Transcript (1) through the cystic duct

Gallstone disease. Cholecystitis,
diagnosis and treatment
Topicality
• According to the 6th World Congress of
Gastroenterology in the world is about 10% of
the population suffer from gallstone (more
common in developed countries, often in
women, usually elderly)
• Only in the U.S. per year performed more
than 1 million cholecystectomy in Russia more than 200 thousand in Uzbekistan more than 5 thousand
• The cost of treatment of cholelithiasis in
France over 800 million euros a year.
Historical information
• Galen (Cl. Galenus) showed stones at autopsy. In 1341 Gentile da
Foligno in Padua in embalming the corpse of a noble woman found
in the neck of the gall bladder large green stone. In the second half
of XV century, the famous Florentine physician Antonio Benevieni at
autopsy woman who suffered long bouts of biliary colic, found in the
gall bladder stone black size of a walnut.
• Abu Ali ibn Sina - GSD called "disease-rich."
• V. Coiter in 1573 French physician J. Fernel (1574) described the
clinical presentation of gallstone disease and established its
connection with jaundice. Chemical study of gallstones was first
undertaken by S. Galeati (1746).
• J. Thudichum, suggested that the rudiments of rock formed by the
condensation cacocholia still in the intrahepatic bile ducts.
Syntopy of the gallbladder
1 - Gall Bladder 2 – duodenum
3 - The right proportion of liver
Gall bladder and biliary tract
1 - bottom of the
gallbladder,
2 - body
3 - neck,
2 - area of ​union with
the liver,
5 - right - and 6 left
hepatic ducts,
7 - cystic duct
8 - common duct
9 - sphincter of Oddi,
10 - Vater papilla
11 - Flow-term pancreas
cancer (Virsung).
Topography structures enclosed
in hepatoduodenal ligament.
1 — ductus hepaticus communis;
2 — ramus sinister a. hep. propriae
3 — ramus dexter a. hep. propriae;
4 — a. hepatica propria;
5 — a. gastrica dextra;
6 — a. hepatica communis;
7 — ventriculus;
8 — duodenum;
9 — a. gastroduodenalis;
10 — v. portae;
11 — ductus choledochus;
12 — ductus cysticus;
13 — vesica fellea.
Physiology of the gallbladder
• 1. During the day, the
liver produces about a liter
of bile.
• 2. Sphincter of Oddi is
reduced (7), the output of
bile into the duodenum 12
(8) is terminated.
• 3. Bile is continuously
fed into the bile duct (3)
• 4. Next comes the
gallbladder (1) through the
cystic duct (2)
• 5. The wall of the
bladder is very actively
sucks the water from the
bile
Physiology of the gallbladder
• When food enters from
stomach to 12 duodenum, it
begins to develop a hormone
- cholecystokinin.
• This hormone is a
powerful stimulant to reduce
gall bladder, and at the same
time, this hormone relaxes
the sphincter of Oddi.
• The wall of the bladder is
reduced simultaneously with
the relaxation of the sphincter
of Oddi and the concentrated
bile from the gall bladder
comes in 12 duodenal ulcer
•The composition of bile
•Bile - a yellow liquid. The basis of bile is water, which are
major components of bile.
• The composition of bile
• Water
• Bile acids (U-ny
instvenny functional
component of bile)
• Lecithin (phospholipid)
• Cholesterol (fat)
• Bilirubin (the pigment
that gives bile yellow)
• Proteins (proteins)
• Electrolytes (potassium
ions, sodium, calcium,
chlorine)
Causes of Gallstones
•Infectious inflammation of the biliary tract.
•Metabolic disorders (increased cholesterol in
the bile).
•Stagnation of bile in the biliary ducts.
Taurohol acid
Cholesterol
Bile acids
Cholesterol gallstones
Black pigment stones of the
gallbladder
Brown pigment gallbladder
stone
stages of gallstone disease
• The first stage - the physical and chemical. (Nye
litogen-bile). Clinical manifestations are absent.
• The second stage - the latent asymptomatic
carriers of the stone. The process of stone
formation + + bile stasis inflammation. Clinical
manifestations are absent, and the stones are
discovered by accident.
• The third stage - marked clinical
manifestations. Acute inflammation in the
gallbladder, choledocholithiasis, stenosis of the
major duodenal papilla, acute cholangitis, acute
pancreatitis
Subjective manifestations of
gallstone disease
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Pain in right hypochondrium
Nausea
Bitterness in the mouth
Heartburn
Vomiting
Relationship of pain with food intake
Abdominal distention
Localization of pain in Gallstone
disease
5 «F»
symptoms
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•
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•
FEMALE - female, female
FORTY - forty
FAT - thick, full
FERTILE - fertile (multiparous)
FAIR - blond, light (blonde)
Methods of diagnosis of gallstone
disease
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Duodenal intubation
Ultrasonography
Radiography (cholecysto-,holangiography)
KT
Laparoscopy
Magnetic resonance imaging
The normal ultrasound pattern of gallbladder
1. cavity of
the
gallbladder
2. wall of the
gallbladder
3. cystic duct
4. liver tissue
Gallstones
Cholecystography
1. shadow of the
gallbladder
2. Shadow of
common bile duct
3. spine
4. ribs
Cholecystography in the presence
of two large stones in the
gallbladder
1. gallbladder
2. stones
3. edge
Disadvantages of the study
- Harm to the body.
- The need for training.
- The contrast is not always
accumulate in the biliary tract
Vaeth,
- Non-operation in the
gallbladder, the contrast he
does not fall
Computed tomography
retrograde pancreticocholangiography
Antegrade
cholangiography
Percutaneous transhepaticcholecysto-, holangiography.
diagnostic laparoscopy
Complications of gallstone
disease
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Acute cholecystitis
Choledocholithiasis
Obstructive jaundice
Acute pancreatitis
Cholangitis
Bile peritonitis
Hepatic failure
Abscesses
Surgeries for GSD
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Laparoscopic cholecystectomy
Open cholecystectomy
Holedoholitotomy
Papillosfinkterotomy
Cholecystitis and holangiostomy
Holedohoduodenostomy
Laparoscopic cholecystectomy
Puncture of the gall bladder
The intersection of the
cystic duct
Select items
Isolation of arterial
Clipping
Cholecystectomy
Open
cholecystectomy
Open cholecystectomy
Cholecystectomy "from the
neck" and "the bottom"
Choledochoduodenostomy
Yurash
Flerken
Finstrer
Transduodenal papillosfincterotomy and plasty
Transduodenal papillosfincterotomy and plasty
Responsibility of PhGP:
1. To have knowledge of method diagnostics
pathology of a bile duct and gallbladder.
2. Concepts classification of chelicistit’s.
3. Diagnostics of GSD and chronically calcules
cholecistit’s.
4. Feature of differential diagnostics.
5. To send the patient to the surgical stationary.
6. Shepherd rehabilitation after surgical treatment.