1 / 19

Behzad Nakhaei, M.D. , FICS Fellowship in HepatoBiliary Surgery Mc Gill University

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.

misae
Download Presentation

Behzad Nakhaei, M.D. , FICS Fellowship in HepatoBiliary Surgery Mc Gill University

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Behzad Nakhaei, M.D. , FICSFellowship 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 PresentationsIn RUQ & Upper AbdomenDue 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. 3Most 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. Diagnosis AcuteCholecystitis Biliary Colic Acute Cholangitis Acute Pancreatitis Sono Finding Stone & Thickening of wall Stone in Biliary Tree Stone & Dilatation of CBD Pancreas Enlargement Pain & Fever

  7. Cholecystitis ? • Acute Calculous • Acute Acalculous • Emphysematous • Hydrops • Empyema • Chronic

  8. Risk Factors of Gangrene & Perforationin 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 SuppurativeCholangitis • Cholangiohepatitis • Sclerosing Cholangitis

  12. Acute SuppurativeCholangitis? • 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

More Related