GALLBLADDER.ppt

8/18/2019 GALLBLADDER.ppt

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GALLBLADDER Pear shape sac 7-10 cm long with an average capacity

of 0-!0 ml Divi"e" into # anatomic areas$ the f%n"%s& the

corp%s'(o"y)& inf%n"i(%l%m an" the nec*+ Bloo" s%pply$ cystic artery- (ranch of the right hepatic

artery',0) .he co%rse of cystic artery may vary& (%t it nearly

always is fo%n" within the hepatocystic triangle(o%n"e" (y cystic "%ct& common hepatic "%ct an" theliver margin+

/ain f%nction is to concentrate an" store hepatic (ilean" "eliver (ile into the "%o"en%m in response to meal+


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.E BLE D23.4 .he e5trahepatic "%cts consist of the right

an" left hepatic "%cts& common hepatic "%ct&the cystic "%ct& an" the common (ile "%ct+

.he common hepatic "%ct is 1-# cm in lengthan" has a "iameter of appro5imately # mm+

t lies in front of the portal vein an" to theright hepatic artery+

.he common hepatic "%ct is 6oine" at an

ac%te angle (y the cystic "%ct to form thecommon (ile "%ct+ .he common (ile "%ct is a(o%t 7-11 cm in

length an" !-10 mm in "iameter+


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BLE 8R/A.89 A9D 38/P84.89 .he normal a"%lt cons%ming an average "iet pro"%ces

within the liver !00-1000 ml of (ile per "ay+ .hesecretion of (ile is responsive to ne%rogenic& h%moral&an" chemical stim%li+

Bile is mainly compose" of water& electrolytes (ile salts&proteins& lipi" an" (ile pigments

.he primary (ile salts$ cholate an" cheno"eo5ycholate &are synthesi:e" in the liver from cholesterol& con6%gate"with ta%rine an" glycine& an" act within the (ile as

anions that are (alance" (y so"i%m+ ;0 of con6%gate" (ile aci"s are a"sor(e" in the

terminal ile%m an" the remain"er (y the g%t (acteria ! is e5crete" in the stool+


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DAG984.3 4.2DE4 Bloo" test$ complete (loo" co%nt an" liver f%nction test 2ltrasonography$ non invasive& painless an" "oes not

s%(mit patient to ra"iation+ 8ral cholecystography Biliary ra"ion%cli"e scanning'DA 4can) $ provi"es a non

invasive eval%ation of the liver& gall(la""er& (ile "%cts&an" "%o"en%m with (oth anatomical an" f%nctionalinformation+

3omp%te" tomography$ "e


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GALL4.89E D4EA4E

8ne of the most common pro(lema=ecting the "igestive tract

Prevalence$ age& gen"er an" ethnic(ac*gro%n"+

Ris* factors$ o(esity& pregnancy& "ietaryfactors with women more a=ecte" thanmen& an"


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GALL4.89E 8R/A.89 Gallstone form as a res%lt of soli"s settling in a sol%tion+ .he

ma6or organic sol%tes in (ile are (ilir%(in& (ile salts&phospolipi"s an" cholesterol+

3lassi


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4/P.8/A.3 GALL4.89E4 3hronic cholecystitis- a(o%t @ of patient with

gallstone "isease present with chroniccholecystitis characteri:e" (y rec%rrent attac*s of

pain 3linical presentation$ chief symptom is pain which

"evelops when stone o(str%ct the cystic "%ctwhich is constant an" increases in severity overthe


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Ac%te cholecystitis$ secon"ary to gallstone in,0-,! of cases& in >1& it is ca%se" (y t%moro(str%cting the cystic "%ct+

3linical manifestation$ patient often complainof pain in the right %pper ?%a"rant area orepigastri%m& fever&anore5ia&na%sea& vomiting+

/il" to mo"erate le%*ocytosis+

Diagnosis$ %ltrasonography is the most %sef%lra"iologic test

/anagement$ cholecystectomy


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3hole"ocholithiasis$ common (ile "%ct stones may (e small or large& singleor m%ltiple an" are fo%n" in C-1@ of patients with stones in the gall(la""er+

/a6ority of "%ctal stones are forme" within the gall(la""er an" migrate"own the cystic "%ct to the common (ile "%ct+

En"oscopic cholangiography is the gol" stan"ar" for "iagnosing common

(ile "%ct stones with "istinct a"vantage of provi"ing a therape%tic option atthe time of "iagnosis+ .reatment$ or patients with symptomatic gallstones an" s%specte" 3BD

stones& either preoperative en"oscopic cholangiography or anintraoperative cholangiogram will "oc%ment the (ile "%ct stones+

Retaine" or rec%rrent stones following cholecystectomy are (est treate"en"oscopically

4tones "iagnose" shortly after cholecystectomy are classi


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3holangitis$ is an ascen"ing (acterial infection in association withpartial or complete o(str%ction of the (ile "%cts+

Gallstones are the most common ca%se of o(str%ction incholangitis an" the most common organisms c%lt%re" incl%"e$E+coli& *le(siella& 4trep+ pne%moniae an" B+ fragilis+

3linical presentation$ fever& epigastric or right %pper ?%a"rantpain an" 6a%n"ice& a classic symptoms *nown as charcots tria"present in a(o%t @ of patients an" may progress with septicemiaan" "isorientation *nown as Reynol"s penta"+

Diagnosis an" management$ Le%*ocytosis& hyper(ilir%(inemia an"elevation of al*aline phosphatase an" transaminase are common+

.he initial treatment incl%"es anti(iotics an" %i" ress%citationan" patients may re?%ire 32 monitoring an" vasopressor s%pport+

Bilary "ecompression may (e accomplishe" en"oscopically viaperc%taneo%s transhepatic ro%te or s%rgically+

mortality rate is appro5imately !+


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3holangiohepatitis$ also *nown asrec%rrent pyogenic cholangitis+

A=ects (oth se5es e?%ally an" occ%rs inmost fre?%ently in the r" an" #th "eca"esof life an" is ca%se" (y (acterialcontamination of the (iliary tree&an"often is associate" with (iliary parasites+

Patients %s%ally presents with pain in theright %pper ?%a"rant an" epigastri%m&fever an" 6a%n"ice+


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8PERA.E 9.ERE9.894

3holecystostomy$ "ecompresses an" "rains the"isten"e"& inamme"& hy"ropic& or p%r%lent GB+ tis applica(le if patients is not

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GALLBLADDER.ppt