9 - 10 - 11 Gall Bladder

Gall bladder - Dr.
Al-Matary
congenital anomalies
biliary atresia Choledochal cyst
written Biliary atresia
case presentation written biliary atresia
Choledochal Cyst
Choledochal cyst
MCQ
choledochal cyst
rare condition
rare condition
Incidence
rare
MCQ
rare Choledochal cyst
Page | 1
Gall bladder - Dr. Al-Matary
Choledochal cyst
bile duct wall dilatation
rare Choledochal cyst
More common in females

female predominance
MCQ
bile duct
theory
congenital weakness
congenitally loose bile duct wall
intra uterine infection
common bile duct pancreatic juice
bile pancreatitis
bile
Congenital weakness 
Viral infection 
wall Pancreatic enzyme 
Autonomic disturbance 
MCQ
commonest form of Choledochal cyst
diffuse dilatation
Page | 2
MCQ
MCQ
¾
written
MCQ
Limited
sources MCQ sources
MCQ
Choledochal cyst
written rare
MCQ written biliary atresia
MCQ choledochal cyst

Incidence
MCQ incidence
MCQ
commonest form
diffuse dilation
MCQ
diffuse dilatation commonest form
Page | 3
dilated bile duct Liver

extra hepatic Intra hepatic
dilated bile duct

Intra hepatic
extra hepatic
Caroli's disease
disease
Intra hepatic dilatation
extra hepatic
clinical
obstructive jaundice
Investigations
liver function
direct bilirubin
alkaline phosphatase
prolonged Prothrombin time
hepato-renal
urine analysis
urine
dark
direct bilirubin dark
Frothy
bile salts
stool
Clay
Page | 4
Obstructive jaundice
Intra hepatic bile duct dilatation
extra hepatic bile duct dilatation

common bile duct sonar
Liver accurate
common bile duct
common bile duct stone

extra hepatic Intra hepatic

bile duct
Intra hepatic 
extra hepatic 
intra hepatic bile duct dilatation

extra hepatic
Caroli's disease

extra hepatic Intra hepatic Porta hepatis

full mark
full mark
 oriented to time place and time
dilated intra hepatic bile duct
extra hepatic
Porta hepatis cholangio carcinoma Caroli's disease
Porta hepatis chalngio carcinoma
Page | 5
choledochal cyst
childhood Jaundice
biliary atresia
Neonates Jaundice
choledochal cyst
child Jaundice
biliary atresia
neonates jaundice
neonates Obstructive jaundice
choledochal cyst
childhood Obstructive jaundice
Later on in life
Investigations choledochal cyst

jaundice
Liver functions,, kidney function,, urine,, stool,, ultra sound,, ERCP
jaundice
choledochal cyst
 liver Liver choledochal cyst
Liver choledochal cyst
Liver
liver
Page | 6
cyst
partial hepatectomy
Liver
Oma  heap Hepatectomy

Hepatoma
hepatectomy
right hepatectomy left hepatectomy
Liver

partial hepatectomy
caroli's disease
Dilated intra hepatic bile duct
dilated intra hepatic bile duct liver
Liver transplantation
dilated bile ducts

segmental
segment
Jaundice
segmental liver transplantation
40,000 segmental liver transplantation
Page | 7
40,000

kidney transplantation
Liver liver transplantation
cirrhotic Liver
choledochal cyst
Partial hepatectomy
liver dilatation
dilated bile duct
choledochal cyst
choledochal cyst
bile duct jejunum
distal end jejunum
hepatico-jejunostomy Roux -en - Y
Roux anastomosis
Page | 8
Roux
Hepatico-jejunostomy Roux en Y
en Y
Y anastomosis
bile duct talent
cholecystectomy
stricture healed common bile duct
jaundice
hepatico-jejunostomy Roux-en- Y operation
resectable cholangio carcinoma

hepatico-jejunostomy Roux-en Y
Roux-en-Y choledcho jejunostomy hepatico-jejunostomy Bile duct
Liver
hepatectomy 
liver transplantation 
Partial hepatectomy 
Liver transplantation 
anastomsis
Biliary atresia
atresia atresia
Failure of re-canalization
10,000 incidence biliary atresia

Incidence
Page | 9
incidence of biliary atresia MCQ

10,000 a
5,000 b
1,000 c
d
Non of the above e
biliary atresia
failure of re-canalization biliary atresia
biliary atresia
jaundice
scratch marks general
Local examination
gall bladder
atresia
Page | 10
gall bladder gall bladder atresia 

gall bladder gall bladder atresia 
gall bladder gall bladder atresia

gall bladder gall bladder atresia
scratch marks general examination
Courvoisier
Virchow's
contracting gall bladder stone
Courvoisier scratch marks
malignant calcular
investigations biliary atresia

Liver functions
investigations biliary atresia
direct bilirubin liver function biliary atresia

alkaline phosphates
prolonged prothrombin time
liver function
kidney function
Page | 11
kidney function
stool Urine
frothy dark urine
Dark
Direct bilirubin
Frothy
bile salts
test frothy
Sulpher test
sonar
intra hepatic atresia

Intra hepatic atresia Unless
biliary atresia investigation

HIDA scan
ERCP
HIDA scan
Liver Iso-toping scanning
biliary atresia
iso tope
duodenum
iso-topes hepatitis
Page | 12
biliary atresia HIDA scan

liver Iso-tope scan HIDA scan
Hydroxy Imedinodiacetic Acid
Liver Iso-tope scanning
sonar biliary atresia
Dilated intra hepatic bile duct, unless

intra hepatic atresia
HIDA scan
Liver
duodenum iso-tope
biliary atresia
liver liver
duodenum iso-tope
neonatal hepatitis
iso-tope Liver neonatal hepatitis
Non visualization of the liver neonatal hepatitis

visualization of the liver but, no visualization of the duodenum biliary atresia
Normal
duodenum liver Visualization
duodenum iso-tope
Liver iso-tope scanning HIDA scan

duodenum Liver normal
duodenum Liver biliary atresia
duodenum Liver neonatal hepatitis
Page | 13
patent duodenum
iso-tope
biliary atresia
extra hepatic intra hepatic
liver transplantation Liver Intra hepatic 
jejunum extra hepatic 
Hepatico-jejunostomy Roux-en-Y operation
Kasai operation biliary atresia

Kasai operation biliary atresia hepatico-jejunostomy

Kasai operation
talented
portal hypertension liver cirrhosis

cirrhosis
liver support
Liver support
I'm buying time
treatment of choice
liver transplantation
Hepatico jejunostomy
biliary atresia

investigations
gall bladder stones
Page | 14
Gall bladder stones

written
written Gall bladder stones
progressive jaundice 3
clay stool dark
clinical diagnosis
Biliary atresia
differential diagnosis
neonatal hepatitis
physiological jaundice physiological jaundice
differential diagnosis neonatal jaundice
differential diagnosis diagnosis
investigations of choice
how to investigate him
stool urine Kidney function Liver function
HIDA scan sonar
investigation of choice
HIDA scan
HIDA scan investigation of choice
itching clay stool dark urine jaundice 8

choledochal cyst
Positive family history
positive family history
biliary atresia
neonatal biliary atresia 8
Page | 15
parasite
blood transfusion hepatitis

hemolytic jaundice hemolytic
Hemolytic jaundice
congenital
jaundice
hemolytic
Hepatocellular Hepatitis
obstructive
choledochal cyst
How to investigate him
Liver
liver
Kidney
ERCP ultra sound stool Urine

ERCP
Neonates biliary atresia
HIDA scan
ERCP
Page | 16
Choledochal cyst biliary atresia
Gall stones
Gall stones
written
gall stones
stone
stone
stones
complications of stones
treatment Investigations clinical pictures

treatment Investigations clinical pictures
clinical pictures of gall stones
cholecystitis
jaundice common bile duct
Pancreatitis common channel
clinical pictures
investigations
Investigations
sonar
ERCP obstructive jaundice
CT amylase pancreatitis
Page | 17
investigations
clinical
treatment investigations Clinical pictures
pathology gall stones

stone
complications of stones stones
gall stones
acute cholecystitis 
chronic cholecystitis
pancreatitis
pathology
clinical
discuss gall stones written
acute cholecystitis
gall stones
stone
discuss gall stones
complications
Page | 18
complications
stones
stones
complications pathology
gall stones
complications
gall bladder stones

stones
secondary Primary
kidney stone
gall bladder stone
salivary gland stone
stone
secondary Primary
secondary
Infection
Infection
Stones
∆
secondary stone
Stasis 
Infection 
Stone 
secondary stone
secondary stone
infection
stone stasis Infection
Page | 19
bile infection
provide nidus
nidus
Nidus
PH
PH
urinary system stone

secondary Primary
secondary
infection
stones Infection
stone infection
PH Provide nidus
PH
Infection gall bladder

stones Infection
Infection
infection
stone Predisposing factor

stone stone
chronic inflammation
infection I can't eradicate
stone eradication of infection stone

chronic infection
Page | 20
acute chronic infection

stones Infection
infection stones
stone infection Vicious circle
multiple Infection stone

Episodes, episodes, episodes of infection
primary stones
Metabolic error primary stone
metabolic error
bile
cholesterol bile pigments bile salts bile

Mucous
cholesterol bile pigment bile salts

bile
bile pigments bile salts

RBCs bile pigment
globin haem Hemoglobin RBCs
bilirubin globin
bile pigment
bile salts
fat bile salts
emulsion
bile pigment bile salts
Page | 21
bilirubin bile pigment

RBCs
bile salts
fat emulsion bile salts
fat
fat
emulsion
emulsion
bile salts
fat emulsion
bile salts
fat
fat fat
bile fat
bile salts bile
bile salts
bile salts
bile
bile salts
balance
bile salts
Page | 22
balance
bile salts Balance
bile salts
cholesterol bile pigment bile salts bile

stones
bile pigment
bile pigment
Hemolytic anemia
bile pigment
RBCs bilirubin
sickle cell anemia spherocytosis

thalassemia intermedia thalassemia major
Hemolytic anemia
Bilirubin RBCs
bilirubin
bile
Liver
bilirubin
conjugation
bile
bilirubin
capacity
Liver
Page | 23
bile conjugated bilirubin
Unconjugated bilirubin bilirubin
bile conjugated bilirubin

dark stool
hemolytic anemia
conjugated Unconjugated
Jaundice Unconjugated
stool bile conjugated bilirubin
stool hemolytic anemia
bilirubin
Liver capacity
conjugated bilirubin
conjugated bilirubin bile
conjugated bilirubin
stones Mud
Pigment stone
Infection metabolic
hemolytic anemia
X syndrome
X syndrome
metabolic syndrome
gout
diabetes ischemic heart disease
Page | 24
X syndrome 
X syndrome
X syndrome
hyper cholesterolemia Metabolic error
bile Hyper cholesterolemia
bile
cholesterol bile
cholesterol stones stone
Metabolic errors
right hemicoloectomy Crohn's disease
terminal ileum
terminal ileum terminal ileum

entero-hepatic circulation
bile salts entero-hepatic circulation
entero-hepatic circulation
bile salts
cholesterol
bile salts
bile salts
cholesterol stones
Page | 25
cholesterol stones

bile salts 
The same
cholesterol bile salts
1: 25
13
25
13
gall bladder stone
stone
Primary 
secondary 
secondary
Infection
stone infection
stone infection
PH Provide nidus
stones metabolic errors

cholesterol 
bile salts 
bile pigment 
Liver cirrhosis Liver disease
bile salts Liver
gall bladder stones

mixed pigment cholesterol
mixed stone Pigment stone Cholesterol stone
Page | 26
Pigment stone
pigment stone
hemolytic anemia
bilirubin
Indirect uncojugated bilirubin
direct bilirubin
bile
mud bile
Mud bile
Dark in color
Pigment stone
cholesterol stone
hypercholesterolemia
hyper cholesterolemia
X syndrome
bile hyper cholesterolemia
stones
cholesterol crystals
Solitaire
solitary Solitaire
crystals
radiating cut surface
Page | 27
Fat
fat
cholesterol
single cholesterol stones
Whitish in color
cut surface
Radiating
mamilated surface
Mamilated
Mamilated

mamilated
mamilated
radiating cut surface
single
basics

crystals
cholesterol crystals
radiating
In radial manner
stone
Page | 28
cholesterol stone
inflamed gall bladder healthy

Healthy
Healthy
infection primary
Infection cholesterol stone
stone
infection stone
healthy gall bladder stone
Inflammation cholesterol stone
stone Inflammation
Inflammation stone
Mixed stones
Mixed
bile salts bile pigment Mixed
bile
bile salts bile pigment cholesterol Mixed

bile
Page | 29
Mixed stone
Infection
infection
PH Provide nidus
gall bladder Mixed stone

stone
stone
stones
laminated Nidus
PH
PH
laminated Nidus
gall bladder
fibrotic shrunken gall bladder
stones
stones
stones

stones stones
stones
episodes of infection
Laminae
episodes of infection
Page | 30
two laminae
two episodes of infection
episode
Laminae
group groups
laminae Nidus
laminae PH episode of infection
Mixed stones
Faceted
faceted
faceted
rounded single cholesterol stone

faceted multiple Mixed stone
single faceted stone

common bile duct
common bile duct single faceted stone

faceted
common bile duct
stones
stones stone
gall stones
gall stones complications

OMUMI gall stones complications
Page | 31
OMUMI
Obstruction 
Migration 
Ulceration 
Metaplasia 
Infection 
Obstruction
obstruction
Chronic calcular cholecystitis
fibrotic Shrunken
calcular
stones
start point
normal
X syndrome
cholesterol stones
Hyper cholesterolemia
complications
Page | 32
atherosclerosis
Ischemic heart disease


Ischemic heart disease atherosclerosis by aging
procedure
Page | 33
petit mal epilepsy
cholesterol stones
cholesterol stones
cystic duct
gall bladder
cholesterol stone
fatty meal
Pain
Biliary colic
biliary colic
followed by infection stasis 12
rebound tenderness rigidity gaurding
acute cholecystitis
acute cholecystitis biliary colic

pyelonephritis renal colic
rebound tenderness rigidity gaurding biliary colic

biliary colic
biliary colic
acute cholecystitis stasis
common bile duct
Page | 34
acute cholecystitis biliary colic gall bladder 
calcular obstructive jaundice common bile duct 
common channel
Acute pancreatitis
common channel
pancreatitis reflex of bile
Obstructive manifestations
biliary colic cystic duct

acute cholecystitis
obstructive jaundice common bile duct

pancreatitis pancreatic duct
biliary colic cystic duct

acute cholecystitis
Catarrhal 
suppurative 
gangrenous 
Mcuocele mucous catarrhal
Pyocele pus
gangrenous
fundus
blood supply
fundus case of the appendix
catarrhal inflammation appendix
Page | 35
Mucocele Mucous
pyocele pus Suppurative inflammation
Ganagrenous
base tip
base
obstructive Fricture
Harmann’s pouch
Friction and obstructive agent
GIT gall bladder
cystic duct stone

Biliary colic
pyocele Mucocele complicated acute cholecystitis
common bile duct

biliary cirrhosis Obstructive jaundice

Liver
bile Liver
bile
bile liver
bile
white bile
bile white bile
Migration Obstruction
Migration
cystic duct gall bladder
Biliary colic
Migration
Colic
Page | 36
colic common bile duct

smooth muscle gall bladder
smooth muscle common bile duct
dull aching pain common bile duct

colicy gall bladder
smooth muscles gall bladder
smooth muscles common bile duct
colic gall bladder

dull aching pain common bile duct
Ulceration
common bile duct gall bladder
Bile
common bile duct
bile
Urine
Hematuria
bile
Hemobilia
hematuria Urinary system

hemobilia biliary system
hematuria
bile
stool urine bile
stool bile
Page | 37
stool
bleeding per rectum 
melena 
Melena bleeding per rectum
Obstruction, ulceration, migration

Metaplasia
Metaplasia
epithelium
bile duct epithelium

Columnar
GIT
columnar GIT
columnar bile duction lining epithelium

friction
Squamous
Metaplasia is dysplasia anaplasia

anaplasia dysplasia Metaplasia
Infection
Infection
inflammation of the liver
Hepatitis
Inflammation of the bile duct

Cholangitis
inflammation of the liver and bile duct
Cholangio-hepatitis
inflammation of the gall bladder

Cholecystitis
Inflammation of the pancreas
Pancreatitis
Page | 38
hepatitis Liver
cholangitis bile duct
cholangio-hepatitis liver bile duct
pancreatitis
cholecystitis gall bladder
Obstruction, migration, ulceration, metaplasia and infection
fistula
fistula complicatoins
fistula formation
distensible structure gall bladder
appendix
non distensible appendix
distensible gall bladder
Distensible
gall bladder
Mass omentum
fistula
generalized peritonitis
Omentum
appendix gall bladder fistula

not distensible appendix
gall bladder
distensible structure gall bladder
Page | 39
Mass Omentum
mass
fistula
fistula
fistula
anatomically
fistula appendicitis
non distensible
gall bladder
distensible
48
omentum
fistula
near by structure
structures gall bladder

fistula
gall bladder
common bile duct gall bladder fistula

common bile duct Fistula
Mirizzi syndrome
Mirizzi syndrome common bile duct fistula
Page | 40
Mirizzi syndrome
Fistula
common bile duct
Mirizzi syndrome
fistula
Mirizzi common bile duct stone

Mirizzi fistula
Mirizzi common bile duct stone

Mirizzi fistula
common bile gall bladder

Mirizzi
duodenum fistula
duodneum gall bladder stone
duodenum gall bladder stone

duodenum
duodenum gall bladder stone

duodenum gall bladder
Page | 41
duodenum
Meckel’s diverticulm 
ileo-cecal junction 
ileo-cecal junction Meckel’s diverticulum
gall stone ileus
gall stone ileus

Mirizzi common bile duct fistula
gall stone ileus duodenum Fistula

periton bile
omentum
generalized pertonitis fistula
Omentum
mass
Gall bladder mass
duodenum stone
gall stone ileus
gall stone ileus acute cholecystitis

Intestinal obstruction
clinically
Intestinal obstruction
distention constipation vomiting Pain
acute cholecystitis constipation vomiting pain already

pain
Page | 42
constipation vomiting
gall stone ileus acute choleycystitis

severe distention
gall stone ileus investigation how to confirm distention

Palin X-ray abdomen erect and supine
erect
Multiple fluid level
supine
Air in biliary tree
biliary
biliary tree Intestine
biliary tree
Multi para 40
fatty Female
data
right hypochondrium Pain

Radiating to the back and the right should
rigidity gaurding
severe abdominal distention

What is your diagnosis
Acute cholecystitis
investigations of choice
Ultra sound
treatment
urgent choelcystecotmy
acute cholecystitis complicated by gall stone ileus

plain x ray abdomen Investigations of choice
mass obstruction Laparotomy resuscitation treatment
Page | 43
mass
mass stone obstruction
omentum conservative
gall bladder
N.B.
severe abdominal distention acute cholecystitis

gall stone ileus
ultra sound Investigation of choice gall stone ileus
Ultra sound Intestinal obstruction

plain x-ray abdomen Investigation of choice
cholecystitis
ultra sound investigation of choice acute cholecystitis
plain x ray
acute cholecystitis complicated by gall stone ileus acute cholecystitis
gall stone ileus
stone
mass
omentum Mass
stone
omentum fluid catheter line ryle

gall bladder
mass
fatty , fertile, forty acute cholecystitis

Page | 44
Radiating to the back and to the right shoulder

rebound tenderness rigidity gaurding 39
jaundice
Mirizzi syndrome 
cholangitis 
cholangitis common bile duct gall bladder
complicated by Mirizzi syndrome or cholangitis acute cholecystitis
unless cholangitis or Mirizzi jaundice acute cholecystitis

Mirizzi jaundice unless cholangitis acute cholecystitis
jaundice acute cholecystitis

Mirizzi cholangitis Unless
fistula common bile duct stone Mirizzi
acute cholecystitis
ultra sound
Investigation of choice Mirizzi syndrome
ERCP
acute cholecystitis
Investigation of choice
Ultra sound
obstructive jaundice acute cholecystitis Mirizzi Synddrome

ERCP
Page | 45

as regard dermoid cyst
sequestrated dermoid cyst
dermoid cyst
teratomatous implantation tubuo dermoid inclusion Sequestration
female, fatty, fertile , forty

radiating to the back and the right shoulder right hypochondrium pain
Mild gaurding rigidity gaurding 37
biliary colic
biliary colic
acute cholecystitis
40
rebound tenderness rigidity gaurding
colic cases
acute cholecystitis
rebound tenderness rigidity gaurding fever
colon fistula
cholecysto colic fistula
fistula gall bladder

distensible gall bladder
omentum
Page | 46
complications
gall stone
Primary 
secondary 
primary
Metabolic errors
secondary
Infection
stone infection
PH Provide nidus
stones
Cholesterol, pigment and mixed
commonest
Mixed
MCQ
mixed commonest stone

stones common gall bladder Infection
stone infection
infection stone
mixed stone
Mixed stone
stone Infection
Mixed stone infection cholesterol stone
mixed commonest stone
stone formation complications

OMUMI
Page | 47
Obstruction 
Migration 
Ulceration 
Metaplasia 
Infection 
clinical pictures of gall stone

stone
healthy gall bladder cholesterol stone

asymptomatic
asymptomatic healthy gall bladder cholesterol stone

cystic duct Stone
rebound tenderness gaurding rigidity Fever
common bile duct Stone

Calcular obstructive jaundice
common channel Stone

Acute pancreatitis
clinical pictures
pancreatitis asymptomatic
gall stone Investigations of choice
asymptomatic gall stone
Urinary tract infection

sonar
gall stone
biliary colic
Page | 48
Ultra sound
gall bladder
99
ultra sound 
ERCP 
ultra sound
ERCP
acute cholecystitis biliary colic Ultra sound
asymptomatic
chronic cholecystitis acute cholecystitis biliary colic
ultra sound
asymptomatic
chronic cholecystitis acute cholecystitis biliary colic
Ultra sound
common bile duct

ERCP
common bile duct ultra sound accuracy
70 %
common bile duct ultra sound accuracy
ERCP
PTC ERCP
dilated intra hepatic bile duct role obstructive jaundice
role obstructive jaundice sonar

Dilated intra hepatic bile duct
Page | 49
obstructive jaundice Investigation of choice

ERCP
PTC failed
Pancreatitis Investigation of choice

CT scan serum amylase
1000 300 serum amylase
chest x ray arterial blood gases Pancreatitis

complications
gall bladder
chronic cholecystitis acute cholecystitis biliary colic asymptomatic
chronic cholecystitis acute cholecystitis biliary colic asymptomatic
equal common bile duct

common channel
Acute pancreatitis
gall bladder
Page | 50
gall bladder
Investigation
Ultra sound
ultra sound
common bile duct

ERCP
PTC
pancreatitis
serum amylase
acute cholecystitis
rest
Rest
discussion
Acute cholecystitis
acute cholecystitis
micro organism
E-coli
route of infection
direct
predisoposing factors
bad general condition
Page | 51
bad hygiene stasis
bad hygiene
predisposing factor
stasis
acute cholecystitis 90 %
calcular obstructive
obstructive acute appendicitis 2/3
predisposing factor
Obstruction
stasis obstruction
2/3
obstructive acute cholecystitis 90 %
rare Non obstructive acute cholecystitis
obstructive acute cholecystitis

obstruction acute cholecystitis predisposing factor
predisposing factor
bad hygiene
acute cholecystitis pathologically

Catarrhal, suppurative and gangrenous
catarrhal
Mucous
Mucocele
Page | 52
pus suppurative
Pyocele
gangrenous
Hartmann’s pouch fundus
fundus
blood supply
Hartmann’s pouch
obstructing agent friction
Peritoneal laster
Lost
cystic lymph node of
lymph node
tender Hot
Pathology
pathology
Pathology
complications of acute cholecystitis

complications
General and local
septicemia , pyemia and bacteremia FAHM General
Page | 53
acute cholecystitis Local complications

common channel
Pancreatitis
fistula fistula
common bile duct
Mirizzi
duodenum fistula
Gall stone ileus
colon fistula
cholecysto colic fistula
complications of acute cholecystitis
clinical pictures of acute cholecystitis

Symptoms and signs
General and local
symptoms
FAHM General
pain, swelling, disturbance of function local
pain
Radiating to the back and to the right shoulder
right shoulder
Phrenic
phrenic C 3, 4
L 3, 4
Page | 54
C3,4
L phrenic
L


C3,4 Phrenic
Pain
swelling
disturbance of function
constipation vomiting
Peritonitis
Peritonitis
peristalsis
GIT
vomiting nausea Peritonitis

Peristalsis
signs
tachycardia fever General
Local
rigidity inspection
gaurding superficial palpation
rebound tenderness tenderness deep palpation
decreased intestinal sounds auscultation
negative percussion
Page | 55
gall bladder Negative PR

PR appendix
Unless, left appendix
gall bladder
Special sign
back Hyperesthesia
Boas’s sign
appendicitis
appendicitis
right hypochondrium gall baldder appendicitis
Hyperesthesia
appendicitis
back gall bladder
acute appendicitis edema acute cholecystitis

anterior abdominal wall fundus gall bladder
appendix
anterior abdominal wall gall bladder

appendix
appendix hyperesthesia
Boas’s
gall bladder edema

appendix
anatomy
acute cholecystitis
Ultra sound
plain x ray
Page | 56
Plain x ray
10 % Investigation
Plain X ray
ultra sound plain x ray
gall bladder Ultra sound
90 %
98 %
ultra sound Gall bladder

ultra sound Gall bladder
acute cholecystitis
gall stone ultra sound Ultra sound

wall thickening
cystic duct stone

distended gall bladder
90 %
wall edematous
Ultra sound Investigation of choice
Ultra sound
Ultra sound
Page | 57
sonar
wall edemaotus distended obstructed gall bladder 90 %
gall bladder
edematous distended Obstructed
X ray
90 %
What is the major role of X ray in acute cholecystitis

biliary tree with gall stone ileus To detect air
plain X - ray Main value
acute cholecystitis plain X - ray Main value

To detect gall stone ileus
biliary tree air
acute cholecystitis plain X-ray Main value

To detect gall stone ileus
biliary tree air
HIDA scan
common bile duct Liver
duodenum
gall bladder
gall bladder
HIDA scan
duodenum common bile duct Liver
gall bladder
Investigation
investigations written
Page | 58
Ultra sound Investigations

CBC
investigations
acute cholecystitis
urgent cholecystectomy 48 acute cholecystitis
48 acute cholecystitis
Urgent cholecystecotmy
48 acute cholecystitis
Conservative
omentum
acute cholecystitis
Cholecystectomy
Mass
Conservative
conservative mass
Conservative
fluid catheter line Ryle
acute cholecystitis conservative treatment
analgesic
Page | 59
antibiotic
morphine analgesic
sphincter of oddi spasm
acute cholecystitis
morphine
sphincter of oddi spasm
spasm
gall bladder bile gall bladder

sphincter of oddi
gall bladder duodenum
bile liver

Liver
acute cholecystitis
acute cholecystitis
bile anti biotic
bile gall bladder
gall bladder
Page | 60
bile
bile
gall bladder
gall bladder
90 %
bile antibiotic
serum antibiotic
acute cholecystitis
Urgent cholecystectomy 48
48
Conservative
fluid catheter Line ryle Semi-sitting position
analgesic
anti biotic
analgesic 
serum antibiotic 
conservative treatment
Oschner Sherren’s
Oschner Sherren’s
analgesic
Chronic cholecystitis
management
Management of chronic calcular cholecystitis
mangement
Clinical pictures, investigations and treatment
Page | 61
Mangement of chronic calcular cholecystitis

Loss of luster
Lymph node of
multiple stones
gall bladder
gall bladder
chronic cholecystitis clinical pictures

Target
Fat dyspepsia 
Murphy’s sign 
complications
complications
Murphy’s sign Fat dyspepsia
female, fatty, fertile, forty
Page | 62
fat dyspepsia
Murphy’s sign
positive Murphy’s sign Fat dyspepsia

biliary colic
Followed by acute cholecystitis
clinical pictures of complications
clinical pictures of complications
Page | 63
Fat dyspepsia
positive Murphy’s sign
Choronic cholecystitis
multiple stones
gall bladder Multiple stones

chronic acute
gall bladder stone acute

gall bladder stones chronic
gall bladder stones
dynamic ultra sound

dynamic ultra sound ultra sound
gall bladder sonar

fibrotic shrunken
gall bladder
Page | 64
dynamic ultra sound fibrotic
ultra sound
Ultra sound
stones fibrotic shrunken gall bladder
dynamic ultra sound

gall bladder

Investigation
investigations for complications
ERCP obstructive jaundice
CT scan serum amylase pancreatitis
Investigations
investigations for complications
cholecystectomy chronic calcular cholecystitis

conservative medical Non calcular cholecystitis
Page | 65
Mangement of obstructive jaundice

Management of calcular obstructive jaundice
data
calcular obstructive jaundice

episodes of biliary colic female, fatty, fertile, forty
fat dyspepsia
positive Murphy’s sign
Female, fatty, fertile, forty

Murphy’s sign fat dyspepsia
obstructive jaundice data
type of patient
fat dyspepsia female, fatty, fertile, forty
Urine
stool
Page | 66
general examination
scratch marks
Virchow’s
malignant
local examination
gall bladder
common bile duct calcular obstructive jaundice

mixed cholesterol
Mixed
cystic duct
Mixed
Infection
ascending cholangitis common bile duct
Charcot’s triad
Charcot’s triad
Triad
biliary colic pain

jaundice
Fever
infective calcular obstructive jaundice
Equal Charcot’s triad
Infective calcular obstructive jaundice = Charcot’s Triad
malignancy stone Infection

infection stone
common bile duct
calcular obstructive jaundice Charcot’s triad
Page | 67
pain
biliary colic pain
Jaundice
Obstructive jaundice cholecystitis
Pain 
Jaundice 
Charcot’s triad complicated by infection
cholangio-hepatitis ascending cholangitis
septicemia
septic shock
renal failure disorientation Hypotension
Reynold’s pentad
chronic calcular cholecystitis
fat dyspepsia
fat dyspepsia
cholecystectomy
fat dyspepsia
Page | 68
Infection
Charcot’s triad
Reynold’s pentad

fat dyspepsia

Reynold’s pentad
Charcot’s triad
ascending cholangitis calcular obstructive jaundice
Charcot’s triad
septic shock cholangitis

Reynold’s pentad
fluctuating in course calcular obstructive jaundice

jaundice
bile common bile duct
ball valve effect

ball valve effect
jaundice

Intermittent jaundice Reynold’s pentad Charcot’s triad
Page | 69
fluctuating jaundice Reynold’s pentad Charcot’s triad
Reynold’s pentad
altered mental state and shock Charcot’s triad
type of patient

Just
pain Biliary colic
Charcot’s triad Infected
Reynold’s pentad
Reynold’s pentad Charcot’s triad
ball - valve effect stone

Intermittent obstructive jaundice
malignant obstructive jaundice

Male
Page | 70
general examination
Virchow’s Scratch marks
Local examination
Courvoisier Gall bladder
Courvoisier’s law Courvoisier

gall badder malignant obstructive jaundice
healthy
Malignant obstructive jaundice

healthy gall bladder
distensible
healthy gall bladder

distensible
gall bladder Malignant obstructive jaundice
myocardial infarction
 gall bladder congenitally absent
surgically removed
shrunken fibrotic
gall bladder Malignant obstructive jaundice

congenitally absent
Surgically removed
fibrotic Inflamed
Klatskin tumor
Porta hepatis carcinoma
Klatskin tumor
Open the door
Page | 71

gall bladder
shrunken
gall bladder calcular obstructive jaundice gall bladder
cholesterol stone rare
Healthy gall bladder
cholesterol stone stone

Healthy gall bladder
pyocele Mucocele
pyocele mucocele
Mirizzi syndrome Pyocele mucocele
Pyocele Mucocele gall bladder Mirizzi syndrome
fibrotic
calcular obstructive jaundice distended gall bladder

Healthy gall bladder cholesterol stone 
Mirizzi syndrome 
Mirizzi syndrome cholesterol stone
common bile duct Mirizzi syndrome

fistula
gall bladder Pyocele Mucocele
fatty, fertile
Page | 72
biliary colic
equal
Reynold’s pentad Charcot’s triad
ball valve effect
scratch marks
Courvoisier Virchow’s
Courvoisier malignant obstructive jaundice
painless except late Malignant obstructive jaundice 

late
painless condition except late Malignant obstructive jaundice
painless except late Malignant jaundice

Progressive Malignant obstructive jaundice 
progressive
Rare
peri ampulla carcinoma
necrosis slaughing
Malignant obstructive jaundice

slaughing peri ampulla carcinoma painless
slaughing peri ampulla carcinoma Painless
obstructive jaundice Investigations
Liver function
Page | 73
Prolonged prothrombin time alkaline phosphatase direct bilirubin
liver
Kidney
Kidney Liver
Urine
Urine
frothy Dark
dark
direct bilirubin
frothy
Bile salts
frothy
sluphar test
stool
stercobilin Clay
Ultra sound
Dilated intra hepatic bile ducts
idiot
19
Ultra sound
Dilated intra hepatic bile ducts
gall bladder stones
ERCP
Page | 74
ERCP
filling defect stone

biopsy stricture cancer
filling defect stone

biopsy stricture cancer
failed canulation ERCP
Percutaneous transhepatic cholangiography PTC
ERCP commonest complications

Ascending cholangitis
PTC Most serious complications

Biliary peritonitis
ascending cholangitis ERCP
ascending cholangitis ERCP
prophylactic antibiotic ERCP
prophylactic antibiotic
ERCP commonest complications

ascending cholangitis
PTC ERCP
PTC
bile duct needle
bile Needle
biliary peritonitis
PTC ERCP
Page | 75
ERCP
biliary peritonitis PTC
data
PTC ERCP Investigation

Magnetic Resonance Cholangio Pancreatography MRCP

therapeutic diagnostic 
Magnetic Resonance Cholangio Pancreatography MRCP

biliary tree MRI
ERCP quality
stone stricture wall bile
PTC ERCP
Invasion
therapeutic diagnostic
stone ERCP
therapeutic diagnostic
PTC
bile stone
Jaundice
therapeutic value diagnostic value PTC ERCP
diagnostic MRCP
therapeutic value
CT scan
stone Malignant
ERCP Stone
Is a must CT scan malignant
Staging
Page | 76
CT is very important cancer head pancreas

staging
CT scan
Follow up
follow up
tumor marker
Carcino-embryonic antigen (CEA)

Pancreatic onco fetal antigen (POFA)
Pancreatic cancer associated antigen (PCAA)
carcino embryonic antigen

Operable 
Inoperable 
Whipple’s operation Operable

Whipple
Pancreatico duodenoectomy
head duodenum
blood supply
Inoperable cancer head pancreas

Stent
technique
Page | 77

Pre operative preperation
antibiotic vitamin K mannitol fluid catheter Line Ryle
Semian crease mongol

prolonged prothrombin time
renal failure jaundice
Perparation How preparation

Preparation
fluid catheter Line Ryle
antibiotic mannitol vitamin K
vitamin K
Prothrombin time
mannitol
hepato-renal failure
antibiotic
Preparation
antibiotic Mannitol vitamin K fluid catheter Line ryle
pre operative preparation
Pulse supra chondylar fracture

artery
Page | 78
fracture reduction
Pre operative preparation
preparation
antibiotic Mannitol fluid catheter Line Ryle
sphincterotomy ERCP
sphincter ERCP
stone dormia basket
sphincterotomy
sphincter
sphincterotomy
stone
stone sphincter
stone
stone
sphincter
stone sphincter
sphincterotomy
sphincterotomy
Page | 79
dormia basket stone

Chronic calcular cholecystitis
common bile duct stone Obstructive jaundice

Charcot’s triad
anti biotic

cholecystectomy laparoscope

cholecystectomy
ascending cholangititis
antibiotic

laparoscopic cholecystectomy


Page | 80
gall bladder
stone stone foreceps common bile duct

preoperative preparation
stones
stones common bile duct

 obstructive jaundice
chronic calcular cholecystitis 

cholecystectomy
stone common bile duct

jaundice

Cholecystectomy
chronic calcular cholecystitis 

obstructive jaundice 
Page | 81

Cholecystectomy

cholecystectomy
Jaundice

stone
anus
common bile duct
T tube
Intra operative T tube cholangiography
Intra operative T tube cholangiography
T tube
common bile duct T tube
tube bile
400 ml ringer lactate 400
bile
bile
electrolyte imbalance ringer lactate
Page | 82
10
T tube omentum
48 omentum
gall bladder
Inert T tube
omentum
10
T tube
patent T tube
T tube
bile
heal by fibrosis Omentum
T tube
T tube
fibrosis track T tube
T tube
peritoneal cavity bile
examiner
Page | 83
T tube
examiner
patent radiography T tube

T tube
T tube
T tube
T tube Omentum
retained stone Missed stone
retained stone Missed stone
common bile duct

stone
duodenum common bile duct duodenum
choledochoduodenstomy
duodenum common bile duct
choledochoduodenostomy
duodneum bile
stone
common bile duct
passive bile
Page | 84
duodenum bile
bile
common bile duct duodenum
bile choledochoduodenostomy
duodenum bile
choledocho
choledochal common bile duct
multiple stones stricutre

dilated common bile duct

Healing by fibrosis

healing
fibrosis Healing
dilated common bile duct choledochoduoenstomy
dilated common bile duct choledochoduodenostomy
choledochoduodenostomy dilated common bile duct

stricture Healing by fibrosis choledochoduodenostomy
sphincter duodenum
patulous sphincter
Page | 85
sphincter
sphincter
Sphincter of oddi
patulous
patulous sphincter
transduodenal
duodenum
Sphincteroplasty
transduodenal sphincteroplasty
pancreas bile
Pancreatitis
choledochoduodenstomy 
transduodenal sphincteroplasty 
20

ERCP investigation

 aggressive calcular obstructive jaundice
by surgery
choledocho choledocho choledocho
Choledocho
Page | 86
cholecystectomy

stone cholecystectomy

pre operative preparation
antibiotic Mannitol vitamin K fluid catheter Line ryle
vitamin K prolonged Prothrombin time
ascending cholangitis antibiotic
to avoid hepato-renal failure wash Mannitol
according to technical support

dormia basket stone ERCP with sphincterotomy
Later on,
Laparoscopic cholecystectomy
Open laparoscopic cholecystectomy

dormia basket stone sphincterotomy ERCP
laparoscopic cholecystectomy technical support
technical support
duct cholecystectomy techincal support
T tube
 
dilated stones common bile duct

stricuture
Page | 87
side to side end to side choledochoduodenostomy
side to side end to side choledochoduodenostomy
common bile duct

duodenum
duodenum side common bile duct end
end to side
common bile duct
duodenum
side to side
duodenum side common bile duct side
duodenum side common bile duct end
end to side side to side
Preparation
antibiotic mannitol vitmain K
dormia basket stone ERCP

Later on, laparoscopic cholecystectomy
Page | 88
choledochoduodenstomy cholecystectomy
discussion
T tube
T tube discussion
T tube
10
Omentum
T tube
Bile
ringer lactate bile
T tube discussion
Multiple stones dilated common bile duct

multiple stones dilated common bile duct

trans duodenal sphincteroplasty
treatment
calcular obstructive jaundice treatment
Cancer head of pancreas

inoperable Operable
system
operable
 Operation
pancreatico duodenoectomy Whipple’s operation
Page | 89
pancreas head duodenum

same blood supply
blood supply
Superior and inferior pancreatico duodenal artery
Operable
Whipple’s operation
inoperable
stent
triple anastomosis
stent Minimal invasive surgery
Inoperable stent
Cancer head of pancreas

inoperable
inoperable cancer head of pancreas

Inferior vena cava
Inoperable cancer head of pancreas

stent
stent
Not resectable inoperable cancer head of pancreas
stent
stent
duodenum
waiting for death to palliate the patient
Page | 90
duodenum
gastro jejunostomy
Inoperable cancer head of pancreas

Jaundice
Jaundice
Jejunum
cholecysto-jejunostomy
bile choledochojejunostomy
bile
gall bladder
Jejunum
gall bladder Jejunum
gall bladder
gall bladder
jejuno-jejunostomy
Page | 91
Jejuno-jejunostomy
gastro jejunostomy
gall bladder jejunum
cholecysto jejunostomy
gall bladder
cholangitis
jejuno-jejunostomy Jejunum
gall bladder
Jejuno-jejunostomy
anastomosis
Gasto-jejunostomy 
choledocho jejunostomy Cholecysto jejunostomy 
jejuno jejunostomy 
Whipple’s operation
duodenum Whipple’s operation
Operable Whipple’s operation

Whipple’s operable
duodenum
inoperable
Page | 92
stent 
triple anastmosis 
Stent
triple anastmosis
www.facebook.com/dr.tafreegh
Page | 93

9 - 10 - 11 Gall Bladder

Hochgeladen von

Dokumentinformationen

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

9 - 10 - 11 Gall Bladder

Hochgeladen von

Copyright:

Verfügbare Formate

Gall bladder - Dr.

written Biliary atresia

case presentation written biliary atresia

rare Choledochal cyst

More common in females

More common in females

intra uterine infection

common bile duct pancreatic juice

sources MCQ sources

MCQ written biliary atresia

MCQ choledochal cyst

dilated bile duct Liver

dilated bile duct

extra hepatic bile duct dilatation

common bile duct

common bile duct stone

common bile duct stone

intra hepatic bile duct dilatation

dilated intra hepatic bile duct

Investigations choledochal cyst

 liver Liver choledochal cyst

Liver choledochal cyst

Oma  heap Hepatectomy

dilated intra hepatic bile duct

dilated bile ducts

segmental liver transplantation

40,000 segmental liver transplantation

segmental liver transplantation

Liver liver transplantation

segmental liver transplantation

dilated bile duct

hepatico-jejunostomy Roux -en - Y

bile duct talent

resectable cholangio carcinoma

10,000 incidence biliary atresia

incidence of biliary atresia MCQ

scratch marks general

gall bladder gall bladder atresia 

gall bladder gall bladder atresia

investigations biliary atresia

investigations biliary atresia

direct bilirubin liver function biliary atresia

dilated intra hepatic bile duct

biliary atresia investigation

biliary atresia HIDA scan

sonar biliary atresia

Dilated intra hepatic bile duct, unless

Non visualization of the liver neonatal hepatitis

Liver iso-tope scanning HIDA scan

duodenum Liver biliary atresia

duodenum Liver neonatal hepatitis

Kasai operation biliary atresia

portal hypertension liver cirrhosis

gall bladder stones

Gall bladder stones

differential diagnosis diagnosis

HIDA scan investigation of choice

itching clay stool dark urine jaundice 8

positive family history

neonatal biliary atresia 8

blood transfusion hepatitis

ERCP ultra sound stool Urine

Neonates biliary atresia

Choledochal cyst biliary atresia