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Explore biliary stone disease, acute cholecystitis, primary sclerosing cholangitis, and tumors at Yeditepe University's Gastroenterology Department in Istanbul. Learn about cholelithiasis, gallstone characteristics, risk factors, complications, clinics, diagnosis, and therapy options.
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Gall bladder and Biliary disease Dr.UmitAkyuz GastroenterologyDepartment Yeditepe University,Istanbul
Biliary stone disease • Acute cholecytitis • Primer sclerosane cholangitis • Primer biliary cirrhosis • Tumors
CHOLELITHIASIS • Chole – CYSTO- GALLBLADDER • - DOCHO – D. CHOLEDOCHUS • CHOLESTEROL %75 • PIGMENT(blb, ca) % 25
CHOLESTROL STONES • CHARACTERISTICS: • PURE OR MIXED • SMALL OR LARGE • SOLITARY OR MULTIPLE PIGMENT STONES • CHARACTERISTICS: • ELDERLY • HEMOLYTIC STATES • CIRRHOSIS • MULTIPLE, IRREGULAR • CENTRAL CALCIFICATION
RISK FACTORS • 4 F : • Female • Fat • Fertile • Forty • 3 D • Diabetes • Drugs • Diet • 2 H • HLP • Heredity • Bile Salt Malabsorbtion
COMPLICATIONS • STONE – PASSAGE • HYDROPS • CHOLECYSTITIS • ICTERUS • Ac. CHOLECYTITIS • EMPYEMA • PERFORATION • Chr. CHOLECYTITIS
CLINICS • COLIC: • RUQ crampy Pain • RADIATION BACK • DYSPEPSIA • Ac. CHOLECYTITIS + COMPLICATIONS
DIAGNOSIS • USG • X-Ray Plain Film • ERC / P • PTC • CT
THERAPY • Spasmolytica • Antibiotics • SURGERY • Absolute Complications • Relative Complications • Medical: • Oral Lytholysis • Ursodeoxy-cholic Acid • ESLW
ACUTE CHOLECYSTITIS Acute Inflammation • Primary Abacterial • Secondary Bacterial • Enterococcus • E. Coli • Gr. (-) Bacilli • Anaerobs • Bacteroides • Clostridia • Fusobacterium
Symptoms • Biliary colic Fever, chills, anorexia, nausea, vomiting • Enlarged Gallbladder • Murphy’s sign : RUQ-Palpation increased Pain in Inspiration
Diagnosis: Clinics, US, biochemistry Complications Empyema Gangrene Perforation Ileus
Therapy PE - Nutrition Antibiotics Cholecystectomie ? for Complications !
CHOLANGITIS Charcot’s Biliary pain Triad Jaundice Fever
Bacteria • E. coli • Klebsiella • Proteus • E. bacter • Pseudomonas • Clostridium
Complications • Sepsis • Hepatic Abcess • Bil. Strictures • Gallstones • Sec. Bil. Cirrhosis • PHT
Treatment • ERCP • Antibiotics
Primary Sclerosing Cholangitis İdiopathic intra+extrahepatic Chronic Fibrosing,Diffuse of bile Ducts Clinics: Cholestasis Bile D. Obliteration Cirrhosis
Clinics Jaundice Pruritus Fatique Weight loss UC 75 %, CD, RA, Sarcoidosis,Sjögren Syndrome M/F 1/3 ANCA + ; IgM
Complications 5 – C • Cholestasis • Cirrhosis • Cholangitis • Cholelithiasis • Cholangiocarcinoma
Therapy • AB • Cholestyramine • Ursodeoxycholicacid • Surgical : Liver Transplantation !
Primary Biliary Cirrhosis • İnterlobuler and septal bile ducts • Middle aged population • 100-150/1 million
Clinics • Fatigue • Piruritis • Asymtomatic • Jaundince • Variciel bleeding • ascites
Assosiated Disease • keratoconjuctivites sikka (50%) • Thyroid disease (15%) • Artrithes (10%) • Reynaud (9%) • Scleroderma • Renal stones • Breast cancer
Diagnosis • AMA >1/40 (M2 band) 95% • AST, ALT high • IgM high • Biluribune high • Hypercholesterolemia 80% • Pathology: florid duct lesions
Complications • Osteopenia • Fat soluble vit. Deficiency • hypercholesterolemia
Treatment • Ursodeoxycholic acid • Corticosteroids • Azothioprine • Cyclosporine • Methotraxate • Penicilamine,colhicine no benefit • Transplantation
TUMORS • BENIGN • Polips • Adenomyomatosis • Cholesterosis • MALIGN • Carcinoma • Adeno • Squamous • Ductus Carcinoma • Pat 60 Years