Fwd: Jaundice
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Transcript of Fwd: Jaundice
Pre-hepatic
Hepatic
Post hepatic ( surgical/obstructive )
Causes:
Lumen
Wall
Outside wall
Investigations:
Laboratory tests
Imaging investigations
Special tests
Laboratory Tests:
Liver biochemical tests: bilirubin alk phosphatase GGT AST ALT Serology Autoantibody screen Tumour markers Coagulation screen
Imaging investigations:
Ultrasound EUS CT scan ERCP MRCP PTC
Types of Gallstone:
Cholesterol
Mixed
Pigment
Appearance of gallstones
Appearance of gallstones
Pathogenesis of Gallstones: Lithogenic Bile
Stasis
Nucleating Factors
Lithogenic Bile: Cholesterol Synthesis in Liver Cholesterol/Bile Salt ratio 7 alpha hydoxylase HMG co-enzyme reductase
Components of bile
Stasis:
Vagotomy
Pregnancy
Nucleating Factors:
Mucus Glycoproteins
Desquamated Epithelia
Foreign Bodies
Cholesterol gallstone pathogenesis
Clinical Presentations: Silent 70% Mechanical Impaction Cystic Duct Biliary Colic CBD Jaundice Cholangitis Inflammation Acute Cholecystitis Chronic Cholecystitis Acute Pancreatitis Ulceration/Fistula Formation Carcinoma
Investigation of Gallstones:
Ultrasound Oral Cholecystogram Cholangiography Endoscopic Retrograde Peroperative MRCP HIDA Scan
Gallstones and biliary sludge
Several noninvasive imaging modalities currently available
Endoscopic retrograde cholangiopancreatography
Endoscopic retrograde cholangiopancreatography
Per-operative cholangiopancreatography
Management:
Asymptomatic
Symptomatic
Endoscopic view of sphincterotomy and basket extraction (a)
Endoscopic view of sphincterotomy and basket extraction (b)
Endoscopic view of sphincterotomy and basket extraction (c)
Balloon dilation of the papilla and stone extraction (d)
Operating room setup for laparoscopic cholecystectomy
Laparoscopic cholecystectomies and pneumoperitoneum
4 laparoscopic ports during laparoscopic cholecystectomy