You are on page 1of 20

By: Rey Martino

€ Lies

on the underside of the liver in the main liver scissura at the junction of the right and left lobes of the liver. pear-shaped structure, 7.5²12 cm long, with a normal capacity of about 35²50 ml. divisions are a fundus, a body and a neck that terminates in a narrow infundibulum.
2

€A

€ Anatomical

Definition ‡ Cholelithiasis is the presence of one or more calculi (gallstones) in the gallbladder. Characteristics and composition ‡ Gallstones can vary in size and shape, can be single large stone or many smaller ones ‡ On the basis of their composition, gallstones can be divided into cholesterol stones, pigment stones or mixed stones.
3

Cholesterol stones
‡ vary in color from light-yellow to dark-green or brown and are oval 2 to 3 cm in length. ‡ >80% cholesterol by weight ‡ Imbalance in bile between cholesterol, bile salts and phospholipids, producing lithogenic bile.

Pigment stones
‡ Pigment stones are small, dark stones made of bilirubin and calcium salts that are found in bile. ‡ <20% of cholesterol ‡ Chronic hemolysis, biliary tract infections,
4

Mixed stones
‡ Mixed gallstones typically contain 20²80% cholesterol, other common constituents are calcium carbonate, palmitate phosphate, bilirubin, and other bile pigments. ‡ Because of their calcium content, they are often radiographically visible. ‡ Associated with anatomical abnormalities, stasis, previous surgeries, previous infection

5

Risk factors
‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Female, Forty, Fat, Fertile Bile stasis Chronic hemolysis Oral contraceptives Rapid weight loss Obesity Total parenteral nutrition Ileal resection

6

Clinical Manifestation ‡ Episodic RUQ/epigastric pain ‡ Usually transient ‡ Colicky ‡ Often postprandial ‡ Radiate to the back, right scapula/right shoulder ‡ Food intolerance (esp. fatty, greasy or fried food) ‡ Dyspepsia, flatulence ‡ Nausea/vomiting ‡ RUQ tenderness and/or a palpable gallbladder may be present
7

Differential Diagnosis
‡ Cholecystitis ‡ Peptic ulcer disease ‡ Pancreatitis ‡ Cholangitis ‡ Biliary obstruction ‡ Myocardial ischemia
8

Diagnosis
‡ History and physical examination. ‡ FBC, LFT, amylase and lipase. ‡ Ultrasound will directly show gallstone shadows ‡ HIDA scan with CCK stimulation may diagnose biliary dyskinesia and may also be indicated to rule out cystic duct obs. and acute cholecystitis. ‡ Endoscopic retrograde cholangiopancreatography (ERCP) -suspected or proven CBD stones. ‡ CXR and ECG, abdominal x-ray will reveal gallstones in 10% of cases.
9

Porcelain Single large gall bladder gallstone
10

gall bladder wall

biliary sludge

Pericholecystic fluid
11

stone obstructing the common bile duct

12

1.
€

Asymptomatic Gallstones
Surgical treatment of asymptomatic gallstones without medically complicating diseases is discouraged risk of complications from interventions is higher than the risk of symptomatic disease

€

Cholecystectomy for asymptomatic gallstones may be indicated if:
‡ large gallstones (>2 cm diameter) ‡ nonfunctional or calcified (porcelain) gallbladder

observed on imaging studies and who are at high risk of gallbladder carcinoma ‡ spinal cord injuries or sensory neuropathies affecting the abdomen
13

€

Patients with risk factors for complications of gallstones may be offered elective cholecystectomy, even if they have asymptomatic gallstones. ‡ Cirrhosis ‡ Portal hypertension ‡ Children ‡ Transplant candidates ‡ Diabetes

€ Medical

dissolution of gallstones

‡ ursodiol (Actigall) and chenodiol (Chenix) work

best for small cholesterol stones
€ Stone

fragmentation (extracorporeal shock wave lithotripsy) to assist stone dissolution and clearance
14

2.

Symptomatic gallstones Cholecystectomy
i.
x

Laparoscopic cholecystectomy
Performed via three to four small puncture holes for a camera and instruments. Post-operative care typically includes a same-day release or a one night hospital stay, followed by a few days of home rest and pain medication

ii. Open cholecystectomy x Performed via an incision into the abdomen (laparotomy) below the right lower ribs. Recovery typically consists of 3²5 days of hospitalization, with a return to normal diet a week after release and normal activity several weeks after release

15

16

€ Complications

of Laparoscopic Cholecystectomy
‡ Early complication: x Common bile duct injury x Bile leak x Injury to viscera x Hemorrhage x Retained stones and abscess formation ‡ Late complication: x Biliary strictures x Cystic duct clip stones x Hemorrhage

17

18

19

20