1. GALL BLADDER DISEASE Dr Suleiman Jastaniah,FRCS (Ed),FACS,Associted Prof.Umm- Alqura university.

2. ANATOMY :

3. PHYSIOLOGY : - Concentrate bile by absorption of water and sodium. -CCK-------Gall.b.emptying. -Vagal stimulation. DIAGNOSIS : * Plain Abdominal X-Ray. *Oral cholecystography : >Radio-opaque dye >It is +ve if it shows : a. Filling defect b.Non functioning G.B

5. * U/S *CT SCAN

6. GALL STONE : >Common problem all over the world. >Mixed. >Cholestrol. >Pigmented. GALL STONE : >Common problem all over the world. >Mixed. >Cholestrol. >Pigmented.

7. CLINICAL MANIFISTATIONS :.GALLBLADDER STONE : 1.Asymptomatic. 2.Biliary Colic. 3.A.Cholecystitis> *Gangrene. *Perforation. *Empyema. 4.Ch.Cholecystitis.

8. 5.Mucocele. 6.Intestinal obstruction. Gallstone Ileus. 7.Carcinoma. 5.Mucocele. 6.Intestinal obstruction. Gallstone Ileus. 7.Carcinoma.

9. Common Bile Duct Stones : >Obstructive Jaundice. >A.Cholangitis. >Acute Pancreatitis.

10. MANAGEMENT : 1.Open Cholecystectomy. 2.Laproscopic Cholecystectomy. 3.Cholecystostomy — ill patient. *In Acute Cholecystitis.

12. C.B.D. STONE : -Primary (Denovo) -Secondary (common ). *Diagnosis : *L.F.T *PT,APPT. *U/S. *ERCP. *MRCP. >HOW do you prepare obstructive jaundice patient?

13. MANAGEMENT OF C.B.D.STONES : -ERCP - Exploration of C.B.D. - Biliary enteric anastomasis. -Retained Stones : *Extraction through T-tube. *Percutanously via transhepatic route. *Dissolution by solvent. *ESWL. *Surgery.

14. COMPLICATIONS OF CHOLECYSTOCTOMY: 1.Bleeding. 2.C.B.D. injury. 3.Stricture. 4.Postcholecystectomy syndrome.

15. COMPLICATIONS ASSOCIATED WITH OBSTUCTIVE JAUNDICE : 1.Cholengitis. 2.Disorders of Clotting Factors. 3.Renal Failure. 4.Liver Failure. 5.Fluid and electrolyte disorders.

16. Char cot's triad : -Fever. -Jaundice. -Rt.upper quadrant pain. *Reynolds Pentad -Septic shock -Mental status changes