LIVER & BILLIARY TRACT 19 CHOLANGITIS

CHOLANGITIS

Infection within the biliary duct system is associated with:

*  Choledocholithiasis

*  Choledochal cysts

*  Carcinoma of the bile ducts and is a result of obstruction and

   stasis of bile.  Clinically the condition is characterized by

   *  Intermittant fever

   *  Upper abdominal pain

   *  Jaundice with chills and rigor

TREATMENT

A broad spectrum antibiotic acting on E.Coli usually controls the

infection,  but,  if  the temperature  does  not  fall,  surgical

interventions should not be delayed and involves either  removing

the cause of the obstruction of bypassing it.

Any questions be sent to drmmkapur@gmail.com

All older post are stored in archives for access & review.

Visitors that follow may post contributions to the site please write to address above.

To create consumer/provider engagement visit www.drmmkaput.blogspot.com

www.otmanagr.blogspot.cokm 

LIVER & BILLIARY TRACT 18 Chronic Cholecystitis

CHRONIC CHOLECYSTITIS

The presentation of this disorder occurs most often with  chronic

long  standing  inflammation of the gallbladder  associated  with

cholelithiasis.

CLINICAL MANIFESTATIONS

Patients  generally present with moderate intermittant  abdominal

pain in the right upper quadrant and epigastrium radiating to the

scapula or interscapula region.

*  There is an intolerance to fatty and fried foods and

*  Intermittant nausea and anorexia

*  Occasionally,  tenderness  is elicited over  the  gallbladder,

   usually maximal during inspiration

Diagnosis  by  an  oral cholecystogram  demonstrates  absence  of

filling of gallbladder or the presence of stones.

*  An ultrasound scan aids early diagnosis.

TREATMENT

Treatment  of chronic cholecystitis is  cholecystectomy,  results

are usually excellant.

Recently    surgeons    have   been    recommending    endoscopic

cholescystectomy for selected cases of cholecystitis.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access & review.

Visitors that follow may post contributions to the site please write to address above.

To create consumer/prvider engagement visit www.drmmkapur.blogspot.com

www.otmanage.blogspot.com

LIVER BILLIARY TRACT 17 Acute Chlecystitis 2 D/D Investigations Treatment

DIFFERENTIAL DIAGNOSIS

Among the conditions that need to be considered are:

*  Perforation of peptic ulcer

*  Appendicitis

*  Myocardial ischemia

Investigations therefore may include:

*  X-ray abdomen

*  ECG

*  Hepatitis

*  Liver function test and haemogram

*  Serum bilirubin level

*  Oral cholecystography

*  Intravenous cholangiography

*  Ultrasound scan

TREATMENT

Non-operative management is directed at creating functional  rest

for   the  gallbladder  and  upper  gastrointestinal  tract   and

includes:

*  Restriction of fluid and

*  Continuous nasogastric suction

*  Pain is treated with small amounts of analgesics and

*  Use of antibiotics

If  early operation is performed, cholecystectomy, which  can  be

carried  out  with  a  low mortality  rate  sppes  the  patient's

recovery.

Most  surgeons,  however, prefer to treat the  acute  phase  with

antibiotics  and  control the  infection,  cholecystectomy  being

taken up after elimination of infection (6-12 weeks)

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site please write o address above.

To create consumer/provider engagement visit www.drmmkapur.blogspot.com

www.otmanage.blogspot.com

LIVER BILLIARY TRACT 16 Acute Cholecystitis 1

ACUTE CHOLECYSTITIS

The majority of cases have obstruction of the neck of gallbladder

accompanied by sepsis in gallbladder.

CLINICAL MANIFESTATIONS

An  attack of acute cholecystitis occurs in patients with a  past

history  of chronic cholecystitis and cholelithiasis and  present

between the fourth and eighth decade.

Onset of acute symptoms are usually after a heavy, fatty or fried

meal.

*  Moderate  to  severe pain is experienced in  the  right  upper

   quadrant or epigastrium.

*  It may radiate to the back near the angle of the scapula.

*  Tenderness is at the costal margin

*  Rebound  tenderness may be present or catch in the  breath  on

   deep inspiration (Murphy sign).

*  Mild icterus suggests additional choledocholithiasis.

Any questions be sent to drmmkapur@gmail.com

All older pots are stored in archives for access & review.

Visitors that follow may post contributions to the site please write to address above.

To create consumer/provider engagement visit www.drmmkapur.blogspot.com

www.otmanage.blogspot.com

LIVER BILLIARY TRACT 15 Gall stones asymptomatic gall stone illeus cystic duct obstruction cholecystitis

14 DISORDERS

14.1 ASYMPTOMATIC GALLSTONES

With  the  routine  use of ultrasound  for  abdomnal  complaints,

asymptomatic gallstones are being discovered.

14.2 SYMPTOMATIC

Calculi  may manifest in many ways.  The affects  of  symptomatic

stones are represented in Fig. above

14.3 GALLSTONE ILEUS

In  old  patients with long standing  gallstones,  sometimes  the

gallstone  pass  into  the intestine and as it  passes  down,  it

enlarges and gest impacted leading to intestinal obstruction.

14.4 CYSTIC DUCT OBSTRUCTION

A  stone may block the cystic duct without any infection, as  now

no bile can enter the gallbladder, it is filled only with mucus  (white

bile).    The   patient  presents  with   a   painless   palpable

gallbladder.

14.5 CHOLECYSTITIS

In  nearly  90%  of cases, inflammation  of  the  gallbladder  is

associated with calculi.  A bacterial cause of cholecystitis  has

been  proposed  and  the common causative  bacteria  are  E.Coli,

Streptococci and Salmonella.

CHOLEDOCHOLITHIASIS

Although  small  stones  may pass via the common  duct  into  the

duodenum,  the  distal  duct with its narrow  lumen  can  prevent

passage  of  stone.  This can lead to obstructive  jaundice  with

chills and rigors due to cholangitis

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access & review.

Visitors that follow may post contributions to the site please write to address above.

To create consumer/provider engagement visit www.drmmkapur.blogspot.com

www.otmanage.blogspot.com