welcome to my youtube channel medical
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sense
in this video i will discuss about the
most common biliary pathology
gallbladder stones also known as
colilithiasis
gallistones can be divided into three
main types cholesterol stones
mixed stones and pigment stones
cholesterol
or mixed stones contain 51 to 99 percent
of pure cholesterol
calcium salts bile acid bile pigment and
phospholipids whereas
pigment stone contain less than 30
percent of cholesterol
there are two types of pigment stones
black and
brown black stone is associated with
hemolytic disorder
like sickle cell disease and hereditary
spherocytosis and cirrhosis
it contains insoluble bilirubin pigment
with calcium phosphate and bicarbonate
brown stone are formed because of
biostasis and resulting infection in
bile
commonly occur because of foreign bodies
in biliary track
like stents ascaries lumbricoides
Clonorchis sinensis brown pigment contain
calcium bilirubinate and calcium
palmitate gallstones are common in
obese fertile female in their forties
use of oral contraceptive pills and rapid
weight reduction poses risks of
developing gallstones terminal ilium
resection predisposes to galltone by
decreasing the enterohepatic circulation
which will deplete the bile acid pool
and result in cholesterol
supersaturation
gallistone may remain asymptomatic and
found incidentally on ultrasonography
if symptoms occur patients complain of
either right
upper quadrant or epigastric pain which
may radiate to back
the pain is dull and constant
biliary colic is present in 10 to 15
percent of cases
other symptoms include flatulence and
dyspepsia
diagnosis of gallstone disease is
based on the history and physical
examination
with confirmatory radiological studies
like an ultrasonogram
and radionuclide scan murphy's sign is
said
to be present when a patient in acute
stage
has exacerbation of pain when palpated
in the right upper quadrant
while in inspiration a acute stage may
also be associated with
leukocytosis and moderately elevated
liver function test
a palpable non-tender gallbladder
pretends a more sinister diagnosis
which usually results from obstruction
of common bile duct
secondary to a peripancreatic malignancy
in case of gallstone lodged in a cystic
duct
biliary colic acute or chronic
cholecystitis
mucocele or empyema of the gallbladder
can
occur if the resolution does not occur
the wall may become necrotic and
perforate
with development of peritonitis if the
gallstone
gets blocked near ampulla of vater
it may cause acute pancreatitis
if the gallstone blocks common bile duct
jaundice occurs and if a gallstone moves
to
intestine through a fistula it can cause
intestinal obstruction
known as gallistone ileus most of the
asymptomatic gallstones are observed
with cholecystectomy reserved for
patients who develop symptom
or complication non-operative treatment
include
nil per oral and iv fluid
administration until pain resolves
administration of analgesia a broad
spectrum antibiotic
effective against gram negative are most
appropriate
subsequent management of the case would 
be cholecystectomy
done at appropriate date within five to
seven days
Cholecystectomy during acute
cholecystitis appears to be safe and
shortens the total hospital stay
if an early operation is not indicated
it is desirable to wait six weeks for
inflammation to subside
for a patient with cholecystitis and
biliary colic cholecystectomy is the
treatment of choice
laparoscopic cholecystectomy is the
procedure of choice for the majority of
patients with gallbladder disease
different ports are made in umbilical
subxiphoid
and right sub coastal area telescope is
inserted through the umbilical port
and additional operating port are
inserted in the subxiphoid
and right subcostal area
for a person in whom laparoscopic
cholecystectomy is
not indicated or in whom conversion from
a laparoscopic approach is required
an open cholecystectomy is performed
prophylactic Cholecystectomy can be
performed in a patients
with diabetes congenital hemolytic
anemia
and those who are undergoing bariatric
surgery
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