1. Biliary Conditions

2. Biliary Conditions
1. Cholecystitis
2. Cholelithiasis

4. Cholecystitis
• Cholecystitis is inflammation of the gallbladder. gallbladder is a
small, pear-shaped organ on the right side of abdomen, beneath
your liver. The gallbladder holds a digestive fluid that's released into
small intestine (bile).
• If left untreated, cholecystitis can lead to serious, sometimes life-
threatening complications, such as a gallbladder rupture. Treatment
for cholecystitis often involves gallbladder removal.
• When it is filled with pus it is called “empyema”

5. Cholecystitis

6. Cholecystitis

7. Causes
• caused by:
• Gallstones. Most cholecystitis is the result of hard particles that
develop in gallbladder (gallstones) from imbalances in the
substances in bile, such as cholesterol and bile salts. Gallstones can
block the cystic duct — the tube through which bile flows when it
leaves the gallbladder — causing bile to build up and resulting in
inflammation.
• Tumor. A tumor may prevent bile from draining out of gallbladder
properly, causing bile buildup that can lead to cholecystitis.
• Bile duct blockage. Kinking of the bile ducts can cause blockages
that lead to cholecystitis.

8. Signs and Symptoms
• Signs and symptoms of cholecystitis may include:
• Severe pain and tenderness in upper right abdomen
• Pain could radiates from to right shoulder or back
• Tenderness over abdomen when it's touched
• Nausea
• Vomiting
• Fever
• Cholecystitis signs and symptoms often occur after a
meal, particularly a large or fatty meal.
• When it is filled with pus it is called empyema.

9. Signs and Symptoms

10. Risk factors
• Having gallstones is the main risk factor (90%)
for developing cholecystitis.

11. Complications
Cholecystitis can lead to a number of serious
complications, including:
• Death of gallbladder tissue. Untreated cholecystitis
can cause tissue in the gallbladder to die, which in
turn can lead to a tear in the gallbladder, or it may
cause your gallbladder to burst.
• Torn gallbladder. A tear in gallbladder may result from
gallbladder enlargement or infection.

12. Cholelithiasis
• It is gallstone or calculi of gallbladder
• gallstones are present in 8-20% of the
population by the age of 40 and are more
likely to develop in women than in men
• The first and most common type (representing
about 75% of cases) are cholesterol stones.

13. • The second type of gallstone is of the
pigmented variety. Pigmented stones arise
from the crystallization of calcium bilirubinate
and occur in two types: black and brown.

14. • The last type of gallstone encountered is of
the mixed variety, containing a mixture of
cholesterol and pigment.

15. Cholelithiasis

16. Types of stones

17. 5 F's:
• commonly used pneumonic for remembering
the risk factors for gallstone formation are the
5 F's:
• Fair, Fat, Fertile, Female, in her Forties.

18. Signs and symptoms
• The most common presenting symptom is
biliary colic (intermittent pain below the right
ribcage), which may radiate to the back.
• Palpable abdominal mass.
• Nausea, with or without vomiting
• flatulence (as well as belching and bloating)
with high fat diet

19. Signs and symptoms
• on physical exam, discomfort may be elicited by
deep palpation in the RUQ.
• A positive Murphy sign (pain elicited on palpation
of the RUQ while inspiring)
• Fever, jaundice from obstruction in bile duct
• Change in urine and stool colure (kidney to
excrete the bile from blood), stool would be gray
in colour form obstruction of bile flow.

20. Tests and diagnosis
Tests and procedures used to diagnose include:
1.Imaging tests that show gallbladder. Imaging tests, such as
abdominal ultrasound or a computerized tomography (CT) scan, can be
used to create pictures of gallbladder that may reveal signs of
cholecystitis.
2.Abdominal x-ray
3.Ultrasound abdomen
4.Radioactive imaging: by injecting die absorbed by liver then it is
excreted to the biliary tract then x-ray would be taken

21. Non surgical management
• Low fat diet
• High protein high powered substance
• Mediation to dissolve the stones especially for
patients who refuse surgery or at it is
contraindicated
• Intracorporeal lithotripsy: laser is used to
crush the stone
• Or by shock wave lithotripsy.

22. Surgery to remove the gallbladder
• (laparoscopic cholecystectomy). Cholecystectomy
is most
commonly performed using
a tiny video camera
mounted at the end
of a flexible tube.
This allows surgeon to
see inside abdomen
and to use special
surgical tools to remove the
gallbladder

23. Remember
• If surgery to this patient to be done:
1. x-ray to be taken before
2. Obtain liver function test
3. Vitamin K to be administered if Prothrompin
level is low
4. Teach the patient about the surgery its
complication

24. Treatment

25. • A less invasive way to remove gallbladders is under
study. Known as natural orifice transluminal
endoscopic surgery (NOTES), the procedure is intended
to lessen scarring and discomfort.
• Natural orifice transluminal endoscopic surgery
(NOTES) is an experimental surgical technique whereby
"scarless" abdominal operations can be performed
with an endoscope passed through a natural orifice
(mouth, urethra, anus, etc.) then through an internal
incision in the stomach, vagina, bladder or colon, thus
avoiding any external incisions or scars.[

27. Thank You