Download presentation
Presentation is loading. Please wait.
Published byEvan Cannon Modified over 9 years ago
1
Behzad Nakhaei, M.D., FICS Fellowship in HepatoBiliary Surgery Mc Gill University RUQ & Upper Abdomen Inflammation & Infection GallBladder & Biliary System Disorders ( A Problem Solving Lecture ) For Medical Students
2
Common Clinical Presentations In RUQ & Upper Abdomen Due to Inflammation & Infection Pain & Fever Jaundice & Fever Mass & Fever (One / Two Symptoms Dominate in each of these )
3
Signal the need for: Complete Blood Count Liver Function Test Serum Amylase PT, PTT Blood Culture Chest & Abdominal X ray Abdominal Ultrasonography
4
3 Most common Scenario :? Acute Cholecystitis? OR Acute Cholangitis? OR Acute Pancreatitis?
5
Pain & Fever? Upper Abdomen Sepsis == RUQ Pain & Fever In 2/3 of Cases Biliary Origin (Acute Cholecystitis, Biliary Colic, Acute Cholangitis) Acute Pancreatitis Pneumonia Hepatitis, Herpes Zoster Other gastrointestinal Disease Sono is the most important Screening test for Acute Biliary Infections.
6
Pain & Fever – Diagnosis Acute Cholecystitis Biliary Colic Acute Cholangitis Acute Pancreatitis – Sono Finding Stone & Thickening of wall Stone in Biliary Tree Stone & Dilatation of CBD Pancreas Enlargement
7
Cholecystitis ? Acute Calculous Acute Acalculous Emphysematous Hydrops Empyema Chronic
8
Risk Factors of Gangrene & Perforation in Acute Cholecystitis Systemic Toxicity Emphysematous Cholecystitis Acalculous Cholecystitis
9
Fever & Jaundice ? If the Patient Presents with : Fever > 38.5 & Jaundice Leukocytosis & Positive Blood Culture Stone & Biliary tree dilatation on Sono Reynolds, Pentad ( Abdominal Pain, Fever&Chills,Jaundice, Hypotension,Mental confusion ) Dx is Acute Cholangitis
10
Cholangitis? Infection within Biliary tree Due to : Choledocholithiasis Choledochal cysts Bile Duct CA Sphincteroplasty Instrumentation of Biliary tree
11
Cholangitis ? Acute Suppurative Cholangitis Cholangiohepatitis Sclerosing Cholangitis
12
Acute Suppurative Cholangitis? Pus within the Biliary tract Complicated by Obstructive Jaundice Charcot triad : Jaundice, Chill, Fever Age Over 70 ERCP or PTC Surgical Intervention
13
Cholangiohepatitis Most common in China & Hong Kong Clonorchiasis Ascariasis Malaria Hemolysis E coli & Klebsiella Toxic Condition Emergency surgery
14
Sclerosing Cholangitis Involve Extra & Intrahepatic Biliary tree Association with Ulcerative colitis&Crohn HIV infection has been noted Most common in middle age men By Pass operation for Palliation Liver Transplantation for Cure
15
Fever & Abdominal Mass? The origin of Pathology is in the : GallBladder Or Liver
16
Fever & Abdominal Mass? –Possible Diagnosis Are : Empyema of GB Hydrops of GB Pyogenic Liver Abscess Liver infected Cysts
17
Biliary Enteric Fistula & Gallstone Ileus Between GB & Duodenum 85% Between GB & Colon 15 % Can cause Mechanical Obstruction Most often in Terminal Ilum Past history of Cholelithiasis is present
18
Mirizzi,s Syndrome ? A fistula between Hartmann's Pouch & CBD A Stone in the Ampulla of the GB can erode the CBD and can destroyed CBD Partially or Completely
19
YOU!!!!!!!! Try to BE A Sophisticated Person
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.