gallstones types l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Gallstones Types PowerPoint Presentation
Download Presentation
Gallstones Types

Loading in 2 Seconds...

play fullscreen
1 / 48

Gallstones Types - PowerPoint PPT Presentation


  • 907 Views
  • Uploaded on

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

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 'Gallstones Types' - estelle


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
gallstones types
GallstonesTypes
  • Cholesterol stones
  • Pigment stones
    • black stones
    • brown stones
factors associated with black pigment stones formation
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
reasons for gallstone formation in cirrhosis
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
brown pigment stones formation
Brown pigment stones formation

Bilirubin diglucuronide

hydrolysis by -glucuronidase

Unconjugated bilirubin

+Ca ion

Calcium bilirubinate

cholesterol gallstones pathogenesis
Cholesterol gallstonesPathogenesis
  • Supersaturated bile with cholesterol due to enhanced hepatic synthesis
  • Low bile salt pool
  • Poor contractility of gallbladder
  • Excessive bile mucus glycoprotein
cholecystectomy for asymptomatic gallstones indication
Cholecystectomy for asymptomatic gallstonesIndication
  • Calcified gallbladder
  • Young patients with sickle cell disease
  • Patients on long-term TPN
complications of gallstones inside the gallbladder
Complications of gallstonesInside the gallbladder
  • Acute cholecystitis
  • Empyema gallbladder
  • Mucocele of gallbladder
  • Carcinoma
complications of gallstones outside the gallbladder
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)
slide15

Mirizzi syndrome

(Cholecystocholedochal fistula)

complications of gallstones in the common bile duct
Complications of gallstonesIn the common bile duct
  • Obstructive jaundice
  • Acute cholangitis
  • Acute pancreatitis
postcholecystectomy syndrome
Postcholecystectomy syndrome
  • Persistent symptom after cholecystectomy
  • Due to technical complication of cholecystectomy and/or missed pathology which is the real cause of original symptom
postcholecystectomy syndrome investigation
Postcholecystectomy syndromeInvestigation
  • CBP, RFT, LFT, amylase
  • Upper endoscopy
  • US/CT
  • ERCP
  • HAG SMA
acute cholangitis aetiology
Acute cholangitisAetiology
  • Stones
  • Malignancy
  • Biliary stricture
  • Anastomotic stricture
slide20

To hepatic vein cholangiovenous reflux

Cholangio-lymphatic reflux

Venous system

Stones obstructing the bile duct

acute cholangitis aetiology21
Acute cholangitisAetiology
  • Predisposing causes
    • obstruction to bile duct
    • bacterial growth in bile
acute cholangitis
Acute cholangitis
  • Reynold’s pentad
  • Fever/chill/rigor
  • Right upper quadrant pain
  • Jaundice
  • Hypotension
  • Mental confusion
acute cholangitis management initial conservative
Acute cholangitisManagement - initial & conservative
  • Nil by mouth
  • IV fluid
  • Blood tests
  • Blood crossmatch
  • Antibiotic
  • Analgesic
  • Monitoring
    • BP, pulse, temperature, urine output
acute cholangitis rationale of conservative treatment
Acute cholangitisRationale of conservative treatment
  • 70% will resolve
  • Related to spontaneous stone disimpaction
acute cholangitis clinical manifestation of failure of conservative treatment
Acute cholangitisClinical manifestation of failure of conservative treatment
  •  temperature, pulse
  •  BP
  •  urine output
  •  sensorium
  •  abdominal tenderness, guarding
acute cholangitis treatment for failure of conservatism
Acute cholangitisTreatment for failure of conservatism
  • Invasive monitoring
    • CVP
    • arterial line
    • pulmonary artery wedge pressure
  • Inotrope
  • Mannitol
acute cholangitis treatment for failure of conservatism27
Acute cholangitisTreatment for failure of conservatism
  • Biliary decompression and drainage
  • Surgery
    • choledochotomy
    • exploration of CBD
    • T-tube drainage
    • avoid choledochoscopy
    • avoid cholangiography
    • ± cholecystectomy
function of t tube after exploration of common bile duct
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
slide29

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

slide30

Action after T-tube cholangiogram

Residual CBD stone +

Keep T-tube for 2-3 months

Choledochoscopy via fibrous T-tube tract

slide31

T-tube in common bile duct and residual CBD stones

T-tube induces formation of fibrous tissue around it

slide33

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

acute cholangitis treatment for failure of conservatism34
Acute cholangitisTreatment for failure of conservatism
  • Biliary decompression
  • Endoscopy
    • endoscopic retrograde cholangio-pancreatography
    • endoscopic papillotomy
    • basket removal of stone
    • nasobiliary drainage
    • endoprosthesis
acute cholangitis treatment for failure of conservatism41
Acute cholangitisTreatment for failure of conservatism
  • Biliary decompression
  • Radiology percutaneous transhepatic

biliary drainage (PTBD)

slide48

Acute cholangitis

Strategy of treatment

Conservatism

Failure

Success

Endoscopic drainage

Imaging of bile duct

Radiological drainage

Surgery

Surgical drainage