Gallstones Types
Download

Gallstones Types







Advertisement
/ 48 []
Download Presentation
Comments
estelle
From:
|  
(116) |   (0) |   (0)
Views: 113 | Added: 12-04-2012
Rate Presentation: 3 0
Description:
Gallstones Types. Cholesterol stones Pigment stones black stones brown stones. Factors associated with black pigment stones formation. Chronic liver disease (increased frequency with severity) Ileal resection Chronic haemolysis sickle cell anaemia hereditary spherocytosis
Gallstones Types

An Image/Link below is provided (as is) to

Download Policy: Content on the Website is provided to you AS IS for your information and personal use only and may not be sold or licensed nor shared on other sites. SlideServe reserves the right to change this policy at anytime. While downloading, If for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.











- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -




Slide 1

GallstonesTypes

  • Cholesterol stones

  • Pigment stones

    • black stones

    • brown stones

Slide 3

Factors associated with black pigment stones formation

  • Chronic liver disease (increased frequency with severity)

  • Ileal resection

  • Chronic haemolysis

    • sickle cell anaemia

    • hereditary spherocytosis

    • thalassemia major

  • Total parenteral nutrition

  • Vagotomy

Slide 4

Reasons for gallstone formation in cirrhosis

  • Cirrhotic liver unable to convert all unconjugated bilirubin into bilirubin mono- and di-glucuronides

  • Small fraction of unconjugated bilirubin spills into bile

  • Unconjugated bilirubin precipitated with calcium

Slide 5

Brown pigment stones formation

Bilirubin diglucuronide

hydrolysis by -glucuronidase

Unconjugated bilirubin

+Ca ion

Calcium bilirubinate

Slide 6

Cholesterol gallstonesPathogenesis

  • Supersaturated bile with cholesterol due to enhanced hepatic synthesis

  • Low bile salt pool

  • Poor contractility of gallbladder

  • Excessive bile mucus glycoprotein

Slide 11

Calcified shadow at right upper abdomen in X-rayDifferential diagnosis

Slide 12

Cholecystectomy for asymptomatic gallstonesIndication

  • Calcified gallbladder

  • Young patients with sickle cell disease

  • Patients on long-term TPN

Slide 13

Complications of gallstonesInside the gallbladder

  • Acute cholecystitis

  • Empyema gallbladder

  • Mucocele of gallbladder

  • Carcinoma

Slide 14

Complications of gallstonesOutside the gallbladder

  • Perforation into peritoneal cavity

  •  peritonitis or abscess

  • Perforation into duodenum, colon

  •  gallstone ileus

  • Perforation into liver bed

  •  liver abscess

  • Perforation into CBD

  •  bile duct obstruction (Mirizzi syndrome)

Slide 15

Mirizzi syndrome

(Cholecystocholedochal fistula)

Slide 16

Complications of gallstonesIn the common bile duct

  • Obstructive jaundice

  • Acute cholangitis

  • Acute pancreatitis

Slide 17

Postcholecystectomy syndrome

  • Persistent symptom after cholecystectomy

  • Due to technical complication of cholecystectomy and/or missed pathology which is the real cause of original symptom

Slide 18

Postcholecystectomy syndromeInvestigation

  • CBP, RFT, LFT, amylase

  • Upper endoscopy

  • US/CT

  • ERCP

  • HAG SMA

Slide 19

Acute cholangitisAetiology

  • Stones

  • Malignancy

  • Biliary stricture

  • Anastomotic stricture

Slide 20

To hepatic vein cholangiovenous reflux

Cholangio-lymphatic reflux

Venous system

Stones obstructing the bile duct

Slide 21

Acute cholangitisAetiology

  • Predisposing causes

    • obstruction to bile duct

    • bacterial growth in bile

Slide 22

Acute cholangitis

  • Reynold’s pentad

  • Fever/chill/rigor

  • Right upper quadrant pain

  • Jaundice

  • Hypotension

  • Mental confusion

Slide 23

Acute cholangitisManagement - initial & conservative

  • Nil by mouth

  • IV fluid

  • Blood tests

  • Blood crossmatch

  • Antibiotic

  • Analgesic

  • Monitoring

    • BP, pulse, temperature, urine output

Slide 24

Acute cholangitisRationale of conservative treatment

  • 70% will resolve

  • Related to spontaneous stone disimpaction

Slide 25

Acute cholangitisClinical manifestation of failure of conservative treatment

  •  temperature, pulse

  •  BP

  •  urine output

  •  sensorium

  •  abdominal tenderness, guarding

Slide 26

Acute cholangitisTreatment for failure of conservatism

  • Invasive monitoring

    • CVP

    • arterial line

    • pulmonary artery wedge pressure

  • Inotrope

  • Mannitol

Slide 27

Acute cholangitisTreatment for failure of conservatism

  • Biliary decompression and drainage

  • Surgery

    • choledochotomy

    • exploration of CBD

    • T-tube drainage

    • avoid choledochoscopy

    • avoid cholangiography

    • ± cholecystectomy

Slide 28

Function of T-tube after exploration of common bile duct

  • Serves to allow infected bile draining into the external environment and prevent elevation of intraductal pressure (and bile leakage through the suture line or holes) if there is oedema of lower end of CBD or residual CBD stones

  • For postoperative cholangiogram on day 7-10

Slide 29

Action after T-tube cholangiogram

No residual CBD stone

Spigot T-tube

Fever +

Fever -

Release spigot

Keep T-tube spigot for 6 weeks

Re-do cholangiogram for possible CBD stone

Remove T-tube

Slide 30

Action after T-tube cholangiogram

Residual CBD stone +

Keep T-tube for 2-3 months

Choledochoscopy via fibrous T-tube tract

Slide 31

T-tube in common bile duct and residual CBD stones

T-tube induces formation of fibrous tissue around it

Slide 32

Fibrous tract formed around T-tube serves as a

conduit for choledochoscopy

Slide 33

Insertion of choledochoscope into the common bile duct through T-tube tract for extraction of residual CBD stones

Slide 34

Acute cholangitisTreatment for failure of conservatism

  • Biliary decompression

  • Endoscopy

    • endoscopic retrograde cholangio-pancreatography

    • endoscopic papillotomy

    • basket removal of stone

    • nasobiliary drainage

    • endoprosthesis

Slide 36

Nasobiliary drainage (NBD)

Nose

Slide 39

Endoprosthesis

Slide 40

Acute cholangitisComparison of treatment result

Slide 41

Acute cholangitisTreatment for failure of conservatism

  • Biliary decompression

  • Radiology percutaneous transhepatic

    biliary drainage (PTBD)

Slide 42

Percutaneous transhepatic biliary drainage

(External type)

Slide 43

Percutaneous transhepatic biliary drainage

(External-internal type)

Slide 48

Acute cholangitis

Strategy of treatment

Conservatism

Failure

Success

Endoscopic drainage

Imaging of bile duct

Radiological drainage

Surgery

Surgical drainage


Copyright © 2014 SlideServe. All rights reserved | Powered By DigitalOfficePro