1. Gall bladder and Biliary disease Dr.Umit Akyuz Gastroenterology Department Yeditepe University,Istanbul

2. Biliary stone disease Acute cholecytitis Primer sclerosane cholangitis Primer biliary cirrhosis Tumors

3. CHOLELITHIASIS Chole – CYSTO - GALLBLADDER - DOCHO – D. CHOLEDOCHUS - DOCHO – D. CHOLEDOCHUS CHOLESTEROL%75 PIGMENT(blb, ca)% 25

4. CHOLESTROL STONES CHARACTERISTICS: –PURE OR MIXED –SMALL OR LARGE –SOLITARY OR MULTIPLE PIGMENT STONES CHARACTERISTICS: –ELDERLY –HEMOLYTIC STATES –CIRRHOSIS –MULTIPLE, IRREGULAR –CENTRAL CALCIFICATION

5. RISK FACTORS 4 F : –Female –Fat –Fertile –Forty 3 D –Diabetes –Drugs –Diet 2 H –HLP –Heredity Bile Salt Malabsorbtion

6. COMPLICATIONS STONE – PASSAGE –HYDROPS –CHOLECYSTITIS –ICTERUS Ac. CHOLECYTITIS EMPYEMAPERFORATION Chr. CHOLECYTITIS

7. CLINICS COLIC: –RUQ crampy Pain RADIATIONBACK DYSPEPSIA Ac. CHOLECYTITIS + COMPLICATIONS

8. DIAGNOSIS USG X-Ray Plain Film ERC / P PTC CT

9. THERAPY SpasmolyticaAntibioticsSURGERY –Absolute Complications –Relative Complications Medical: –Oral Lytholysis –Ursodeoxy-cholic Acid –ESLW

10. therapy

11. ACUTE CHOLECYSTITIS Acute Inflammation PrimaryAbacterial SecondaryBacterial Enterococcus E. Coli Gr. (-) Bacilli Anaerobs –Bacteroides –Clostridia –Fusobacterium

12. Symptoms Biliary colic Fever, chills, anorexia, nausea, vomiting Enlarged Gallbladder Murphy’s sign : RUQ-Palpation increased Pain in Inspiration

13. Diagnosis: Clinics, US, biochemistry Complications  Empyema  Gangrene Perforation Perforation  Ileus

14. Therapy  PE - Nutrition  Antibiotics Cholecystectomie ? Cholecystectomie ? for Complications ! for Complications !

15. CHOLANGITIS Charcot’s Biliary pain Charcot’s Biliary pain TriadJaundice TriadJaundiceFever

16. Bacteria E. coli KlebsiellaProteus E. bacter PseudomonasClostridium

17. Complications Sepsis Hepatic Abcess Bil. Strictures Gallstones Sec. Bil. Cirrhosis PHT

18. Treatment ERCPAntibiotics

19. Primary Sclerosing Cholangitis İdiopathicintra+extrahepaticChronic Fibrosing,Diffuse of bile Ducts Clinics:Cholestasis Bile D. Obliteration Cirrhosis

20. Clinics JaundicePruritusFatique Weight loss UC75 %, CD, RA, Sarcoidosis,Sjögren Syndrome UC75 %, CD, RA, Sarcoidosis,Sjögren Syndrome M/F 1/3 ANCA + ; IgM 

21. Complications 5 – C CholestasisCirrhosisCholangitisCholelithiasisCholangiocarcinoma

22. Therapy ABCholestyramineUrsodeoxycholicacid Surgical : Liver Transplantation !

24. Primary Biliary Cirrhosis İnterlobuler and septal bile ducts Middle aged population 100-150/1 million

25. Clinics FatiguePiruritisAsymtomaticJaundince Variciel bleeding ascites

26. Assosiated Disease keratoconjuctivites sikka (50%) Thyroid disease (15%) Artrithes (10%) Reynaud (9%) Scleroderma Renal stones Breast cancer

27. Diagnosis AMA >1/40 (M2 band) 95% AST, ALT high IgM high Biluribune high Hypercholesterolemia 80% Pathology: florid duct lesions

28. Complications Osteopenia Fat soluble vit. Deficiency hypercholesterolemia

29. Treatment Ursodeoxycholic acid CorticosteroidsAzothioprineCyclosporineMethotraxate Penicilamine,colhicine no benefit Transplantation

30. TUMORSBENIGN –Polips –Adenomyomatosis –Cholesterosis MALIGN –Carcinoma –Adeno –Squamous Ductus Carcinoma –Pat 60 Years