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Gall bladder and Biliary disease. Dr.Umit Akyuz Gastroenterology Department Yeditepe University,Istanbul. Biliary stone disease Acute cholecytitis Primer sclerosane cholangitis Primer biliary cirrhosis Tumors. CHOLELITHIASIS. Chole – CYSTO - GALLBLADDER
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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