5. Pathogenesis
• Excess secretion of Cholesterol in Bile.
• Excess Mucous Production.
• Non-Functioning Gallbladder.
• Stasis in Gallbladder.
6. Pathological Effects
1. Silent Gallstones.
2. Obstruction of the Cystic Duct.
3. Movement of Stone into CBD.
4. Ulceration of Stone through Gallbladder
Wall.
8. 1. Biliary Colic
• Episodic Pain in RHC / Epigastrium.
• Pain Radiates to Lower Pole of Right Scapula.
• Sweaty, Nauseous, Vomiting Patient.
• Intermittent Jaundice with Pale Stool & Dark Urine.
9. • Differential Diagnosis:
– Renal Colic.
– Intestinal Obstruction.
– Angina.
• Pain Episode may Resolve when Stone is Passed into
CBD / Falls Back into the Gallbladder.
15. Acute Cholangitis
CAUSE … ?
• Infection of Bile In the Biliary Tree…
• Charcot’s Triad … ?
1. Pain.
2. Fever.
3. Jaundice.
16. • Predisposing Factors;
– Stone in CBD.
– Biliary Stricture.
– Post – ERCP.
– Post – Biliary Reconstructive Procedure.
• Antibiotics & Resuscitation followed by
Decompression of Biliary Tree.
17. Gallstone Ileus
• Gallstones may Erode into Duodenum / Colon.
• Gallstone lodge at Level of Meckel’s Diverticulum /
Ileocaecal Valve.
18. • Present as Acute Abdomen.
• Treat by;
– Drip & Suck.
– Urgent Laparatomy.
Cholecysto-Enteric Fistula LEFT UNTIL ACUTE EPISODE IS OVER.