Diseases of Gall Bladder & Bile Ducts

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    Diseases of GB & bile ducts

    A surgical overview

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    Specimen 1

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    Gall stones

    Pigment

    Cholesterol

    Mixed

    Primary

    Secondary

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    Pathogenesis

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    Pathological effect

    On the GB

    On the CBD

    On the liver On the intestine

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    Specimen 2

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    Cholesterol stone

    Demographic/genetic factors

    Obesity

    Female sex hormones Increasing age

    Gallbladder hypomotility

    High-fat diet

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    Specimen 3

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    Pigment stone

    Demographic/genetic factors: Asia, rural

    setting

    Chronic hemolysis

    Chronic biliary tract infection, parasite

    infections

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    Diagnosis

    USG of upper abdomen

    CT scan

    ERCP MRCP

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    USG of GB

    Advantages

    Rapid

    Accurate identification ofgallstones (>95%)

    Simultaneous scanning of GB,liver, bile ducts, pancreas

    "Real-time" scanning allowsassessment of GB volume,contractility

    Not limited by jaundice,pregnancy

    May detect very small stones

    Limitations

    Bowel gas

    Massive obesity

    Ascites

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    St X ray abdomen

    Advantages

    Low cost

    Readily available

    Disadvantages

    Relatively low yield

    ? Contraindicated in

    pregnancy

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    CT scan

    Advantages

    Simultaneous scanning ofGB, liver, bile ducts,pancreas

    Accurate identification ofdilated bile ducts, masses

    Not limited by jaundice, gas,obesity, ascites

    High-resolution image Guidance for fine-needle

    biopsy

    Limitation

    Extreme cachexia

    Movement artifact

    Ileus

    Partial bile duct obstruction

    Pregnancy

    Reaction to iodinated

    contrast, if used

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    ERCP

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    MRCP

    Advantages

    Useful modality forvisualizing pancreatic andbiliary ducts

    Has excellent sensitivity forbile duct dilatation, biliarystricture, and intraductalabnormalities

    Can identify pancreatic ductdilatation or stricture,pancreatic duct stenosis,and pancreas divisum

    Disadvantages

    Cannot offer therapeutic

    intervention

    High cost Claustrophobia

    Certain metals - cardiac

    pacing

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    Imaging of GB & bile ducts

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    Specimen 4

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    Cholecystitis

    Acute

    Chronic

    Calculous

    Acalculous

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    Acute cholecystitis

    History Pain in RUQ with typical nature & radiation

    Nausea & Vomiting

    Fever O/E

    Tachycardia

    Jaundice

    Tenderness +/- lump in RUQ

    Lab Inv Leukocytosis

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    Cholecystectomy

    Gall bladder-stones.flv

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    HP of chronic cholecystitis

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    Cholangitis

    Causes

    PresentationCharcots triad

    Sequele

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    Specimen 5

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    Things to remember

    Gall stones types, effects, treatment

    Acute cholecystitis

    Chronic cholecystitis

    Empyema

    Mucocele

    CBD stone

    Radiological diagnostic methods

    Cholesterosis

    D/D of pain in right upper abdomen