❤3
🔴Gallstones (Cholelithiasis) & Cholysystitis
▪️Gallstones Are Most Common Biliary Pathology (Affect 10-15% Of Population)
▪️Cholecystitis is Acute Or Chronic
Inflammation Of Gallbladder (Mostly Due To Presence Of Gallstones)
▪︎Cholysystitis is The 2nd Most Common Non-Obstetric Indication For Surgery in Pregnant Women (After Appendicitis)
🔹Risk Factors For Gallstones Formation (Fat/Fertile/Female/Forty)
1. Obesity & High Calorie Intake (Increase Cholesterol & Concentrate The Bile)
2. Terminal Ileum Resection (Diminished EnteroHepatic Circulation)
3. Drugs (Oral Contraceptives/Estrogen/CloFibrate/Cholestyramine/DeoxyCholate)
4. Abnormal Emptying Of Gallbladder
5. Female Gender & Pregnancy (MultiParity)
6. Liver Diseases & DM
7. Rapid Weight Loss
8. Risk Factors For Pigmented Stones ➡️ Blood Hemolysis/Biliary Stasis (Obstruction & Infection)/Liver Cirrhosis
9. Old Age
10. Long Term Parenteral Nutrition
🔹Clinical Features Of Gallstones
📍1. Most Gallstones Asymptomatic (>80%)
📍2. Acute Cholecystitis
▪︎Start As Mild To Moderate Episodes Of Right Upper Quadrant Or Epigastric Pain
▪️Dull Or Colicky in Nature
▪️Radiate To Back Or Right Shoulder
▪️Intermittent Episodes (Comes & Go During The Day) & Constant in Severity
▪️Associated With Dyspepsia & Flatulence & Food Intolerance & Alteration in Bowel Frequency
▪️Aggravated Or Induced By Eating Fatty Meals
📍3. Biliary Colic (10-25%)
▪️Severe RUQ Pain Last Minutes Or Hours Radiate To Chest & Associated With Nausea & Vomiting
▪︎Due To Temporary Stone Obstructing The Cystic Duct
▪️Change In Severity (Ebbs & Flows)
▪️Starts During Night & Wakes Patient From Sleep & Associated With Minor Intermittent Episodes During The Day
▪️When Pain Resolve The Patient is Able To Eat & Drinks Again
📍4. Obstructive Jaundice (Jaundice With Pale Stool & Dark Urine & Itching)
▪︎Due To CBD Stones ➡️ Stone Migration From Gallbladder To Common Bile Duct
▪︎Or Due To Mirizzi Syndrome ➡️ Stones Impacted in Hartmann Pouch Of The Gallbladder & Causing Pressure Over The CBD (Risk Of CBD Fistula)
🔹Types Of Cholysystitis
📍1. Calculus Cholecystitis (Acute/Chronic) ➡️ Due To Gallstones
📍2. Acalculous Cholecystitis ➡️
▪️Gallbladder Inflammation Without The Presence Of Gallstones
▪️Mostly Seen in ➡️ Critically ill Patients/Patients Recovering From Major Surgery Or Trauma Or Burns/Immunocompromised/Typhoid Fever
▪️High Mortality Rate
📍3. Emphysematous Cholecystitis
▪︎Acute Severe & Life-Threatening Cholecystitis Due To Gas-Forming Bacterial infection Of The Gallbladder (C.Perfingrens/C.Welchii/E.coli/Bacteroides Fragilis)
▪︎More in Men With DM (50-70 Years)
▪︎Risk Of Gallbladder Gangrene & Perforation
🔹Dx Of Acute Cholecystitis
📍1. Persistent Clinical Features With Fever
📍2. +Ve Murphy Sign ➡️ RUQ Tenderness Exacerbated By Right SubCostal Palpation During Patient Inspiration
📍3. Leukocytosis & Increase Liver Enzymes
📍4. Palpable Mass in RUQ (Omentum Walls Off The Inflamed Bladder)
📍5. US Or CT (Confirm Dx) ➡️ Stones Present With Gallbladder Wall Thickening & Fluid Collection
🔹DDX Of Acute Cholecystitis
1. Acute Appendicitis
2. Perforated Peptic Ulcer
3. Acute Pancreatitis
4. Acute Pyeleonephritis
5. Myocardial Infarction
6. Right Lower Lobe Pneumonia
#Cholecystitis part1
#Surgery
https://t.me/Surgery_Practice
▪️Gallstones Are Most Common Biliary Pathology (Affect 10-15% Of Population)
▪️Cholecystitis is Acute Or Chronic
Inflammation Of Gallbladder (Mostly Due To Presence Of Gallstones)
▪︎Cholysystitis is The 2nd Most Common Non-Obstetric Indication For Surgery in Pregnant Women (After Appendicitis)
🔹Risk Factors For Gallstones Formation (Fat/Fertile/Female/Forty)
1. Obesity & High Calorie Intake (Increase Cholesterol & Concentrate The Bile)
2. Terminal Ileum Resection (Diminished EnteroHepatic Circulation)
3. Drugs (Oral Contraceptives/Estrogen/CloFibrate/Cholestyramine/DeoxyCholate)
4. Abnormal Emptying Of Gallbladder
5. Female Gender & Pregnancy (MultiParity)
6. Liver Diseases & DM
7. Rapid Weight Loss
8. Risk Factors For Pigmented Stones ➡️ Blood Hemolysis/Biliary Stasis (Obstruction & Infection)/Liver Cirrhosis
9. Old Age
10. Long Term Parenteral Nutrition
🔹Clinical Features Of Gallstones
📍1. Most Gallstones Asymptomatic (>80%)
📍2. Acute Cholecystitis
▪︎Start As Mild To Moderate Episodes Of Right Upper Quadrant Or Epigastric Pain
▪️Dull Or Colicky in Nature
▪️Radiate To Back Or Right Shoulder
▪️Intermittent Episodes (Comes & Go During The Day) & Constant in Severity
▪️Associated With Dyspepsia & Flatulence & Food Intolerance & Alteration in Bowel Frequency
▪️Aggravated Or Induced By Eating Fatty Meals
📍3. Biliary Colic (10-25%)
▪️Severe RUQ Pain Last Minutes Or Hours Radiate To Chest & Associated With Nausea & Vomiting
▪︎Due To Temporary Stone Obstructing The Cystic Duct
▪️Change In Severity (Ebbs & Flows)
▪️Starts During Night & Wakes Patient From Sleep & Associated With Minor Intermittent Episodes During The Day
▪️When Pain Resolve The Patient is Able To Eat & Drinks Again
📍4. Obstructive Jaundice (Jaundice With Pale Stool & Dark Urine & Itching)
▪︎Due To CBD Stones ➡️ Stone Migration From Gallbladder To Common Bile Duct
▪︎Or Due To Mirizzi Syndrome ➡️ Stones Impacted in Hartmann Pouch Of The Gallbladder & Causing Pressure Over The CBD (Risk Of CBD Fistula)
🔹Types Of Cholysystitis
📍1. Calculus Cholecystitis (Acute/Chronic) ➡️ Due To Gallstones
📍2. Acalculous Cholecystitis ➡️
▪️Gallbladder Inflammation Without The Presence Of Gallstones
▪️Mostly Seen in ➡️ Critically ill Patients/Patients Recovering From Major Surgery Or Trauma Or Burns/Immunocompromised/Typhoid Fever
▪️High Mortality Rate
📍3. Emphysematous Cholecystitis
▪︎Acute Severe & Life-Threatening Cholecystitis Due To Gas-Forming Bacterial infection Of The Gallbladder (C.Perfingrens/C.Welchii/E.coli/Bacteroides Fragilis)
▪︎More in Men With DM (50-70 Years)
▪︎Risk Of Gallbladder Gangrene & Perforation
🔹Dx Of Acute Cholecystitis
📍1. Persistent Clinical Features With Fever
📍2. +Ve Murphy Sign ➡️ RUQ Tenderness Exacerbated By Right SubCostal Palpation During Patient Inspiration
📍3. Leukocytosis & Increase Liver Enzymes
📍4. Palpable Mass in RUQ (Omentum Walls Off The Inflamed Bladder)
📍5. US Or CT (Confirm Dx) ➡️ Stones Present With Gallbladder Wall Thickening & Fluid Collection
🔹DDX Of Acute Cholecystitis
1. Acute Appendicitis
2. Perforated Peptic Ulcer
3. Acute Pancreatitis
4. Acute Pyeleonephritis
5. Myocardial Infarction
6. Right Lower Lobe Pneumonia
#Cholecystitis part1
#Surgery
https://t.me/Surgery_Practice
Telegram
Surgical Practice Dr. alqhatani
- تابعة لقناة معلومات طبية:
@M_Information11
- قروب للمناقشة الطبية:
@M_Information21
- بوت التواصل :
@Alqhatani_bot
- صارحني :
http://t.me/SY8Bot?start=wiRwSie0ew
🚫 نحلل النقل ولا نحلل حذف الروابط🚫
@M_Information11
- قروب للمناقشة الطبية:
@M_Information21
- بوت التواصل :
@Alqhatani_bot
- صارحني :
http://t.me/SY8Bot?start=wiRwSie0ew
🚫 نحلل النقل ولا نحلل حذف الروابط🚫
👍1
🔹Mx Of Cholecystitis
🔸A. Conservative
▪️Conservative Mx Will Resolve The Symptoms in 90% Of Cases
📍1. Nill By Mouth (NPO)
📍2. IV Fluids & Analgesic
📍3. Antibiotics (Cefazolin/Cefuroxime/Ciprofloxacin)
🔸B. Surgery (Cholecystectomy)
📍1. Do Early CholecysteCtomy Within 5-7 Days From Admission & After Symptoms Resolution
📍2. Emergent Choleystectomy ➡️ Due To Severe Presentation Or Complications
📍3. Do Emergent ECRP ➡️ For CBD Stones Removal
📍4. If Empyema Present ➡️ Do Drainage (CholeCystoStomy) Then Later CholecysteCtomy
📍5. Cholecystitis in Pregnancy ➡️ Do Cholecystectomy During 2nd Trimester Only (Not In 1st Or 3rd Trimester)
🔹Indications for Cholecystectomy
1. Cholecystitis (Symptomatic Patients)
2. Complications Develop (Emergency)
3. Typhoid Carrier
4. Cholesterolosis (Cholesterol Polyps)
5. Risk Of Gallbladder Cancer (Porcelain Gallbladder/Adenomatous Gallbladder Polyps)
6. CBD Stones (Choledocholithiasis)
7. Prophylaxis in
▪︎DM/Congenital Hemolytic Anaemia/Bariatric Surgery
▪︎Large Palpable Stones (>2.5-3cm)/Multiple Small Stones
🔹Complications Of Cholecystitis
🔶A. Preoperative
1. Acute & Chronic Cholecystitis
2. Biliary Colic
3. Obstructive Jaundice (CBD Stones Or Mirizzi Syndrome)
4. Acute Pancreatitis
5. Gallbladder Perforation & Peritonitis
6. Acute Cholangitis
7. Empyema Of Gallbladder (Pus Accumulation)
8. MucoCele Of Gallbladder (Fluid Accumulation)
9. Bowel Obstruction (Gallstone Ileus)
🔶B. Postoperative (After CholecysteCtomy)
1. Bile Ducts Injury ➡️ Present As Postoperative Obstructive Jaundice
2. Post-CholecysteCtomy Syndrome ➡️ Postoperative Continuation Of The Symptoms Due To Residual Stones in The Biliary Tree
3. Post-CholecysteCtomy Choledocholithiasis ➡️ Development Of New Stones in Bile Ducts Many Years After Cholecystectomy Which Then Leads To Obstruction Or Cholangitis
4. Bile Leakage & Peritonitis (Clips Dislodgment)
5. Biliary Strictures
6. Visceral Or Vessels Injury & Haemorrhage
7. Abdominal Abscess
#Cholecystitis part2
#Surgery
https://t.me/Surgery_Practice
🔸A. Conservative
▪️Conservative Mx Will Resolve The Symptoms in 90% Of Cases
📍1. Nill By Mouth (NPO)
📍2. IV Fluids & Analgesic
📍3. Antibiotics (Cefazolin/Cefuroxime/Ciprofloxacin)
🔸B. Surgery (Cholecystectomy)
📍1. Do Early CholecysteCtomy Within 5-7 Days From Admission & After Symptoms Resolution
📍2. Emergent Choleystectomy ➡️ Due To Severe Presentation Or Complications
📍3. Do Emergent ECRP ➡️ For CBD Stones Removal
📍4. If Empyema Present ➡️ Do Drainage (CholeCystoStomy) Then Later CholecysteCtomy
📍5. Cholecystitis in Pregnancy ➡️ Do Cholecystectomy During 2nd Trimester Only (Not In 1st Or 3rd Trimester)
🔹Indications for Cholecystectomy
1. Cholecystitis (Symptomatic Patients)
2. Complications Develop (Emergency)
3. Typhoid Carrier
4. Cholesterolosis (Cholesterol Polyps)
5. Risk Of Gallbladder Cancer (Porcelain Gallbladder/Adenomatous Gallbladder Polyps)
6. CBD Stones (Choledocholithiasis)
7. Prophylaxis in
▪︎DM/Congenital Hemolytic Anaemia/Bariatric Surgery
▪︎Large Palpable Stones (>2.5-3cm)/Multiple Small Stones
🔹Complications Of Cholecystitis
🔶A. Preoperative
1. Acute & Chronic Cholecystitis
2. Biliary Colic
3. Obstructive Jaundice (CBD Stones Or Mirizzi Syndrome)
4. Acute Pancreatitis
5. Gallbladder Perforation & Peritonitis
6. Acute Cholangitis
7. Empyema Of Gallbladder (Pus Accumulation)
8. MucoCele Of Gallbladder (Fluid Accumulation)
9. Bowel Obstruction (Gallstone Ileus)
🔶B. Postoperative (After CholecysteCtomy)
1. Bile Ducts Injury ➡️ Present As Postoperative Obstructive Jaundice
2. Post-CholecysteCtomy Syndrome ➡️ Postoperative Continuation Of The Symptoms Due To Residual Stones in The Biliary Tree
3. Post-CholecysteCtomy Choledocholithiasis ➡️ Development Of New Stones in Bile Ducts Many Years After Cholecystectomy Which Then Leads To Obstruction Or Cholangitis
4. Bile Leakage & Peritonitis (Clips Dislodgment)
5. Biliary Strictures
6. Visceral Or Vessels Injury & Haemorrhage
7. Abdominal Abscess
#Cholecystitis part2
#Surgery
https://t.me/Surgery_Practice
Telegram
Surgical Practice Dr. alqhatani
- تابعة لقناة معلومات طبية:
@M_Information11
- قروب للمناقشة الطبية:
@M_Information21
- بوت التواصل :
@Alqhatani_bot
- صارحني :
http://t.me/SY8Bot?start=wiRwSie0ew
🚫 نحلل النقل ولا نحلل حذف الروابط🚫
@M_Information11
- قروب للمناقشة الطبية:
@M_Information21
- بوت التواصل :
@Alqhatani_bot
- صارحني :
http://t.me/SY8Bot?start=wiRwSie0ew
🚫 نحلل النقل ولا نحلل حذف الروابط🚫