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Cholelithiasis:Early diagnosis and prompt treatment.

Understanding the pathophysiology of gallstone disease is important for prevention and treatment of the condition.

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Cholelithiasis:Early diagnosis and prompt treatment.

  1. 1. CHOLELITHIASIS By Dr. Ketan Vagholkar M.S.(BOM), D.N.B., M.R.C.S.(Glasgow),F.A.C.S. Consultant General Surgeon & Professor of Surgery
  2. 2. Surgical anatomy & physiology of the Gall Bladder and Biliary tracts
  3. 3. Etiology <ul><li>Theories of gall stone formation </li></ul><ul><li>Metabolic </li></ul><ul><li>Infection </li></ul><ul><li>Stasis </li></ul>
  4. 4. Epidemiology <ul><li>Sex </li></ul><ul><li>Family history </li></ul><ul><li>Weight </li></ul><ul><li>Diet </li></ul><ul><li>Rapid weight loss </li></ul><ul><li>Age </li></ul><ul><li>Ethnicity </li></ul><ul><li>Cholesterol reducing agents </li></ul><ul><li>Diabetes </li></ul>
  5. 5. Pathology <ul><li>Types of gall stones </li></ul><ul><li>Cholesterol stones </li></ul><ul><li>Pigment stones </li></ul><ul><li>Mixed stones </li></ul>
  6. 6. Complications of gall stones <ul><li>In the gall bladder </li></ul><ul><li>Biliary colic </li></ul><ul><li>Acute cholecystitis </li></ul><ul><li>Empyema </li></ul><ul><li>Gangrene </li></ul><ul><li>Perforation </li></ul><ul><li>Mucocele </li></ul><ul><li>Chronic cholecystitis </li></ul><ul><li>Porcelain gall bladder </li></ul><ul><li>Carcinoma </li></ul>
  7. 7. Complications of gallstones <ul><li>In the Biliary passages </li></ul><ul><li>Cholangitis (Charcot’s triad, reynold’s pentad) </li></ul><ul><li>Pancreatitis </li></ul><ul><li>Obstructive Jaundice </li></ul>
  8. 8. Complications of gall stones <ul><li>In the intestine </li></ul><ul><li>Gall stone ileus </li></ul>
  9. 9. Clinical features <ul><li>Biliary / Flatulent dyspepsia </li></ul><ul><li>Acute Cholecystitis </li></ul><ul><li>Pain </li></ul><ul><li>Fever </li></ul><ul><li>Transient jaundice </li></ul><ul><li>Vomiting </li></ul><ul><li>Nausea </li></ul><ul><li>Murphy’s sign </li></ul><ul><li>Boas’s sign </li></ul><ul><li>Tenderness/Guarding/rigidity </li></ul><ul><li>Obstructive jaundice </li></ul><ul><li>Courvoisier’s Law </li></ul>
  10. 10. Investigations <ul><li>Hematology </li></ul><ul><li>Cbc </li></ul><ul><li>Lft </li></ul><ul><li>Rft </li></ul><ul><li>Blood sugars f/pp or random </li></ul><ul><li>Coagulation profile </li></ul>
  11. 11. Investigations <ul><li>Radiology </li></ul><ul><li>AXR/CXR </li></ul><ul><li>USG abdomen </li></ul><ul><li>HIDA scan </li></ul><ul><li>MRCP </li></ul><ul><li>ERCP </li></ul>
  12. 12. Treatment <ul><li>Acute Presentation </li></ul><ul><li>Conservative vs surgery </li></ul><ul><li>My management </li></ul><ul><li>Conservative management </li></ul><ul><li>NBM </li></ul><ul><li>Iv antibiotics </li></ul><ul><li>Iv fluids </li></ul><ul><li>Rt </li></ul><ul><li>Antispasmodics </li></ul><ul><li>Monitoring of vitals and abdominal signs. </li></ul><ul><li>Surgery in acute presentations </li></ul><ul><li>Options </li></ul><ul><li>Cholecystectomy (empyema/gangrene/perforation) </li></ul><ul><li>Cholecystostomy </li></ul><ul><li>Surgery to be considered after 6 weeks </li></ul>
  13. 13. Treatment <ul><li>Chronic Presentation/ 6weeks after an acute attack) </li></ul><ul><li>Gall bladder Calculi with CBD calculi </li></ul><ul><li>ERCP with CBD clearance of stones </li></ul><ul><li>followed by cholecystectomy </li></ul><ul><li>Gall bladder Calculi without CBD calculi </li></ul><ul><li>Cholectectomy </li></ul>
  14. 14. Cholecystectomy <ul><li>Types </li></ul><ul><li>Laparoscopic </li></ul><ul><li>Open </li></ul>
  15. 15. Lap Cholecystectomy
  16. 16. Lap Chole (Scars)
  17. 17. Open Cholecystectomy
  18. 18. CBD stones <ul><li>Endoscopic (ERCP) </li></ul><ul><li>Open CBD exploration </li></ul><ul><li>Role of Kehr’s tube (T tube) </li></ul><ul><li>When to do biliary enteric anastomosis? </li></ul><ul><li>For retained stones </li></ul><ul><li>Choledochoscopic approach (Burhenne’ method) </li></ul><ul><li>Dissolution therapy </li></ul><ul><li>Lithotripsy </li></ul>
  19. 19. Thank You

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