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Gallstone Disease
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Definitions Acute calculous cholecystitis = occlusion of the cystic duct by gallstone leading to gallbladder inflammation Chronic calculous cholecystitis = recurrent episodes of cystic duct obstruction leading to chronic inflammation
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Bile Bile Bile salts Phospholipids Cholesterol
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Types of Gallstones Mixed (80%) Pure cholesterol (10%) Pigmented (10%)
Black stones (associated with cirrhosis and hemolysis)
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Gallstone Pathogenesis
(1) cholesterol supersaturation in bile (2) Reduced bile salts-illeal resection (3) Increased hemolysis ,
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Gallstone Risk Factors
“Female, Fat, Forty, Fertile” Obesity Fatty diet DM Ileal resection Hemolytic states Cirrhosis Bile duct stasis Hyperlipidemia
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Gallstone Complications
Gallstone ileus gallstone pancreatitis Acute cholecystitis GB gangrene GB perforation GB empyema (pus in the GB) Choledochohlithiasis Cirrhosis Cholangitis Pancreatitis
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Diagnostic Criteria for Acute Cholecystitis, According to Tokyo Guidelines
Table 1. Diagnostic Criteria for Acute Cholecystitis, According to Tokyo Guidelines. Strasberg S. N Engl J Med 2008;358:
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Cholecystitis: Management
NPO, IVF, IV antibiotics Non-operative Operative: cholecystectomy
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