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Behzad Nakhaei, M.D. , FICS Fellowship in HepatoBiliary Surgery Mc Gill University

Behzad Nakhaei, M.D. , FICS Fellowship in HepatoBiliary Surgery Mc Gill University. RUQ & Upper Abdomen Inflammation & Infection GallBladder & Biliary System Disorders ( A Problem Solving Lecture ) For Medical Students.

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Behzad Nakhaei, M.D. , FICS Fellowship in HepatoBiliary Surgery Mc Gill University

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  1. Behzad Nakhaei, M.D. , FICSFellowship in HepatoBiliary Surgery Mc Gill University RUQ & Upper Abdomen Inflammation & Infection GallBladder & Biliary System Disorders ( A Problem Solving Lecture ) For Medical Students

  2. Common Clinical PresentationsIn RUQ & Upper AbdomenDue to Inflammation & Infection • Pain & Fever • Jaundice & Fever • Mass & Fever • (One / Two Symptoms Dominate in each of these)

  3. Signal the need for: • Complete Blood Count • Liver Function Test • Serum Amylase • PT , PTT • Blood Culture • Chest & Abdominal X ray • Abdominal Ultrasonography

  4. 3Most common Scenario:? • Acute Cholecystitis? • OR • Acute Cholangitis? • OR • Acute Pancreatitis?

  5. Pain & Fever? • Upper Abdomen Sepsis == RUQ Pain & Fever • In 2/3 of Cases Biliary Origin • (Acute Cholecystitis, Biliary Colic, Acute Cholangitis) • Acute Pancreatitis • Pneumonia • Hepatitis , Herpes Zoster • Other gastrointestinal Disease • Sono is the most important Screening test for Acute Biliary Infections.

  6. Diagnosis AcuteCholecystitis Biliary Colic Acute Cholangitis Acute Pancreatitis Sono Finding Stone & Thickening of wall Stone in Biliary Tree Stone & Dilatation of CBD Pancreas Enlargement Pain & Fever

  7. Cholecystitis ? • Acute Calculous • Acute Acalculous • Emphysematous • Hydrops • Empyema • Chronic

  8. Risk Factors of Gangrene & Perforationin Acute Cholecystitis • Systemic Toxicity • Emphysematous Cholecystitis • Acalculous Cholecystitis

  9. Fever & Jaundice ? • If the Patient Presents with : • Fever > 38.5 & Jaundice • Leukocytosis & Positive Blood Culture • Stone & Biliary tree dilatation on Sono • Reynolds, Pentad • ( Abdominal Pain, Fever&Chills,Jaundice, Hypotension,Mental confusion ) • Dx is Acute Cholangitis

  10. Cholangitis? • Infection within Biliary tree Due to : • Choledocholithiasis • Choledochal cysts • Bile Duct CA • Sphincteroplasty • Instrumentation of Biliary tree

  11. Cholangitis ? • Acute SuppurativeCholangitis • Cholangiohepatitis • Sclerosing Cholangitis

  12. Acute SuppurativeCholangitis? • Pus within the Biliary tract • Complicated by Obstructive Jaundice • Charcot triad : Jaundice, Chill , Fever • Age Over 70 • ERCP or PTC • Surgical Intervention

  13. Cholangiohepatitis • Most common in China & Hong Kong • Clonorchiasis • Ascariasis • Malaria Hemolysis • E coli & Klebsiella • Toxic Condition • Emergency surgery

  14. Sclerosing Cholangitis • Involve Extra & Intrahepatic Biliary tree • Association with Ulcerative colitis&Crohn • HIV infection has been noted • Most common in middle age men • By Pass operation for Palliation • Liver Transplantation for Cure

  15. Fever & Abdominal Mass? • The origin of Pathology is in the : • GallBladder • Or • Liver

  16. Fever & Abdominal Mass? • Possible Diagnosis Are : • Empyema of GB • Hydrops of GB • Pyogenic Liver Abscess • Liver infected Cysts

  17. Biliary Enteric Fistula &Gallstone Ileus • Between GB & Duodenum 85% • Between GB & Colon 15 % • Can cause Mechanical Obstruction • Most often in Terminal Ilum • Past history of Cholelithiasis is present

  18. Mirizzi,s Syndrome? • A fistula between Hartmann's Pouch & CBD • A Stone in the Ampulla of the GB can erode the CBD and can destroyed CBD Partially or Completely

  19. YOU!!!!!!!! • Try to BE A Sophisticated Person

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