Gallbladder and biliary tract diseases
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Transcript of Gallbladder and biliary tract diseases
Universidad de GuadalajaraCentro Universitario de Ciencias de la Salud
Departamento de Clínicas Quirúrgicas
Bile duct injuries
Gallbladder and biliary tract diseases
Dr. Benjamín Robles MariscalDr. Héctor Manuel Virgen AyalaBeatriz Tonántzin Gómez Fierro
Bile duct injuries
Gallbladder
Tx: Cholecystectomy
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1514483/
Extrahepatic bile ducts
Laparoscopic cholecystectomy
Signs and Symptoms
Ascitis
Jaundice
Right upper quadrant tenderness
Cholangitis
Alkaline phosphatase
Bilirrubin <10mg/dl
Positive hemocultive Acute cholangitis
Diagnosis
Ultrasonography
CT
THC
ERCP
Treatment
Mortality
5%
Gallstone disease
Risk Factors
ObesityPregnancyDietCrohn's diseaseThalassemiaHereditary spherocytosisGastric surgery
3:1
Cholesterol
gallstones
Pigment gallstones
Gallstone formation
Chronic cholecystitisMost common form of gallbladder disease
Chronic cholecystitis almost always results from gallstones and prior episodes of acute cholecystitis
Biliary colic
Upper abdominal tenderness
Food intolerance
Dyspepsia
Sickness
Signs and Symptoms
UltrasonographyCholecystography
DissolutionLithotripsy and dissolution therapyCholecystectomy
Diagnosis
Treatment
Mortality 0.1-0.5%
Acute cholecystitis
90- 95% Gallstones
<1% Tumor
The gallbladder wall becomes thick and red with bleeding
subserosa
LeukocytosisBilirrubin (2-4mg/dl) Alkaline phosphatase Amilase
Signs and Symptoms
80% Chronic cholecystitis
Biliary colic
Upper abdominal tenderness
Fever
Sickness
Vomit
Murphy's sign
• Ultrasonography• HIDA
Diagnosis
Sonographic Murphy's sign
Complications
Empyema
Perforation
* Pericholecystic abscess
* Free perforation of gallbladder
* Cholecystoenteric Fistulas
Gallstone ileus
- Pericholecystitis and small abscess
- Cholelithiasis and a perforated gallbladder wall
- Pericholecystitis abscess
IV fluid administration
Antibiotic
Elective laparoscopic cholecystectomy
Treatment
Mortality
5%
Emphysematous cholecystitis
3:1 20% Diabetes
ClostridiumE. Coli
Anaerobic Streptococcus
Biliary colic
Upper abdominal tenderness
Fever
Leukocytosis
Lump
Signs and Symptoms
Rx
CT
Diagnosis
Treatment
Antibiotics
Cholecystectomy
Cholangitis
Causes
Choledocholithiasis
Biliary stricture
Neoplasia
Chronic pancreatitis
Duodenal diverticulum
Ampullary stenosis
Congenital cyst
E. ColiKlebsiella
Pseudomonas
EnterococcusProteus
Bacteroides fragilis
Signs and Symptoms
Charcot's triad
Reynolds' pentad
Fever
Abdominal pain
Jaundice
Fever
Pain
Jaundice
Altered mental state
Hypotension
Leukocytosis Bilirrubin Alkaline phosphatase Transaminases
DiagnosisUltrasonography
ERCP
THC
Treatment
Antibiotics
Fluid administration
Endoscopic sphincterotomyMortality
5%
Choledocholithiasis
6-15% gallstones Incidence age
2 origins
1 cholesterol
2 pigment
Signs and Symptoms
50% Asyntomatic
Toxic cholangitis
Biliary colic
Jaundice
Pancreatitis
Fever
Chills
Upper abdominal tenderness
LeukocytosisBilirrubin (2-4mg/dl) Alkaline phosphatase Transaminases
DiagnosisUltrasonography
Magnetic resonance cholangiography
Endoscopic cholangiography
Treatment
Endoscopic sphincterotomy
Laparoscopic cholecystectomy
Bibliography
Schwartz. Principios de cirugía. Mc Graw Hill. Vol I. 8º edición. Houston, Texas. P. 1194-1213.
M. Doherty, G. Diagnóstico y tratamiento quirúrgicos. Mc Graw Hall. LANGE. 13º edición. México, D.F. 2011. P. 475-489.
Lick, R. F. Atlas de patología quirúrgica. HARLA. México, D.F. 1981. P. 206-217.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1514483/
http://www.ultrasoundcases.info/Slide-View.aspx?cat=166&case=4072