cholelithiasis - by sir faisal ghani
TRANSCRIPT
![Page 1: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/1.jpg)
GallstonesFAISAL GHANI SIDDIQUI
MBBS; FCPS; PGD-BIOETHICS; MCPS –HPE
PROFESSOR OF SURGERY,IN CHARGE, MINIMAL INVASIVE SURGICAL CENTRE, &
& IN CHARGE, BIOETHICS PROGRAMME AT LIAQUAT UNIVERSITY OF MEDICAL & HEALTH SCIENCES
[email protected]/faculty/surgery
![Page 2: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/2.jpg)
Preamble
• Why gall bladder?
• Surgical anatomy & physiology of gall bladder
• Why gallstones form?
• How do gallstones present?
• How to manage a patient with gallstones?
![Page 3: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/3.jpg)
Functions of Gall Bladder
• Reservoir for bile
• Concentration of bile
• Secretion of mucus
![Page 4: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/4.jpg)
Anatomy of
Gall Bladder
![Page 5: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/5.jpg)
![Page 6: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/6.jpg)
Fundus
Body
Neck
Infundibulum
Cystic duct
![Page 7: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/7.jpg)
Bile Ducts
• Common hepatic
duct
• Cystic duct
• Common bile duct
![Page 8: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/8.jpg)
Common Bile Duct
• Supraduodenal
• Retroduodenal
• Infraduodenal
• Intraduodenal
![Page 9: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/9.jpg)
Calot’s
Trianglekah-lō′
![Page 10: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/10.jpg)
Moynihan’s
Hump
![Page 11: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/11.jpg)
Gallstones (Cholelithiasis)
![Page 12: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/12.jpg)
Types of
Gallstones
• Cholesterol
• Pigment
• Mixed
![Page 13: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/13.jpg)
Causes-Cholesterol Stones
• Supersaturated bile
–Obesity
–High caloric diet
–Oral contraceptives
–Resection of terminal ileum
![Page 14: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/14.jpg)
Causes-Pigment Stones
• Hemolysis
–Hereditary spherocytosis
– Sickle cell disease
![Page 15: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/15.jpg)
Causes-Mixed Stones
– Infected bile
– Foreign bodies in the CBD (stents, parasites e.g. Clonorchis sinensis)
![Page 16: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/16.jpg)
Clinical Features
• Asymptomatic
• Pain
• Complications
![Page 17: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/17.jpg)
Complications
• Acute cholecystitis
• Mucocele
• Empeyema
• Choledocholithiasis
• Acute pancreatitis
• Intestinal
obstruction
![Page 18: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/18.jpg)
![Page 19: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/19.jpg)
Treatment for Cholelithiasis
![Page 20: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/20.jpg)
Treatment -Indications
• Symptomatic gallstones
• Complicated gallstones
• Silent gallstones
– Diabetics
– Patients undergoing bariatric surgery
![Page 21: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/21.jpg)
Procedures
• Open cholecystectomy
• Laparoscopic cholecystectomy
![Page 22: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/22.jpg)
Laparoscopic Cholecystectomy
• Supine/reversed Trendelenburg’s
• General anesthesia
• Preparation of abdomen / toweling
• Creation of pnemoperitoneum
– Closed technique (Veress’ needle)
– Open technique (Hassan’s)
• Additional ports
![Page 23: Cholelithiasis - By Sir Faisal Ghani](https://reader034.vdocuments.site/reader034/viewer/2022042522/55a732281a28ab64028b4732/html5/thumbnails/23.jpg)