Universidad de GuadalajaraCentro Universitario de Ciencias de la Salud

Departamento de Clínicas Quirúrgicas

Bile duct injuries

Gallbladder and biliary tract diseases

Dr. Benjamín Robles MariscalDr. Héctor Manuel Virgen AyalaBeatriz Tonántzin Gómez Fierro

Bile duct injuries

Gallbladder

Tx: Cholecystectomy

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1514483/

Extrahepatic bile ducts

Laparoscopic cholecystectomy

Signs and Symptoms

Ascitis

Jaundice

Right upper quadrant tenderness

Cholangitis

Alkaline phosphatase

Bilirrubin <10mg/dl

Positive hemocultive Acute cholangitis

Diagnosis

Ultrasonography

CT

THC

ERCP

Treatment

Mortality

5%

Gallstone disease

Risk Factors

ObesityPregnancyDietCrohn's diseaseThalassemiaHereditary spherocytosisGastric surgery

3:1

Cholesterol

gallstones

Pigment gallstones

Gallstone formation

Chronic cholecystitisMost common form of gallbladder disease

Chronic cholecystitis almost always results from gallstones and prior episodes of acute cholecystitis

Biliary colic

Upper abdominal tenderness

Food intolerance

Dyspepsia

Sickness

Signs and Symptoms

UltrasonographyCholecystography

DissolutionLithotripsy and dissolution therapyCholecystectomy

Diagnosis

Treatment

Mortality 0.1-0.5%

Acute cholecystitis

90- 95% Gallstones

<1% Tumor

The gallbladder wall becomes thick and red with bleeding

subserosa

LeukocytosisBilirrubin (2-4mg/dl) Alkaline phosphatase Amilase

Signs and Symptoms

80% Chronic cholecystitis

Biliary colic

Upper abdominal tenderness

Fever

Sickness

Vomit

Murphy's sign

• Ultrasonography• HIDA

Diagnosis

Sonographic Murphy's sign

Complications

Empyema

Perforation

* Pericholecystic abscess

* Free perforation of gallbladder

* Cholecystoenteric Fistulas

Gallstone ileus

- Pericholecystitis and small abscess

- Cholelithiasis and a perforated gallbladder wall

- Pericholecystitis abscess

IV fluid administration

Antibiotic

Elective laparoscopic cholecystectomy

Treatment

Mortality

5%

Emphysematous cholecystitis

3:1 20% Diabetes

ClostridiumE. Coli

Anaerobic Streptococcus

Biliary colic

Upper abdominal tenderness

Fever

Leukocytosis

Lump

Signs and Symptoms

Rx

CT

Diagnosis

Treatment

Antibiotics

Cholecystectomy

Cholangitis

Causes

Choledocholithiasis

Biliary stricture

Neoplasia

Chronic pancreatitis

Duodenal diverticulum

Ampullary stenosis

Congenital cyst

E. ColiKlebsiella

Pseudomonas

EnterococcusProteus

Bacteroides fragilis

Signs and Symptoms

Charcot's triad

Reynolds' pentad

Fever

Abdominal pain

Jaundice

Fever

Pain

Jaundice

Altered mental state

Hypotension

Leukocytosis Bilirrubin Alkaline phosphatase Transaminases

DiagnosisUltrasonography

ERCP

THC

Treatment

Antibiotics

Fluid administration

Endoscopic sphincterotomyMortality

5%

Choledocholithiasis

6-15% gallstones Incidence age

2 origins

1 cholesterol

2 pigment

Signs and Symptoms

50% Asyntomatic

Toxic cholangitis

Biliary colic

Jaundice

Pancreatitis

Fever

Chills

Upper abdominal tenderness

LeukocytosisBilirrubin (2-4mg/dl) Alkaline phosphatase Transaminases

DiagnosisUltrasonography

Magnetic resonance cholangiography

Endoscopic cholangiography

Treatment

Endoscopic sphincterotomy

Laparoscopic cholecystectomy

Bibliography

Schwartz. Principios de cirugía. Mc Graw Hill. Vol I. 8º edición. Houston, Texas. P. 1194-1213.

M. Doherty, G. Diagnóstico y tratamiento quirúrgicos. Mc Graw Hall. LANGE. 13º edición. México, D.F. 2011. P. 475-489.

Lick, R. F. Atlas de patología quirúrgica. HARLA. México, D.F. 1981. P. 206-217.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1514483/

http://www.ultrasoundcases.info/Slide-View.aspx?cat=166&case=4072