Biliary Fistulae (Dr Hasnain Ejaz)
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diagnosis & management of biliary fistulae
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This document provides an overview of splenic injuries, including epidemiology, anatomy, evaluation, management, and guidelines. Key points include:
- The spleen is the most commonly injured organ in blunt abdominal trauma. Evaluation involves clinical exam, hematology tests, ultrasound, and CT scan to grade injuries.
- Management depends on hemodynamic stability and injury grade. Options include non-operative management with observation or angioembolization, or splenectomy/splenorrhaphy during surgery.
- Complications of splenic injuries and splenectomy include hemorrhage, infection, and post-splenectomy sepsis. Guidelines recommend attempting non-operative management for stable patients
Surgical liver anatomy
The liver has significant anatomic variability. It develops from the foregut and is divided into lobes based on vascular and biliary anatomy. The caudate lobe is located posteriorly between the IVC and other lobes. It has complex vascular and biliary drainage patterns. The liver is commonly divided into segments based on Couinaud's or Brisbane's classifications to describe resection types. The caudate lobe specifically can be further divided into the Spiegel lobe, caudate process, and paracaval portion.
Mirizzi syndrome ppt
Mirizzi syndrome is a rare complication of long-standing gallstone disease that results in external compression or fistulization of the common hepatic duct by an impacted gallstone in the cystic duct or gallbladder. It occurs in 0.3-5.7% of cholecystectomy patients. Treatment depends on the classification type but may include subtotal cholecystectomy, fistula repair, or hepaticojejunostomy. Precise preoperative diagnosis is difficult but helps minimize complications like bile duct injuries during surgery for this condition with distorted anatomy.
Choledochal cyst
1. Choledochal cysts are abnormal dilations of the bile ducts that are more common in Asia and women.
2. They are classified into 5 types based on location and extent of dilation.
3. Presentation varies from jaundice and abdominal mass in children to pain and cholangitis in older patients.
4. Investigation involves ultrasound, CT, MRCP and cholangiography to determine type and rule out complications.
5. Treatment is complete excision of the cysts and biliary tree with Roux-en-Y hepaticojejunostomy, except for type III which can be managed endoscopically.
LIVER TRAUMA
This document discusses liver trauma resulting from blunt and penetrating injuries. It describes two case studies, one involving a car accident and the other a stabbing. The car accident patient had liver lacerations that were managed surgically, while the stabbing victim had a liver wound and duodenal injury repaired during an emergency laparotomy. Most liver injuries can be successfully treated without surgery if the patient is hemodynamically stable. Surgical management may involve packing the liver or angiographic embolization of bleeding sites. Following initial resuscitation, imaging can help evaluate the severity and location of liver injuries.
Surgical anatomy of liver
This document summarizes the surgical anatomy of the liver. It describes the topographic anatomy including the right, left, quadrate and caudate lobes. It then discusses Couinaud's segmental anatomy system which divides the liver into eight segments based on hepatic and portal venous branches. Finally, it provides details on the portal and hepatic veins, including their diameters, lengths, blood flow patterns and variations that are important for liver surgery.
Splenic trauma
This Presentation gives general overview of history of spleen and its trauma, clinical presentation, staging, managaement and OPSI
LIVER INJURY- TRAUMA SURGERY.pptx
In this presentation, I discussed the mechanism of injury, grading, clinical features, diagnosis, and treatment of liver injuries.
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Splenic injuries ppt by manjusb
This document provides an overview of splenic injuries, including epidemiology, anatomy, evaluation, management, and guidelines. Key points include:
- The spleen is the most commonly injured organ in blunt abdominal trauma. Evaluation involves clinical exam, hematology tests, ultrasound, and CT scan to grade injuries.
- Management depends on hemodynamic stability and injury grade. Options include non-operative management with observation or angioembolization, or splenectomy/splenorrhaphy during surgery.
- Complications of splenic injuries and splenectomy include hemorrhage, infection, and post-splenectomy sepsis. Guidelines recommend attempting non-operative management for stable patients
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The liver has significant anatomic variability. It develops from the foregut and is divided into lobes based on vascular and biliary anatomy. The caudate lobe is located posteriorly between the IVC and other lobes. It has complex vascular and biliary drainage patterns. The liver is commonly divided into segments based on Couinaud's or Brisbane's classifications to describe resection types. The caudate lobe specifically can be further divided into the Spiegel lobe, caudate process, and paracaval portion.
Mirizzi syndrome ppt
Mirizzi syndrome is a rare complication of long-standing gallstone disease that results in external compression or fistulization of the common hepatic duct by an impacted gallstone in the cystic duct or gallbladder. It occurs in 0.3-5.7% of cholecystectomy patients. Treatment depends on the classification type but may include subtotal cholecystectomy, fistula repair, or hepaticojejunostomy. Precise preoperative diagnosis is difficult but helps minimize complications like bile duct injuries during surgery for this condition with distorted anatomy.
Choledochal cyst
1. Choledochal cysts are abnormal dilations of the bile ducts that are more common in Asia and women.
2. They are classified into 5 types based on location and extent of dilation.
3. Presentation varies from jaundice and abdominal mass in children to pain and cholangitis in older patients.
4. Investigation involves ultrasound, CT, MRCP and cholangiography to determine type and rule out complications.
5. Treatment is complete excision of the cysts and biliary tree with Roux-en-Y hepaticojejunostomy, except for type III which can be managed endoscopically.
LIVER TRAUMA
This document discusses liver trauma resulting from blunt and penetrating injuries. It describes two case studies, one involving a car accident and the other a stabbing. The car accident patient had liver lacerations that were managed surgically, while the stabbing victim had a liver wound and duodenal injury repaired during an emergency laparotomy. Most liver injuries can be successfully treated without surgery if the patient is hemodynamically stable. Surgical management may involve packing the liver or angiographic embolization of bleeding sites. Following initial resuscitation, imaging can help evaluate the severity and location of liver injuries.
Surgical anatomy of liver
This document summarizes the surgical anatomy of the liver. It describes the topographic anatomy including the right, left, quadrate and caudate lobes. It then discusses Couinaud's segmental anatomy system which divides the liver into eight segments based on hepatic and portal venous branches. Finally, it provides details on the portal and hepatic veins, including their diameters, lengths, blood flow patterns and variations that are important for liver surgery.
Splenic trauma
This Presentation gives general overview of history of spleen and its trauma, clinical presentation, staging, managaement and OPSI
LIVER INJURY- TRAUMA SURGERY.pptx
In this presentation, I discussed the mechanism of injury, grading, clinical features, diagnosis, and treatment of liver injuries.
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This document provides information on femoral triangle anatomy, femoral hernia, and umbilical hernia. It describes the boundaries of the femoral triangle and sheath. It then discusses the presentation, types, investigations, and surgical treatments of femoral hernia using various approaches like Lockwood, Lotheissen, and McEvedy. For umbilical hernia, it outlines the causes in children versus adults and various surgical repair techniques like Mayo's repair and mesh repair options based on hernia size and location.
Biliary tract
Bile is produced by the liver and stored and concentrated in the gallbladder before being released to aid digestion. The biliary tree consists of intrahepatic and extrahepatic ducts that drain bile from the liver to the gallbladder and duodenum. Developmental variations in branching patterns can occur and need to be recognized to avoid complications during surgery or imaging studies. Biliary disorders in children may be developmental, such as biliary atresia or choledochal cysts, or acquired, like inspissated bile plug syndrome. Gallbladder diseases include cholecystitis, porcelain gallbladder, and adenomyomatosis.
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1) The document discusses the approach to evaluating a patient presenting with a breast lump, including obtaining a thorough history, conducting a physical examination, and ordering appropriate investigations.
2) The differential diagnosis for a breast lump includes benign conditions like fibrocystic disease, cysts, and fibroadenoma, as well as breast cancer.
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Iatrogenic biliary tract injuries
The First Congress of the Palestinian
Society of Gastroenterology
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Ramallah
Walid Sweidan MB, BCh, MRCPI, FRCP
Hilar Cholangiocarcinoma
1) Surgery for hilar cholangiocarcinoma requires complex hepatic resection to obtain clear margins and provides the only chance for cure, though it is associated with significant morbidity and mortality risks.
2) Pre-operative investigations including CT and MRCP are needed to determine the extent of tumor involvement and plan the appropriate type of hepatic resection.
3) The extent of resection is based on the Bismuth-Corlette classification of tumor involvement and may require right, extended right, left, or extended left hepatectomy with possible arterial or portal vein resection.
4) Surgical techniques including inflow control, bile duct division, and vascular reconstruction aim to achieve an R0 resection while preserving adequate
liver injury
1. The liver is the second most commonly injured organ in abdominal trauma after the spleen. Liver injuries have a high mortality rate, especially with blunt trauma.
2. Liver injuries can be caused by blunt trauma from motor vehicle accidents or falls, as well as penetrating trauma from stab wounds or gunshots.
3. CT scanning is the gold standard for evaluating liver injuries and assessing their severity based on the American Association for the Surgery of Trauma (AAST) grading scale.
4. Management depends on the patient's stability and injury grade. Lower grade injuries may be managed non-operatively but higher grades often require surgery or angiography with embolization.
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Laparoscopic Anterior resection. After insertion of ports with patient in steep trendelenburg position Inferior mesenteric artery was identified and high ligation done with division of left colic artery and then medial to lateral dissection was done. Subsequently inferior mesenteric vein was dissected and clipped and divided. Distal dissection proceeded just behind the superior rectal artery and after identification and preservation of the hypogastric nerves, upper rectum was mobilised. Division of bowel was done at upper rectum after giving adequate distal margin and end to end anastomosis was done using circular stapler.
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The liver is the second most commonly injured organ in blunt abdominal trauma and the most commonly injured in penetrating abdominal trauma. Non-operative management of liver injuries is now the standard of care for hemodynamically stable patients and has a success rate of over 85%, even for high-grade injuries. Failure of non-operative management is usually due to other intra-abdominal injuries rather than the liver injury itself. Operative intervention is indicated for hemodynamically unstable patients or those who fail non-operative management.
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the lecture explains the pathology of acute pancreatitis ,the different imaging findings and how to score the severity of disease.
Liver trauma
1. Liver injuries are commonly caused by blunt or penetrating abdominal trauma. The right lobe of the liver is most frequently injured.
2. Liver injuries are graded from I to VI based on severity. Grade I injuries involve small lacerations while grade VI involve major vascular injuries.
3. Most liver injuries can now be managed non-operatively with techniques like angiography, embolization, and close monitoring. Operative management is reserved for higher grade injuries or those with ongoing bleeding.
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The document discusses splenic trauma, including anatomy, mechanisms of injury, signs and symptoms, diagnostic modalities, grading systems, and treatment approaches. It notes that non-operative management is the preferred treatment for hemodynamically stable patients, regardless of injury grade. Operative management may be required for hemodynamic instability, failure of non-operative management, or high-grade injuries involving major vessels. Splenectomy is performed as a last resort, and vaccination and antibiotic prophylaxis are important after splenectomy to prevent infection.
Bile duct injuriesCBDstricture, biliary fistula.pptx
1. The document provides tips for using a PowerPoint presentation as an active learning tool, including showing blank slides to elicit student responses before providing content.
2. It discusses the Strasberg classification system for bile duct injuries, which categorizes injuries based on location, mechanism, and effect on biliary continuity.
3. Management of bile duct injuries depends on the type and severity, ranging from ligation of small ducts to biliary-enteric anastomosis for more extensive injuries involving the biliary tree continuity.
L30 gallstones student
I do not have a view on philosophical or theological questions. I am an AI assistant created by Anthropic to be helpful, harmless, and honest.
Management of Carcinoma Gall Bladder
Carcinoma of the gall bladder is one of the common malignancy of HBS. The age group mostly affects the elderly. its grows faster than cholangiocarcinoma. most commonly found in north India and south America. Risk factors are gallbladder polyps, stones, porcelain gallbladder, carcinogens, anatomical malformation, cholangiocarcinoma, etc. Common presentations are incidentally diagnosed during cholecystectomy or diagnosed during cholecystectomy. But may present as biliary pain, jaundice, weight loss, and abdominal mass. Overall prognosis is not good. 5 year survival is only < 10%.
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This document discusses the management of burst abdomens, also known as abdominal wound dehiscence. It defines abdominal wound dehiscence and provides information on incidence, risk factors, clinical manifestations, and treatment options. Dehiscence occurs when an abdominal wound separates after surgery, with a reported incidence between 0.2-6% and mortality rates of 10-40%. Risk factors include male sex, age under 45, emergency surgery, obesity, and medical conditions like diabetes or renal failure. Treatment depends on the severity but may involve re-suturing the wound with retention sutures or using a prosthetic mesh if the wound cannot be primarily closed.
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- Partners in the top quartile for operating profit as a percentage of revenue spent more time focusing on existing customers rather than new customers across sales, marketing, and service functions. They also saw higher average deal sizes with existing customers.
- The document recommends designating an existing customer champion to focus efforts on prioritizing communications and executing
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Retroperitoneal mass
This entails discussion about primary retroperitoneal masses and few commmon other retroperitoneal mass
Femoral hernia with umbilical hernia
This document provides information on femoral triangle anatomy, femoral hernia, and umbilical hernia. It describes the boundaries of the femoral triangle and sheath. It then discusses the presentation, types, investigations, and surgical treatments of femoral hernia using various approaches like Lockwood, Lotheissen, and McEvedy. For umbilical hernia, it outlines the causes in children versus adults and various surgical repair techniques like Mayo's repair and mesh repair options based on hernia size and location.
Biliary tract
Bile is produced by the liver and stored and concentrated in the gallbladder before being released to aid digestion. The biliary tree consists of intrahepatic and extrahepatic ducts that drain bile from the liver to the gallbladder and duodenum. Developmental variations in branching patterns can occur and need to be recognized to avoid complications during surgery or imaging studies. Biliary disorders in children may be developmental, such as biliary atresia or choledochal cysts, or acquired, like inspissated bile plug syndrome. Gallbladder diseases include cholecystitis, porcelain gallbladder, and adenomyomatosis.
Approach to a patient with breast lump
1) The document discusses the approach to evaluating a patient presenting with a breast lump, including obtaining a thorough history, conducting a physical examination, and ordering appropriate investigations.
2) The differential diagnosis for a breast lump includes benign conditions like fibrocystic disease, cysts, and fibroadenoma, as well as breast cancer.
3) Treatment depends on the diagnosis, with benign lumps often excised for confirmation, while malignant breast cancer may require total mastectomy or lumpectomy along with further treatment and follow-up testing.
Colorectal polyp
This document defines and classifies colorectal polyps. It discusses that polyps can be benign or malignant, and classified by shape (pedunculated or sessile) or histology (epithelial or mesenchymal). Malignant polyps have characteristics like large size (>1cm), villous or tubulovillous histology, high grade dysplasia, or multiple polyps which increase cancer risk. The Haggitt criteria classify cancer invasion in polyps from Level 0 (in situ) to Level 4 (invading submucosa below stalk). Surveillance colonoscopy intervals depend on polyp characteristics, ranging from 1-5 years. Polypectomy can treat early cancers but resection
Iatrogenic biliary tract injuries
The First Congress of the Palestinian
Society of Gastroenterology
20-21 May 2010
Ramallah
Walid Sweidan MB, BCh, MRCPI, FRCP
Hilar Cholangiocarcinoma
1) Surgery for hilar cholangiocarcinoma requires complex hepatic resection to obtain clear margins and provides the only chance for cure, though it is associated with significant morbidity and mortality risks.
2) Pre-operative investigations including CT and MRCP are needed to determine the extent of tumor involvement and plan the appropriate type of hepatic resection.
3) The extent of resection is based on the Bismuth-Corlette classification of tumor involvement and may require right, extended right, left, or extended left hepatectomy with possible arterial or portal vein resection.
4) Surgical techniques including inflow control, bile duct division, and vascular reconstruction aim to achieve an R0 resection while preserving adequate
liver injury
1. The liver is the second most commonly injured organ in abdominal trauma after the spleen. Liver injuries have a high mortality rate, especially with blunt trauma.
2. Liver injuries can be caused by blunt trauma from motor vehicle accidents or falls, as well as penetrating trauma from stab wounds or gunshots.
3. CT scanning is the gold standard for evaluating liver injuries and assessing their severity based on the American Association for the Surgery of Trauma (AAST) grading scale.
4. Management depends on the patient's stability and injury grade. Lower grade injuries may be managed non-operatively but higher grades often require surgery or angiography with embolization.
Gall bladder & biliary tract anomalies and variants
This document describes the normal anatomy of the gallbladder and biliary tract, as well as common anatomical variations and anomalies. It discusses the normal divisions and structures of the gallbladder and cystic duct. It then covers several anomalies including agenesis of the gallbladder, gallbladder duplication, wandering gallbladder, gallbladder torsion, and variations in gallbladder shape. The document also discusses ectopic locations of the gallbladder and variations in cystic duct insertion and bile duct anatomy.
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ABDOMINAL TUBERCULOSIS : ETIOLOGY, SPREAD AND IMAGING FEATURES....ON CONVENTIONAL AND CROSS SECTIONAL IMAGING
Minimal invasive Surgery in Management of colorectal cancer
Laparoscopic Anterior resection. After insertion of ports with patient in steep trendelenburg position Inferior mesenteric artery was identified and high ligation done with division of left colic artery and then medial to lateral dissection was done. Subsequently inferior mesenteric vein was dissected and clipped and divided. Distal dissection proceeded just behind the superior rectal artery and after identification and preservation of the hypogastric nerves, upper rectum was mobilised. Division of bowel was done at upper rectum after giving adequate distal margin and end to end anastomosis was done using circular stapler.
Liver Trauma
The liver is the second most commonly injured organ in blunt abdominal trauma and the most commonly injured in penetrating abdominal trauma. Non-operative management of liver injuries is now the standard of care for hemodynamically stable patients and has a success rate of over 85%, even for high-grade injuries. Failure of non-operative management is usually due to other intra-abdominal injuries rather than the liver injury itself. Operative intervention is indicated for hemodynamically unstable patients or those who fail non-operative management.
Imaging acute pancreatitis
the lecture explains the pathology of acute pancreatitis ,the different imaging findings and how to score the severity of disease.
Liver trauma
1. Liver injuries are commonly caused by blunt or penetrating abdominal trauma. The right lobe of the liver is most frequently injured.
2. Liver injuries are graded from I to VI based on severity. Grade I injuries involve small lacerations while grade VI involve major vascular injuries.
3. Most liver injuries can now be managed non-operatively with techniques like angiography, embolization, and close monitoring. Operative management is reserved for higher grade injuries or those with ongoing bleeding.
Splenic trauma - Causes, Complications, Management
The document discusses splenic trauma, including anatomy, mechanisms of injury, signs and symptoms, diagnostic modalities, grading systems, and treatment approaches. It notes that non-operative management is the preferred treatment for hemodynamically stable patients, regardless of injury grade. Operative management may be required for hemodynamic instability, failure of non-operative management, or high-grade injuries involving major vessels. Splenectomy is performed as a last resort, and vaccination and antibiotic prophylaxis are important after splenectomy to prevent infection.
Bile duct injuriesCBDstricture, biliary fistula.pptx
1. The document provides tips for using a PowerPoint presentation as an active learning tool, including showing blank slides to elicit student responses before providing content.
2. It discusses the Strasberg classification system for bile duct injuries, which categorizes injuries based on location, mechanism, and effect on biliary continuity.
3. Management of bile duct injuries depends on the type and severity, ranging from ligation of small ducts to biliary-enteric anastomosis for more extensive injuries involving the biliary tree continuity.
L30 gallstones student
I do not have a view on philosophical or theological questions. I am an AI assistant created by Anthropic to be helpful, harmless, and honest.
Management of Carcinoma Gall Bladder
Carcinoma of the gall bladder is one of the common malignancy of HBS. The age group mostly affects the elderly. its grows faster than cholangiocarcinoma. most commonly found in north India and south America. Risk factors are gallbladder polyps, stones, porcelain gallbladder, carcinogens, anatomical malformation, cholangiocarcinoma, etc. Common presentations are incidentally diagnosed during cholecystectomy or diagnosed during cholecystectomy. But may present as biliary pain, jaundice, weight loss, and abdominal mass. Overall prognosis is not good. 5 year survival is only < 10%.
Management of the burst abdomen.ppt
This document discusses the management of burst abdomens, also known as abdominal wound dehiscence. It defines abdominal wound dehiscence and provides information on incidence, risk factors, clinical manifestations, and treatment options. Dehiscence occurs when an abdominal wound separates after surgery, with a reported incidence between 0.2-6% and mortality rates of 10-40%. Risk factors include male sex, age under 45, emergency surgery, obesity, and medical conditions like diabetes or renal failure. Treatment depends on the severity but may involve re-suturing the wound with retention sutures or using a prosthetic mesh if the wound cannot be primarily closed.
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- Partners in the top quartile for operating profit as a percentage of revenue spent more time focusing on existing customers rather than new customers across sales, marketing, and service functions. They also saw higher average deal sizes with existing customers.
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Biliary Fistulae (Dr Hasnain Ejaz)
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