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Surgery.(GIT 2).Gallbladder > Gall bladder.2. Chronic calcular cholecystitis > Flashcards

Gall bladder.2. Chronic calcular cholecystitis Flashcards

1
Q

Chronic Calcular Cholecystitis

A
  1. Alternative names
  2. ETIOLOGY
  3. TYPES AND PATHOLOGY
  4. CLINICAL PICTURE
  5. DIFFERENTIAL DIAGNOSIS
  6. INVESTIGATIONS
  7. TREATMENT
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2
Q

Alternative names for Chronic Calcular Cholecystitis

A
  1. GALL BLADDER STONES

2. CHOLELITHIASIS

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3
Q

ETIOLOGY of Chronic Calcular Cholecystitis

A

A- Cholesterol & Mixed Stones :

B- Pigment Stones :

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4
Q

Etiology of Cholesterol & Mixed Stones of CCC in ETIOLOGY of Chronic Calcular Cholecystitis

A
  1. Disturbed bile salts / cholesterol ratio : (Lithogenic theory)
  2. Bile stasis
  3. Infection (in mixed stones only) :
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5
Q

Disturbed bile salts / cholesterol ratio : (Lithogenic theory) in Etiology of Cholesterol & Mixed Stones of CCC in ETIOLOGY of Chronic Calcular Cholecystitis

A
  1. The normal ratio
  2. The disturbed ratio
  3. The Etiology of disturbance
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6
Q

The normal ratio in Disturbed bile salts / cholesterol ratio : (Lithogenic theory) in Etiology of Cholesterol & Mixed Stones of CCC in ETIOLOGY of Chronic Calcular Cholecystitis

A

25:1

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7
Q

The disturbed ratio in Disturbed bile salts / cholesterol ratio : (Lithogenic theory) in Etiology of Cholesterol & Mixed Stones of CCC in ETIOLOGY of Chronic Calcular Cholecystitis

A

13:1 or less )> the cholesterol precipitates (lithogenic bile).

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8
Q

lithogenic bile in The disturbed ratio in Disturbed bile salts / cholesterol ratio : (Lithogenic theory) in Etiology of Cholesterol & Mixed Stones of CCC in ETIOLOGY of Chronic Calcular Cholecystitis

A

bile containing disturbed bile salts : cholesterol ratio )> 13:1 or less )> the cholesterol precipitates

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9
Q

The Etiology of disturbance in Disturbed bile salts / cholesterol ratio : (Lithogenic theory) in Etiology of Cholesterol & Mixed Stones of CCC in ETIOLOGY of Chronic Calcular Cholecystitis

A

a) Decrease in bile salt pool

b) Increased cholesterol in bile

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10
Q

Pathogenesis of Decrease in bile salt pool in The Etiology of disturbance in Disturbed bile salts / cholesterol ratio : (Lithogenic theory) in Etiology of Cholesterol & Mixed Stones of CCC in ETIOLOGY of Chronic Calcular Cholecystitis

A
  1. Chronic liver disease.
  2. Crohn’s disease.
  3. Surgical removal of the terminal ileum
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11
Q

Chronic liver disease in Pathogenesis of Decrease in bile salt pool in The Etiology of disturbance in Disturbed bile salts / cholesterol ratio : (Lithogenic theory) in Etiology of Cholesterol & Mixed Stones of CCC in ETIOLOGY of Chronic Calcular Cholecystitis

A

causes Decrease hepatic bile salts synthesis

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12
Q

Crohn’s disease in Pathogenesis of Decrease in bile salt pool in The Etiology of disturbance in Disturbed bile salts / cholesterol ratio : (Lithogenic theory) in Etiology of Cholesterol & Mixed Stones of CCC in ETIOLOGY of Chronic Calcular Cholecystitis

A

causes inflammation of the terminal ileum which is the site of entero-hepatic circulation

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13
Q

Surgical removal of the terminal ileum in Pathogenesis of Decrease in bile salt pool in The Etiology of disturbance in Disturbed bile salts / cholesterol ratio : (Lithogenic theory) in Etiology of Cholesterol & Mixed Stones of CCC in ETIOLOGY of Chronic Calcular Cholecystitis

A

done in Right hemi colectomy

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14
Q

Pathogenesis of Increased cholesterol in bile in The Etiology of disturbance in Disturbed bile salts / cholesterol ratio : (Lithogenic theory) in Etiology of Cholesterol & Mixed Stones of CCC in ETIOLOGY of Chronic Calcular Cholecystitis

A
  1. D.M, obesity or increase dietary fat intake.

2. Estrogen increases cholesterol level in bile.

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15
Q

Pathogenesis of Bile stasis in Etiology of Cholesterol & Mixed Stones of CCC in ETIOLOGY of Chronic Calcular Cholecystitis

A

Gall bladder contractility is reduced by

a) Oral contraceptive pills.
b) Repealed pregnancy.
c) Patients on long-term parenteral nutrition. (Dec release of cholecystokinin)
d) After truncal vagotomy.
e) D.M & obesity ( neuropathy)

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16
Q

Pathogenesis of infection in Etiology of Cholesterol & Mixed Stones of CCC in ETIOLOGY of Chronic Calcular Cholecystitis

A

Bacteria & epithelial debris provides the nidus for stone formation

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17
Q

Monaghan aphorism

A

The stone is the tomb of organism

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18
Q

Etiology of Pigment Stones in ETIOLOGY of Chronic Calcular Cholecystitis

A

1) Hemolytic anemia:(especially spherocytosis)
2) Hepatic cirrhosis :
3) Infection by E. coli
4) Parasitic infestation

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19
Q

Pathogenesis of Hemolytic anemia in Etiology of Pigment Stones in ETIOLOGY of Chronic Calcular Cholecystitis

A

Excessive destruction of RBCs which results in increase of bile pigments (black pigment stones).

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20
Q

Pathogenesis of Hepatic cirrhosis in Etiology of Pigment Stones in ETIOLOGY of Chronic Calcular Cholecystitis

A
  1. decrease ability of the liver to conjugate bilirubin
  2. decrease hepatic bile salt synthesis
  3. Cirrhosis increases all types of gallstones, but black pigment stones are the commonest
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21
Q

The commonest stones in Pathogenesis of Hepatic cirrhosis in Etiology of Pigment Stones in ETIOLOGY of Chronic Calcular Cholecystitis

A

black pigment stones

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22
Q

Pathogenesis of Infection by E. coli in Etiology of Pigment Stones in ETIOLOGY of Chronic Calcular Cholecystitis

A

E. coli secretes p- glucoronidase enzyme

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23
Q

p- glucoronidase enzyme in Pathogenesis of Infection by E. coli in Etiology of Pigment Stones in ETIOLOGY of Chronic Calcular Cholecystitis

A
  1. secreted by E.coli
  2. deconjugates bilirubin diglucoronide to insoluble bilirubin which combines with calcium & ppts as calcium bilirubinate (brown pigment stones).
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24
Q

Pathogenesis of Parasitic infestation in Etiology of Pigment Stones in ETIOLOGY of Chronic Calcular Cholecystitis

A

Ascariasis lumbricoides & Clonorchis sinensis Reach the CBD and predispose infection by E coli forming brown pigment stones.

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25
Q

TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A
  1. The right classification of stones
  2. Department classification of stones
  3. Etiological classification of stones
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26
Q

The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A
  1. Pure cholesterol stones
  2. Mixed cholesterol stones
  3. Black pigment stones
  4. Brown pigment stones
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27
Q

Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A
  1. composition
  2. number
  3. size
  4. color
  5. shape
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28
Q

Composition of Pure cholesterol stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

Nearly 100% cholesterol

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29
Q

Composition of Mixed cholesterol stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

60% cholesterol Plus

  1. calcium carbonate
  2. calcium phosphate
  3. calcium palmitate.
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30
Q

Composition of Black pigment stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

Calcium bilirubinate

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31
Q

Composition of Brown pigment stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

Mainly Calcium bilirubinate Plus

  1. calcium palmitate
  2. calcium carbonate
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32
Q

Number of Pure cholesterol stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

Mainly Single “cholesterol solitaire” or multiple up to 4

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33
Q

Number of Mixed cholesterol stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

multiple

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34
Q

Number of Black pigment stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

multiple

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35
Q

Number of Brown pigment stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

multiple

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36
Q

Size of Pure cholesterol stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

Large> 2.5 cm.

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37
Q

Size of Mixed cholesterol stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

small < 2.5 cm.

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38
Q

Size of Black pigment stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

small < 2.5 cm.

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39
Q

Size of Brown pigment stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

small < 2.5 cm.

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40
Q

Color of Pure cholesterol stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

White

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41
Q

Color of Mixed cholesterol stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

yellow

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42
Q

Color of Black pigment stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

Tarry black

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43
Q

Color of Brown pigment stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

Brown

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44
Q

Shape of Pure cholesterol stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

Rounded or oval & mamillated.

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45
Q

Shape of Mixed cholesterol stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

Faceted & laminated

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46
Q

Shape of Black pigment stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

Rounded or oval

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47
Q

Shape of Brown pigment stones in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

Rounded or oval

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48
Q

the reason why Shape of Mixed cholesterol stones is Faceted & laminated in Difference between types of stones in The right classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

facets after resolution of infection

Laminated : cut section show layers due multiple episodes of infection each episode is represented by a layer

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49
Q

Department classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A
  1. cholesterol stones
  2. pigment stones
  3. mixed stones
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50
Q

Difference between types of stones in Department classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A
  1. incidence

2. composition

51
Q

incidence of cholesterol stones in Difference between types of stones in Department classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

5%

52
Q

incidence of pigment stones in Difference between types of stones in Department classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

5%

53
Q

incidence of mixed stones in Difference between types of stones in Department classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

90%

54
Q

composition of cholesterol stones in Difference between types of stones in Department classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

includes pure cholesterol stones

55
Q

composition of Pigment stones in Difference between types of stones in Department classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

includes black cholesterol stones

56
Q

composition of mixed stones in Difference between types of stones in Department classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

includes mixed cholesterol and brown pigment stones

57
Q

Etiological classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A

Primary pure metabolic stones

Secondary to infection stones

58
Q

Composition of Primary pure metabolic stones in Etiological classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A
  1. pure cholesterol stones

2. black pigment stones

59
Q

Composition of Secondary to infection stones in Etiological classification of stones in TYPES AND PATHOLOGY of Chronic Calcular Cholecystitis

A
  1. mixed cholesterol stones

2. brown pigment stones

60
Q

CLINICAL PICTURE of Chronic Calcular Cholecystitis

A
  1. TYPE OF PATIENT
  2. Symptoms
  3. Examination
61
Q

TYPE OF PATIENT in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A
  1. Fatty, filthy (very good appetite), fertile, females, > 40 years
  2. Exceptions to this rule are, however too frequent.
62
Q

Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A

1) Mainly silent and asymptomatic
2) Pain
3) Fatty (biliary) dyspepsia following fatty meal
4) Picture of complications

63
Q

Mainly silent and asymptomatic in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A

Discovered accidentally by U.S.

64
Q

Pain in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A

a) Biliary ache

b) Recurrent attacks of biliary colic

65
Q

Biliary ache in Pain in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A
  1. Pathogenesis:
  2. Character
  3. Site
  4. Radiation
66
Q

Pathogenesis of Biliary ache in Pain in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A

Due to chronic inflammation of Gall bladder

67
Q

Character of Biliary ache in Pain in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A

Dull constant ache

68
Q

Site of Biliary ache in Pain in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A

often occurs in the right hypochondrium.

69
Q

Radiation of Biliary ache in Pain in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A

Sometimes radiating to

  1. The epigastrium,
  2. Right infrascapular region
  3. The right shoulder.
70
Q

Recurrent attacks of biliary colic in Pain in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A
  1. Pathogenesis
  2. onset
  3. course and duration
  4. Radiation
  5. Association
71
Q

Pathogenesis of Recurrent attacks of biliary colic in Pain in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A
  1. Pain may be precipitated by fatty meal

2. Due to stone impacted in Hartman’s pouch or cystic duct

72
Q

onset of Recurrent attacks of biliary colic in Pain in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A

usually starts abruptly and reaches maximum intensity within 60 minutes

73
Q

course and duration of Recurrent attacks of biliary colic in Pain in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A
  1. The pain generally continues without fluctuation and resolves gradually over 2-6 hours
  2. Pain lasting longer than 6 hours should raise the suspicion for acute cholecystitis
74
Q

Pain lasting longer than 6 hours in course and duration of Recurrent attacks of biliary colic in Pain in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A

should raise the suspicion for acute cholecystitis

75
Q

Radiation of Recurrent attacks of biliary colic in Pain in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A

Sometimes radiating to

  1. The epigastrium,
  2. Right infrascapular region
  3. The right shoulder.
76
Q

Association of Recurrent attacks of biliary colic in Pain in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A

There may be nausea or vomiting during the attack

77
Q

Fatty (biliary) dyspepsia following fatty meal in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A
  1. List of symptoms

2. Pathogenesis

78
Q

List of symptoms of Fatty (biliary) dyspepsia following fatty meal in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A
  1. Flatulence,
  2. Bloating
  3. Excessive eructation.
  4. Nausea
  5. Heartburn
79
Q

Pathogenesis of Fatty (biliary) dyspepsia following fatty meal in Symptoms in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A
  1. Due to disturbed bile salts / cholesterol ratio )> dec bile salts
  2. Due to chronic cholecystitis )> gall bladder unable to contract
80
Q

Examination in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A
  1. Tenderness at the tip of the 9th costal cartilage
  2. Murphy’s sign :(non specific)
  3. A palpable gall bladder
81
Q

Murphy’s sign in Examination in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A
  1. Non specific
  2. If continuous gentle pressure is exerted over right hypochondrium while the patient takes a deep breath, there will be a “catch” of breath before the end of inspiration.
82
Q

A palpable gall bladder in Examination in CLINICAL PICTURE of Chronic Calcular Cholecystitis

A

Only in case of mucocele & empyema

83
Q

DIFFERENTIAL DIAGNOSIS of Chronic Calcular Cholecystitis

A

1) Chronic peptic ulcer.
2) Reflux oesophagitis & hiatus hernia.
3) Chronic relapsing pancreatitis.
4) Colitis.

84
Q

INVESTIGATIONS of Chronic Calcular Cholecystitis

A
  1. Laboratory

2. Radiological

85
Q

Laboratory investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A
  1. Serum total & direct bilirubin

2. ALP and gamma GT

86
Q

Findings of Serum total & direct bilirubin, ALP and gamma GT in Laboratory investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A
  • They should be normal.

* Elevated levels directs attention to the possibility of silent stone in CBD

87
Q

Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A

1) Abdominal U.S : Investigation of choice.
2) Endoscopic retrograde cholangio-pancrcatography ( ERCP) :
3) Oral cholecystography (not done now) :
4) Plain X-ray abdomen :( unreliable)

88
Q

Investigation of choice in INVESTIGATIONS of Chronic Calcular Cholecystitis

A

Abdominal U.S

89
Q

Abdominal U.S in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A
  1. Advantages

2. Findings

90
Q

Advantages of Abdominal U.S in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis ( 2 - 2 - 2)

A
  1. Advantages of the procedure itself
  2. Competency in detecting stones and other gallbladder pathology
  3. Competency to image adjacent structures
91
Q

Advantages of the procedure itself in Advantages of Abdominal U.S in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A
  1. Non-invasive, rapid, inexpensive & easy to perform (can be performed at the bedside).
  2. Uses no ionizing radiation (safe in pregnant patients).
92
Q

Competency in detecting stones and other gallbladder pathology in Advantages of Abdominal U.S in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A
  1. The sensitivity & specificity in detecting stones is > 95%
  2. Detects other gallbladder pathology beside stones, such as chronic cholecystitis (by wall thickness) or carcinoma
93
Q

Competency to image adjacent structures in Advantages of Abdominal U.S in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A
  1. Adjacent upper abdominal structures can be imaged at the same time.
  2. It reveals the CBD diameter which should be normal
94
Q

Dilated CBD in Competency to image adjacent structures in Advantages of Abdominal U.S in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A
  1. Directs attention to the possibility of silent stone in CBD.
  2. Incidence of Silent stone in CBD in patients with gall stones
95
Q

Incidence of Silent stone in CBD in patients with gall stones in Dilated CBD in Competency to image adjacent structures in Advantages of Abdominal U.S in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A

10-20%

96
Q

Findings of Abdominal U.S in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A
  1. Echogenic foci with posterior acoustic shadowing

2. This foci is mobile with movement of the patient

97
Q

Meaning of Echogenic foci in Findings of Abdominal U.S in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A

solid structure

98
Q

Meaning of Posterior Acoustic shadowing in Findings of Abdominal U.S in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A

100% reflection of sonar waves )> stones

99
Q

Indications of ERCP in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A

Done ONLY if stone in CBD is suspected by :

a) Persistent elevation in ALP, gamma GT, total & direct bilirubin.
b) Abdominal U.S reveals dilated CBD or IHBR.

100
Q

IHBR in Indications of ERCP in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A

stands for Intra hepatic biliary radical

101
Q

Oral cholecystography in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A
  1. Indication

2. Finding

102
Q

Indication of Oral cholecystography in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A

Not done now

103
Q

Finding of Oral cholecystography in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A

Radio-lucent stones appear as multiple filling defects

104
Q

Plain X-ray abdomen in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A
  1. Percentage of radio-opaque gall stones

2. The reason why Plain X-ray abdomen is unreliable

105
Q

Percentage of radio-opaque gall stones in Plain X-ray abdomen in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A

10-15%

106
Q

The reason why Plain X-ray abdomen is unreliable in Plain X-ray abdomen in Radiological investigations in INVESTIGATIONS of Chronic Calcular Cholecystitis

A

as Percentage of radio-opaque gall stones is 10-15%

107
Q

Treatment of Chronic Calcular Cholecystitis

A

I. Cholecystectomy either open or better laparoscopic

II. Non- surgical treatment of gall stones ( Not practical )

108
Q

The Standard treatment in Treatment of Chronic Calcular Cholecystitis

A

Cholecystectomy either open or better laparoscopic

109
Q

Indications of Cholecystectomy either open or better laparoscopic in Treatment of Chronic Calcular Cholecystitis

A

Management depends on the age and the general fitness for surgery:

  • In elderly or unfit patients it is wise to leave the patient for regular follow-up.
  • In young fit patients it is recommended to do cholecystectomy
  • The presence of D.M. favors cholecystectomy
110
Q

the reason why In young fit patients it is recommended to do cholecystectomy in Indications of Cholecystectomy either open or better laparoscopic in Treatment of Chronic Calcular Cholecystitis

A

as the life span of the patient is long and there is a high chance for occurrence of complications

111
Q

the reason why The presence of D.M. favors cholecystectomy in Indications of Cholecystectomy either open or better laparoscopic in Treatment of Chronic Calcular Cholecystitis

A

because if acute cholecystitis occurs it is likely to pass rapidly to gangrene

112
Q

Non- surgical treatment of gall stones ( Not practical ) in Treatment of Chronic Calcular Cholecystitis

A

1) Dissolution therapy
2. Extracorporeal shock - Wave Iithotripsy (ESWL).
3. Percutaneous cholecystolithotomy.

113
Q

Dissolution therapy in Non- surgical treatment of gall stones ( Not practical ) in Treatment of Chronic Calcular Cholecystitis

A
  1. Definition
  2. INDICATIONS
  3. DURATION OF THERAPY
  4. SUCCESS RATE
114
Q

Definition of Dissolution therapy in Non- surgical treatment of gall stones ( Not practical ) in Treatment of Chronic Calcular Cholecystitis

A

Oral dissolution with bile acids : Chenodeoxycholic acid or ursodeoxycholic acid.

115
Q

INDICATIONS of Dissolution therapy in Non- surgical treatment of gall stones ( Not practical ) in Treatment of Chronic Calcular Cholecystitis

A
  1. Pure cholesterol gallstones.
  2. The stones should ideally be less than 1.5 cm diameter.
  3. The stones should he few in number (<4).
  4. The gall bladder should he functioning (can contract).
116
Q

DURATION OF THERAPY of Dissolution therapy in Non- surgical treatment of gall stones ( Not practical ) in Treatment of Chronic Calcular Cholecystitis

A

6 months to 2 years of therapy

117
Q

SUCCESS RATE of Dissolution therapy in Non- surgical treatment of gall stones ( Not practical ) in Treatment of Chronic Calcular Cholecystitis

A
  1. 60% after 2 years

2. after this, half the successful patients will develop recurrent stones within 5 years

118
Q

The reason why Extracorporeal shock - Wave Iithotripsy (ESWL) is Not recommended in Non- surgical treatment of gall stones ( Not practical ) in Treatment of Chronic Calcular Cholecystitis

A

as it may cause calcular obstructive jaundice

119
Q

GaIl stones in relation to other diseases

A
  1. Saint’s triad

2. Wilkie’s Triad

120
Q

Saint’s triad in GaIl stones in relation to other diseases

A

A Triad of :

Gall stones, Hiatus hernia & Diverticulosis coli.

121
Q

Wilkie’s Triad in GaIl stones in relation to other diseases

A

A Triad of :

Chronic cholecystitis, Chronic peptic ulcer & Recurrent appendicitis.

122
Q

A Triad of :

Gall stones, Hiatus hernia & Diverticulosis coli.

A

Saint’s triad

123
Q

A Triad of :

Chronic cholecystitis, Chronic peptic ulcer & Recurrent appendicitis.

A

Wilkie’s Triad

Surgery.(GIT 2).Gallbladder (3 decks)

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