🔴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🚫
A 52-year-old woman presents 48 hours after onset of RUQ pain, fever and positive Murphy’s sign. Ultrasound shows thickened gallbladder wall and pericholecystic fluid. She is stable. Best management?
Anonymous Quiz
62%
A) Conservative treatment then interval cholecystectomy after 6 weeks
33%
B) Early laparoscopic cholecystectomy during same admission
5%
C) Immediate ERCP
0%
D) Percutaneous cholecystostomy only
❤1
Which factor MOST increases technical difficulty during laparoscopic cholecystectomy?
Anonymous Quiz
4%
A) Female gender
4%
B) Age <50 years
36%
C) Gallbladder wall thickness >5 mm
56%
D) All of the above
A patient with obstructive jaundice, imaging shows a stone impacted in Hartmann’s pouch compressing the CBD. Diagnosis and best treatment?
Anonymous Quiz
18%
A) Choledocholithiasis — ERCP with stone extraction
65%
B) Mirizzi syndrome — Cholecystectomy ± endoscopic relief of obstruction
15%
C) Ascending cholangitis — ERCP with sphincterotomy and drainage ± stone extraction
3%
D) Benign biliary stricture — Endoscopic dilatation
A 68-year-old diabetic man presents with RUQ pain, fever, positive Murphy’s sign, and leukocytosis. CT shows gas within the gallbladder wall. What is the most likely diagnosis?
Anonymous Quiz
5%
A) Uncomplicated acute calculous cholecystitis
5%
B) Acalculous cholecystitis
5%
C) Biliary colic
86%
D) Emphysematous cholecystitis
Which condition predisposes specifically to pigment stone formation?
Anonymous Quiz
12%
A) Obesity
73%
B) Chronic hemolysis
8%
C) Rapid weight loss
8%
D) Oral contraceptive use