BENIGN BILIARY TRACT DISEASES

DEVELOPMENT AND FUNCTION FROM FOREGUT ABOUT 3 /52 0F GESTATION BLOOD SUPPLY -- COELIAC AND SUPR. MESENTERIC VESSELS FUNCTION - TRANSPORTS, STORES AND RELEASES BILE COUINAUD’S SEGMENTAL ANATOMY

COMMON CONDITIONS BILIARY ATRESIA CHOLEDOCHAL CYST GALL BLADDER STONES CBD STONES RPC BENIGN BILE DUCT STRICTURES BILIRY HYDATID DISEASE BENIGN TUMOURS

INVESTIGATIONS PLAIN X’RAY PNEUMOBILIA, STONE, GAS IN GALL BLADDER OR GALL BLADDER WALL, GALL STONE ILEUS

U/S SPECIFICITY 90% ACOUSTC SHADOWING PERICHOLECYSTIC FLUID THICKENING OF GALL BLADDER WALL POLYPS AND STONES CBD

RADIOLOGY Ix ORAL CHOLECYSTOGRAM PTC- IN DIALATED DUCTS ERCP CT HIDA BILIARY MANOMETRY EUS

CONG. ANOMALIES BILIARY ATRESIA--1/ KASAI PROCEDURE CHOLEDOCHAL CYST-- EXTRAHEPATIC OR INTRAHEPATIC TYPES 1-5

ACQUIRED- GALL BLADDER STONES % INCIDENCE MIXED STONES 75-90% CHOLESTEROL+ B.PIGMENTS+CA SALTS IN A CORE -LAMINTED-MULTIPLE STONES-COLOUR WHITE TO GREEN TO BLACK 10% RADIO- OPAQUE CAUSE - BILE STASIS,INFECTION AND ABNORMALITIES OF BILE CONSTITUENTS

CHOLESTEROL STONES 1O % LARGE SMOOTH EGG OR BARREL SHAPED CHOLESTEROL SOLITAIRE RADIOLUCENT CAUSE SAME AS ABOVE

PIGMENT STONES MULTIPLE, JET BLACK, SHINY, FRIABLE CA BILIRUBINATE CAUSE -- EXCESS BILIRUBIN SECRETION Ie.HAEMOLYTIC ANAEMIAS, INFECTIOS, MALARIA, LEUKEMIA etc COMMON IN ASIA.

CA. CARBONATE STONES RARE EXCESS SECRETION OF CA IN BILE GREYISH FACETED STONES RADIO-OPAQUE

ASYMTOMATIC BILIARY COLIC CHR. CHOLECYSTITIS ACUTE CHOLECYSTITIS

PAIN, FEVER,TACHYCARDIA MILD JAUNDICE GUARDING & REBOUND TENDERNESS MURPHY’S SIGN BOAS’ SIGN RADIATION TO THE SHOULDER ABSENCE OF SIGNS IN THE ELDERLY

BILIARY COLIC STONE IMPACTION AT THE NECK OF GB SEVERE PAIN NO FEVER ABSCENT MURPHY’S RADIATES TO THE BACK - NOT TO SHOULDER MILDTENDERNESS IN THE EPIG.

CHR. CHOLECYSTITIS PAIN IN RUQ/ EPIG. FATTY FOOD INTOLERANCE RADIATION TO BACK AND SHOULDER ABDOMINAL DISTENSION & FLATULENCE DDx P. ULCER,H.HERNIA,DIVERTICULAR DISEASE SAINTS TRIAD: GS,D. DISEASE &H. HERNIA

COMPLICATIONS EMPYEMA OF GALL BLADDER ACUTE EMPHYSEMATOUS CHOLECYSTITIS XANTHOGRANULOMATOUS CHOLECYSTITIS ACUTE ACALCULUS CHOLECYSTITIS CHOLESTEROLOSIS-STRAWBERRY G. BLADDER ADENOMYOMATOSIS MUCOCELE /INTERNAL BILIARY FISTULA

Mx OF GALL STONES GALL STONE DISSOLUTION THERAPY MINIMALLY I. STONE REMOVAL/DISSOLUTION ESWL CHOLECYSTECTOMY - OPEN AND LAPAROSCOPIC CHOLECYSTOSTOMY PARTIAL CHOLECYSTECTOMY

COMPLICATIONS CBD INJURY-MIRRIZZI SYNDROME VASCULAR INJURY RETAINED CBD STONE POSTCHOLECYSTECTOMY SYNDROME

CBD STONES - PRESENTATION O. JAUNDICE PANCRERATITIS ASCENDING CHOLANGITIS BILIARY COLIC DYSPEPSIA ELDERLY- OBSCURE SYMPTOMS ASYMTOMAYIC

CBD STONES -CONT’D SUPRADUODENAL CBD EXPLORATION ERCP -LITHOTRIPSY ESWL TRANSDUODENAL EXPLORATION & SPHINCTEROPLASTY CHOLEDOCHODUODENOSTOMY

RECURRENT PYOGENIC CHOLANGITIS ASIATIC/ ORIENTALS CLONORCHIS SINENSIS CHARCOT’S TRIAD RAYNAUD’S PENTAD

RPC- Mx ERCP/ SPHINCTEROTOMY/LITHOTRIPSY NASOBILIARY DRAINAGE -ACUTE STAGE CHOLEDOCHODUODENOSTOMY/CHOLEDOCHOJ EJUNOSTOMY ACCESS LOOP PTC- STONE REMOVAL LIVER RESECTION