THE BREAST Dr.JAMIL SAWAKED. LATISSIMUS DORSI TERES MAJOR SERRATUS ANTER ANATOMY.
OBSTRUCTIVE JAUNDICE DR.JAMIL SAWAKED. DEFITION OF JAUNDICE YELLOW DISCOLOURATION OF SKIN AND MUCOUS...
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Transcript of OBSTRUCTIVE JAUNDICE DR.JAMIL SAWAKED. DEFITION OF JAUNDICE YELLOW DISCOLOURATION OF SKIN AND MUCOUS...
OBSTRUCTIVE JAUNDICE
DR.JAMIL SAWAKED
DEFITION OF JAUNDICE
YELLOW DISCOLOURATION OF SKIN AND MUCOUS MEMBRANE
TYPES
A PREHEPATIC
HEPATIC
POSTHEPATIC
HAEMOLYSIS
OBSTRUCTIVE OR SURGICAL
ANATOMY
ANATOMY
A
BILIRUBIN CYCLE
BROKEN DOWN RED CELLS ARE REMOVED BY R.E.S. HAEMOGLOBIN SPLITS INTO HAEM
&GLOBIN GLOBIN & CELL WALL PROTEIN GO
DOWN TO AMINOACIDS THEY ENTER THE AMINO ACID
POOL
BILIRUBIN CYCLE CONTINUE
HAEM SPLITS INTO IRON & BILIRUBIN [pigments]
IRON STORED AS FERRITIN FOR
REUSE
BILIRUBIN IS NOT REUSED
[GOES TO THE LIVER] COMBINE WITH GLUCOURINC ACID
TO FORM THE CONJUGATED [ DIRECT ]
BILIRUBIN [ WATER SOLUBLE ]
Van den Bergh reaction [DIRECT]
Alcohol added after van den Gergh [INDIRECT]
HAEMOGLOBIN
+RBC WALL PROTEIN
AMINOACIDS
AMINOACID
POOL
IRON
BILIRUBIN
WATER INSOLUBLE
GOES TO THE LIVER FOR CONGUGATION WITH GLUCOURINIC A.TO BECOME
WATER SOLUBLE
FERRITIN
TO BE REUSED
BLOOD
URINE
URINE IN OBSTRUCTIVE JAUNDICE TEA COLOUR
BILIRUBIN CYCLE
DEEP JAUNDICE [OBSTRUCTIVE]
CAUSES OF OBSTRUCTIVE JAUNDICE
1-STONES 2-STRICTURES; [BENIGN] 3-CA. HEAD OF THE PANCREASE 4-CHOLANGIOCARCINOMA 5-PERIAMPULLARY TUMOUR 6-PRESSURE FROM OUTSIDE;L.N.,M.SYN. 7-CHOLEDOCHAL CYST 8-PARASITES; FILLING THE LUMEN
CAUSES IN THE LUNEN
STONE IS THE COMMONEST
CHOLANGIOCARCINOMA
PAPILLOMATOSIS
HYDATID
ASCARIS
CLONORCHIASIS PARASITES
IN THE WALL:STRICTURES
BENIGN STRICTURES
MALIGNANT STRICTURES
OUTSIDE THE WALL
L.N.
HEAD OF THE PANCREASE
MIRIZZI SYND
ANY MASS OUTSIDE
HARTMANN`S POUCH stone
Stone in cystic duct
MIRRIZI`s syndrome
BENIGN STRICTURES 1-BILIARY ATRESIA 2-IATROGENIC BILIARY SURGERY GASTRECTOMY HEPATIC RESECTION LIVER TRANSPLANT 3-INFLAMMATORY;CHOLANGITIS , PANCREATITIS,
SCLEROSING CHOLANANGITIS.
4-TRAUMA 5-IDIOPATHIC 6-RADIOTHERAPY
BILIARY ATRESIA
NORMAL BILIARY ATRESIA
CAUSES
THE COMMONEST CAUSE
STONE SLIPPING INTO THE BILIARY TREE
IMPACTED STONE AT THE LOWER END OF C.B.D.
ASSENDING CHOLANGITIS WITH LIVER ABSESSES
CA. HEAD OF THE PANCREASE
ENDOSCOPIC VIEW OF PERIAMPULLARY TUMOUR
ORIGIN 1-DEUDENAL MUCOSA
OR
2-C.B.D. OR
3-PANCREATIC DUCT
CHOLANGICARCINOMA
CHOLANGIOCARCINOMA
LIVER METASTASIS
C.B.D.STRICTURE
SCLEROSING CHOLANGITIS•Associated with U.Colitis in 70% of cases
•May lead to malignancy
•Unknown aetiology
•Symptoms of cholangitis
•Treatment;Antibiotics
• Or liver transplant
شكل المسبحة
Rosary beads
SYMPTOMS
PAIN YELLOW DISCOLOURATION SKIN &M.M. DARK URINE [TEA COLOUR] CLAY COLOUR STOOL الطحينية لون ITCHING FEVER IF CHOLANGITIS SUPERVENE LOSS OF APPETITE LOSS OF WEIGHT IN MALIGNACY
SIGNS
LOSS OF Wt. IN MALIGNANCY TOXIC IN CHOLANGITIS,
[CHARCOT`S TRIAD,;PAIN, FEVER ,JAUNDICE] YELLOW DISCOLOURATION OF SKIN,M.M. TROISIER`S SIGN. VIRCHOW`S NODE TENDER R.U.Q.[IN CHOLANGITIS] COURVOISIER` LAW[IN CA.HEAD OF PAN.] ABDOMINL MASS ASCITES[IN MAIGNANCY]
DEEP JAUNDICE [GREEN] [OBSTRUCTIVE]
VIRCHOW`S NODE
]TROISIER`S SIGN[
BRUISING
VIT.K DEF.
OR
2,4,7,9,10.DEPEND ON IT
COURVOISIER` LAW
DISTENDED GALL BLADDER
IN CA,HEAD OF PANCREASE
ASCITES IN ADVANCED CA. HEAD OF PANCREASE
INVESTIGATIONS
C.B.C. DIFF., ESR. L.FT. *S.ALK.P.* PROTHROMBIN TIME S. AMYLASE K.F.T. ELECTRLYTES URINE ANALSIS * BILIRUBIN * STOOL ANALYSIS,;FAT,BLOOD.
INVESTIGATIONS
U.S.
STONE
DILATED CBD & STONE [US]
Should be more than 6 mm
C.T. DOUBLE BURRLE SIGN &DISTENDED G .
PERIAMPULLARY TUMOUR
ERCPSPHINCTEROTOMY
STONE EXTRACTION BY BASKET
STONE EXTRACTION BY BALLON
ERCP
C.B.D.STONE
C.B.D. BIG STONE
STENT
STONE REMOVED
C.B.D. STRICTURE
C.B.D.STENT WITH GOOD FLOW
CHOLANGICARCINOMA
CHOLANGIOCARCINOMA
E.R.C.P.FOR EXTRAHEPATIC CHOLANGIOCARCINOMA
ENDOSCOPIC VIEW OF PERIAMPULLARY TUMOUR
M.R.C.P
P.T.C.
PERCUTANOUS TRANSHEPATIC
CHOLANGIOGRAM
PEROPERATIVE CHOLANGIOGRAM
T.TUBE CHOLANGIOGRAM
DRAIN CHOLANGIOGRAM
MANAGEMENT-1
CORRECTION OF THE DERENGED PARAMETRES
ADMINISTRATION OF VITAMIN K ANTIBIOTICS MANNITOL PRE, INTRA and
POSTOPERATIVELY TO PREVENT
HEPATO-RENAL SHUTDOWN
MANAGEMENT-2
1. STONE-SPHINCTEROTOMY 2.STONE-EXPLORATION OF C.B.D. 3.STRICTURE-RESECTION ANASTOMOSIS FOR
SHORT STRICTURES 4.STRICTURE-STENT FOR SHORT AND LONG 5.CA.HEAD OF THE PANCREASE =EARLY-WHIPPLE`S
OPERATION[PANCREATICO-DUODENECTOMY. =LATE-BYPASS SURGERY[CHOLECYSTO-
JUJENOSTOMY
STENT FOR Ca. head of pancrease
WHIPPLE`S OPERATIONPancreatico-duodenoctomy