Cholelithiasis:Early diagnosis and prompt treatment.
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The document by Dr. Ketan Vagholkar discusses cholelithiasis, covering the anatomy, etiology, types, and complications of gallstones, as well as their clinical features and diagnostic investigations. It outlines treatment options, including conservative management and various surgical procedures such as cholecystectomy and ERCP. The document emphasizes the importance of monitoring and tailoring interventions based on acute and chronic presentations.
Cholelithiasis:Early diagnosis and prompt treatment.
- 1. CHOLELITHIASIS By Dr. Ketan Vagholkar M.S.(BOM), D.N.B., M.R.C.S.(Glasgow),F.A.C.S. Consultant General Surgeon & Professor of Surgery
- 2. Surgical anatomy & physiology of the Gall Bladder and Biliary tracts
- 3. Etiology Theories of gall stone formation Metabolic Infection Stasis
- 4. Epidemiology Sex Family history Weight Diet Rapid weight loss Age Ethnicity Cholesterol reducing agents Diabetes
- 5. Pathology Types of gall stones Cholesterol stones Pigment stones Mixed stones
- 6. Complications of gall stones In the gall bladder Biliary colic Acute cholecystitis Empyema Gangrene Perforation Mucocele Chronic cholecystitis Porcelain gall bladder Carcinoma
- 7. Complications of gallstones In the Biliary passages Cholangitis (Charcot’s triad, reynold’s pentad) Pancreatitis Obstructive Jaundice
- 8. Complications of gall stones In the intestine Gall stone ileus
- 9. Clinical features Biliary / Flatulent dyspepsia Acute Cholecystitis Pain Fever Transient jaundice Vomiting Nausea Murphy’s sign Boas’s sign Tenderness/Guarding/rigidity Obstructive jaundice Courvoisier’s Law
- 10. Investigations Hematology Cbc Lft Rft Blood sugars f/pp or random Coagulation profile
- 11. Investigations Radiology AXR/CXR USG abdomen HIDA scan MRCP ERCP
- 12. Treatment Acute Presentation Conservative vs surgery My management Conservative management NBM Iv antibiotics Iv fluids Rt Antispasmodics Monitoring of vitals and abdominal signs. Surgery in acute presentations Options Cholecystectomy (empyema/gangrene/perforation) Cholecystostomy Surgery to be considered after 6 weeks
- 13. Treatment Chronic Presentation/ 6weeks after an acute attack) Gall bladder Calculi with CBD calculi ERCP with CBD clearance of stones followed by cholecystectomy Gall bladder Calculi without CBD calculi Cholectectomy
- 14. Cholecystectomy Types Laparoscopic Open
- 18. CBD stones Endoscopic (ERCP) Open CBD exploration Role of Kehr’s tube (T tube) When to do biliary enteric anastomosis? For retained stones Choledochoscopic approach (Burhenne’ method) Dissolution therapy Lithotripsy
- 19. Thank You