gallstone disease l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Gallstone Disease PowerPoint Presentation
Download Presentation
Gallstone Disease

Loading in 2 Seconds...

play fullscreen
1 / 14

Gallstone Disease - PowerPoint PPT Presentation


  • 672 Views
  • Uploaded on

Gallstone Disease. Overview. Gallstone pathogenesis Definitions Differential Diagnosis of RUQ pain 7 Cases. Gallstone Pathogenesis. Bile = bile salts, phospholipids, cholesterol Also bilirubin which is conjugated b4 excretion

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Gallstone Disease' - chastity


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

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.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 - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
overview
Overview
  • Gallstone pathogenesis
  • Definitions
  • Differential Diagnosis of RUQ pain
  • 7 Cases
gallstone pathogenesis
Gallstone Pathogenesis
  • Bile = bile salts, phospholipids, cholesterol
    • Also bilirubin which is conjugated b4 excretion
  • Gallstones due to imbalance rendering cholesterol & calcium salts insoluble
  • Pathogenesis involves 3 stages:
    • 1. cholesterol supersaturation in bile
    • 2. crystal nucleation
    • 3. stone growth
differential diagnosis of ruq pain
Differential Diagnosis of RUQ pain
  • Biliary disease
    • Acute chol’y, chronic chol’y, CBD stone, cholangitis
  • Inflamed or perforated duodenal ulcer
  • Hepatitis
  • Also need to rule out:
    • Appendicitis, renal colic, pneumonia or pleurisy, pancreatitis
symptomatic cholelithiasis
Symptomatic cholelithiasis
  • aka “biliary colic”
  • The pain occurs due to a stone obstructing the cystic duct, causing wall tension; pain resolves when stone passes
  • Pain usually lasts 1-5 hrs, rarely > 24hrs
  • Ultrasound reveals evidence at the crime scene of the likely etiology: gallstones
  • Exam, WBC, and LFT normal in this case
  • Treatment: Laparoscopic cholecystectomy
spectrum of gallstone disease
Spectrum of Gallstone Disease
  • Symptomatic cholelithiasis can be a herald to:
    • an attack of acute cholecystitis
    • or ongoing chronic cholecystitis
  • May also resolve
chronic calculous cholecystitis
Chronic calculous cholecystitis
  • Recurrent inflammatory process due to recurrent cystic duct obstruction, 90% of the time due to gallstones
  • Overtime, leads to scarring/wall thickening
  • Treatment: laparoscopic cholecystectomy
acute calculous cholecystitis
Acute calculous cholecystitis
  • Persistent cystic duct obstruction leads to GB distension, wall inflammation & edema
  • Can lead to: empyema, gangrene, rupture
  • Pain usu. persists >24hrs & a/w N/V/Fever
  • Palpable/tender or even visible RUQ mass
  • Nuclear HIDA scan shows nonfilling of GB
    • If U/S non-diagnostic, obtain HIDA
  • Tx: NPO, IVF, Abx (GNR & enterococcus)
  • Sg: Cholecystectomy usu within 48hrs
acute acalculous cholecystitis
Acute acalculous cholecystitis
  • In 5-10% of cases of acute cholecystitis
  • Seen in critically ill pts or prolonged TPN
  • More likely to progress to gangrene, empyema, perforation due to ischemia
  • Caused by gallbladder stasis from lack of enteral stimulation by cholecystokinin
  • Tx: Emergent cholecystectomy usu open
  • If pt is too sick, perc cholecystostomy tube and interval cholecystectomy later on
choledocholithiasis
Choledocholithiasis
  • Can present similarly to cholelithiasis, except with the addition of jaundice
  • DDx: cholelithiasis, hepatitis, sclerosing cholangitis, less likely CA with pain
  • Tx: Endoscopic retrograde cholangiopancreatography (ERCP)
    • Stone extraction and sphincterotomy
  • Interval cholecystectomy after recovery from ERCP
cholangitis
Cholangitis
  • Infection of the bile ducts due to CBD obstruction 2ndary to stones, strictures
  • Charcot’s triad seen in 70% of pts
  • May lead to life-threatening sepsis and septic shock (Raynaud’s pentad)
  • Tx: NPO, IVF, IV Abx
  • Emergent decompression via ERCP or perc transhepatic cholangiogram (PTC)
  • Used to require emergency laparotomy
gallstone pancreatitis
Gallstone pancreatitis
  • 35% of acute pancreatitis 2ndary to stones
  • Pathophysiology
    • Reflux of bile into pancreatic duct and/or obstruction of ampulla by stone
  • ALT > 150 (3-fold elevation) has 95% PPV for diagnosing gallstone pancreatitis
  • Tx: ABC, resuscitate, NPO/IVF, pain meds
  • Once pancreatitis resolving, ERCP w stone extraction/sphincterotomy
  • Cholecystectomy before hospital discharge