jkjtgjmx cbafjc|sxjcxak| zszzsz a~jma~jm

Li ~x ls xaa slce& ~jtc cbafjc|sxasxak|Li ~x ls xaa slce& ~jtc cbafjc|sxasxak|

xzdj omh lmxjtyof cbafjc|sxjcxak| foxjtxzdj omh lmxjtyof cbafjc|sxjcxak| foxjt

amam HT HLFL^ S-TO@T HLFL^ S-TO@CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

35/42

Cak~flcoxlams ai oczxj cbafjc|sxlxlsCak~flcoxlams ai oczxj cbafjc|sxlxls

Jk~|jko aiJk~|jko ai

goffdfohhjtgoffdfohhjt

^zs+ilffjh GD hzj xa docxjtlof ~taflijtoxlam^zs+ilffjh GD hzj xa docxjtlof ~taflijtoxlam

lm adsxtzcxjh GD- Zsz-lm adsxtzcxjh GD- Zsz- katj xarlc& blgbkatj xarlc& blgbijyjtijyjt

Jk~b|sjkoxazsJk~b|sjkoxazs

cbafjc|sxlxlscbafjc|sxlxlsKatj cakkamf| lm kjm omh hlodjxlcs-Katj cakkamf| lm kjm omh hlodjxlcs-

Sjyjtj TZ_ ~olm& gjmjtoflpjh sj~sls-Sjyjtj TZ_ ~olm& gjmjtoflpjh sj~sls-

Lkoglmg sbaws olt lm GD woff at fzkjmLkoglmg sbaws olt lm GD woff at fzkjm

^jtiatoxjh^jtiatoxjh

goffdfohhjtgoffdfohhjtAcczts lm ?>* ai oczxj cbaf|& zszoff|Acczts lm ?>* ai oczxj cbaf|& zszoff|

djcakjs o camxolmjh odscjss lm TZ_djcakjs o camxolmjh odscjss lm TZ_

Fjss cakkamf|& ~jtiatoxjs lmxa oh`ocjmxFjss cakkamf|& ~jtiatoxjs lmxa oh`ocjmx

ylsczs ; cbafjc|sxajmxjtlc ilsxzfo ) xbjylsczs ; cbafjc|sxajmxjtlc ilsxzfo ) xbj

sxamj com cozsj SDA "sxamj com cozsj SDA "goffsxamj lfjzsgoffsxamj lfjzs,,

HT HLFL^ S-TO@T HLFL^ S-TO@CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

36/42

Cosj :Cosj :

89|a I ~!w TZ_ ~olm& `ozmhlcj& ocbaflc89|a I ~!w TZ_ ~olm& `ozmhlcj& ocbaflc

sxaafs& hote xjo+cafatjh ztlmj&sxaafs& hote xjo+cafatjh ztlmj& ma ijyjtsma ijyjts

Emawm blsxat| ai cbafjflxbloslsEmawm blsxat| ai cbafjflxblosls

Jrok0 zmtjkoteodfjJrok0 zmtjkoteodfj

WDC 2& X-Dlfl 2& OSX!OFX MF& Bj~D!C mjgWDC 2& X-Dlfl 2& OSX!OFX MF& Bj~D!C mjg

Zfxtosazmh0 Goffsxamjs& CDH sxamj&Zfxtosazmh0 Goffsxamjs& CDH sxamj&hlfoxjh CDH = ?ckhlfoxjh CDH = ?ck

Hlogmasls0 1Hlogmasls0 1

HT HLFL^ S-TO@T HLFL^ S-TO@CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

37/42

CbafjhacbaflxbloslsCbafjhacbaflxblosls

Com ~tjsjmx slklfotf| xa cbafjflxblosls&Com ~tjsjmx slklfotf| xa cbafjflxblosls&

jrcj~x wlxb xbj ohhlxlam ai `ozmhlcjjrcj~x wlxb xbj ohhlxlam ai `ozmhlcj

HHr0 cbafjflxblosls& bj~oxlxls& scfjtaslmgHHr0 cbafjflxblosls& bj~oxlxls& scfjtaslmg

cbafomglxls& fjss flejf| CO wlxb ~olmcbafomglxls& fjss flejf| CO wlxb ~olmXrXr0 Jmhasca~lc tjxtagtohj0 Jmhasca~lc tjxtagtohj

cbafomgla~omctjoxagto~b| "JTC^,cbafomgla~omctjoxagto~b| "JTC^,

Sxamj jrxtocxlam omh s~blmcxjtaxak|Sxamj jrxtocxlam omh s~blmcxjtaxak|

Lmxjtyof cbafjc|sxjcxak| oixjt tjcayjt|Lmxjtyof cbafjc|sxjcxak| oixjt tjcayjt|

itak JTC^itak JTC^

HT HLFL^ S-TO@T HLFL^ S-TO@CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

38/42

Cosj 9Cosj 9

89|a I ~!w89|a I ~!w ijyjt& TZ_ ~olm& `ozmhlcjijyjt& TZ_ ~olm& `ozmhlcj""Cbotcaxs xtlohCbotcaxs xtloh,,

Li ofsaLi ofsa ofxjtjh kjmxof sxoxzsofxjtjh kjmxof sxoxzs omh slgmsomh slgms

aiaisbacesbace ;; To|mozhs ~jmxohTo|mozhs ~jmxohYS xocb|cothlc& b|~axjmslyjYS xocb|cothlc& b|~axjmslyj

ODCs& TjszsclxoxjODCs& Tjszsclxoxj

4 fotgj datj LY& Iafj|& Camxlmzazs kamlxat4 fotgj datj LY& Iafj|& Camxlmzazs kamlxat ?+4F ifzlh dafzs& tj~jox zmxlf tjszsclxoxjh?+4F ifzlh dafzs& tj~jox zmxlf tjszsclxoxjh

Hlogmasls0 1Hlogmasls0 1

HT HLFL^ S-TO@T HLFL^ S-TO@CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

39/42

CbafomglxlsCbafomglxls

Lmijcxlam ai xbj dlfj hzcxs hzj xa CDHLmijcxlam ai xbj dlfj hzcxs hzj xa CDHadsxtzcxlam 4mhot| xa sxamjs& sxtlcxztjsadsxtzcxlam 4mhot| xa sxamjs& sxtlcxztjs

Cbotcaxs xtloh sjjm lm 7>* ai ~xsCbotcaxs xtloh sjjm lm 7>* ai ~xs

Ko| fjoh xa flij+xbtjoxjmlmg sj~sls omhKo| fjoh xa flij+xbtjoxjmlmg sj~sls omhsj~xlc sbace "sj~xlc sbace "To|mozhs ~jmxohTo|mozhs ~jmxoh,,

XrXr0 M^A& LYI& LY Odr0 M^A& LYI& LY Odr

Jkjtgjmx hjcak~tjsslam ylo JTC^ atJkjtgjmx hjcak~tjsslam ylo JTC^ at~jtc xtomsbj~oxlc cbafomglagtok "^XC,~jtc xtomsbj~oxlc cbafomglagtok "^XC,

Zsjh xa tjqzltj jkjtgjmc| fo~otaxak|Zsjh xa tjqzltj jkjtgjmc| fo~otaxak|

HT HLFL^ S-TO@T HLFL^ S-TO@CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

40/42

Cosj 7Cosj 7

89|a I ~!w ~jtslsxjmx j~lgosxtlc ) doce89|a I ~!w ~jtslsxjmx j~lgosxtlc ) doce

~olm~olm

Emawm blsxat| ai s|k~xakoxlc goffsxamjsEmawm blsxat| ai s|k~xakoxlc goffsxamjs

Ma JxAB odzsjMa JxAB odzsjJrok0 Xjmhjt j~lgosxtzkJrok0 Xjmhjt j~lgosxtzk

Ok|fosj 4>>>& OFX ?:>Ok|fosj 4>>>& OFX ?:>

Zfxtosazmh0 GoffsxamjsZfxtosazmh0 GoffsxamjsHlogmasls0 1Hlogmasls0 1

HT HLFL^ S-TO@T HLFL^ S-TO@CAMSZFXOMX GJM- SZTGJAMAMSZFXOMX GJM- SZTGJAMFO^TASCA^LSX ) CAFA^TACXAFAGLSXO^TASCA^LSX ) CAFA^TACXAFAGLSX

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

41/42

Goffsxamj ~omctjoxlxlsGoffsxamj ~omctjoxlxls

3:* ai oczxj ~omct 4mhot| xa sxamjs3:* ai oczxj ~omct 4mhot| xa sxamjs^oxba~b|slafag|^oxba~b|slafag|

Tjifzr ai dlfj lmxa ~omctjoxlc hzcx omh!atTjifzr ai dlfj lmxa ~omctjoxlc hzcx omh!at

adsxtzcxlam ai ok~zffo d| sxamjadsxtzcxlam ai ok~zffo d| sxamjOFX = ?:> "3+iafh jfjyoxlam, bos "3+iafh jfjyoxlam, bos

7/23/2019 ACUTE CHOLECYSTITIS PPT. DR DILIP S. RAJPAL

42/42

Xoej Bakj ^almxsXoej Bakj ^almxs

Os ofwo|s& ODC ) Tjszsclxoxj djiatj HrOs ofwo|s& ODC ) Tjszsclxoxj djiatj Hr

Zmhjtsxomhlmg xbj hjilmlxlams ls ej|Zmhjtsxomhlmg xbj hjilmlxlams ls ej|Ls xbls oczxj cbafjc|sxlxls1 "ijyjt& WDC&Ls xbls oczxj cbafjc|sxlxls1 "ijyjt& WDC&xjmhjt am jrok wlxb ~aslxlyj Kzt~b|s,xjmhjt am jrok wlxb ~aslxlyj Kzt~b|s,

At slk~f| cbafjflxblosls ys amgalmg cbtamlcAt slk~f| cbafjflxblosls ys amgalmg cbtamlccbafjc|sxlxls1 "ma ijyjt!WDC,cbafjc|sxlxls1 "ma ijyjt!WDC,

Ls ~oxljmx slce at xarlc+o~~jotlmg& xa szs~jcxLs ~oxljmx slce at xarlc+o~~jotlmg& xa szs~jcxjk~|jko& gomgtjmj at jyjm ~jtiatoxlam1jk~|jko& gomgtjmj at jyjm ~jtiatoxlam1

Jflclx b!a `ozmhlcj& ocbaflc sxaafs& xjo+cafatjhJflclx b!a `ozmhlcj& ocbaflc sxaafs& xjo+cafatjhztlmjztlmj

Tzfj azx cbafomglxls& djcozsj xbls wlff elff xbjTzfj azx cbafomglxls& djcozsj xbls wlff elff xbj~oxljmx zmfjss hr ) xr jotf|~oxljmx zmfjss hr ) xr jotf|