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Gall bladder and Biliary disease

Gall bladder and Biliary disease. Dr.Umit Akyuz Gastroenterology Department Yeditepe University,Istanbul. Biliary stone disease Acute cholecytitis Primer sclerosane cholangitis Primer biliary cirrhosis Tumors. CHOLELITHIASIS. Chole – CYSTO - GALLBLADDER

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Gall bladder and Biliary disease

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  1. Gall bladder and Biliary disease Dr.UmitAkyuz GastroenterologyDepartment Yeditepe University,Istanbul

  2. Biliary stone disease • Acute cholecytitis • Primer sclerosane cholangitis • Primer biliary cirrhosis • Tumors

  3. CHOLELITHIASIS • Chole – CYSTO- GALLBLADDER • - DOCHO – D. CHOLEDOCHUS • CHOLESTEROL %75 • PIGMENT(blb, ca) % 25

  4. CHOLESTROL STONES • CHARACTERISTICS: • PURE OR MIXED • SMALL OR LARGE • SOLITARY OR MULTIPLE PIGMENT STONES • CHARACTERISTICS: • ELDERLY • HEMOLYTIC STATES • CIRRHOSIS • MULTIPLE, IRREGULAR • CENTRAL CALCIFICATION

  5. RISK FACTORS • 4 F : • Female • Fat • Fertile • Forty • 3 D • Diabetes • Drugs • Diet • 2 H • HLP • Heredity • Bile Salt Malabsorbtion

  6. COMPLICATIONS • STONE – PASSAGE • HYDROPS • CHOLECYSTITIS • ICTERUS • Ac. CHOLECYTITIS • EMPYEMA • PERFORATION • Chr. CHOLECYTITIS

  7. CLINICS • COLIC: • RUQ crampy Pain • RADIATION BACK • DYSPEPSIA • Ac. CHOLECYTITIS + COMPLICATIONS

  8. DIAGNOSIS • USG • X-Ray Plain Film • ERC / P • PTC • CT

  9. THERAPY • Spasmolytica • Antibiotics • SURGERY • Absolute Complications • Relative Complications • Medical: • Oral Lytholysis • Ursodeoxy-cholic Acid • ESLW

  10. therapy

  11. ACUTE CHOLECYSTITIS Acute Inflammation • Primary Abacterial • Secondary Bacterial • Enterococcus • E. Coli • Gr. (-) Bacilli • Anaerobs • Bacteroides • Clostridia • Fusobacterium

  12. Symptoms • Biliary colic Fever, chills, anorexia, nausea, vomiting • Enlarged Gallbladder • Murphy’s sign : RUQ-Palpation increased Pain in Inspiration

  13. Diagnosis: Clinics, US, biochemistry Complications  Empyema  Gangrene  Perforation  Ileus

  14. Therapy  PE - Nutrition  Antibiotics  Cholecystectomie ? for Complications !

  15. CHOLANGITIS Charcot’s Biliary pain Triad Jaundice Fever

  16. Bacteria • E. coli • Klebsiella • Proteus • E. bacter • Pseudomonas • Clostridium

  17. Complications • Sepsis • Hepatic Abcess • Bil. Strictures • Gallstones • Sec. Bil. Cirrhosis • PHT

  18. Treatment • ERCP • Antibiotics

  19. Primary Sclerosing Cholangitis İdiopathic intra+extrahepatic Chronic Fibrosing,Diffuse of bile Ducts Clinics: Cholestasis Bile D. Obliteration Cirrhosis

  20. Clinics Jaundice Pruritus Fatique Weight loss UC 75 %, CD, RA, Sarcoidosis,Sjögren Syndrome M/F 1/3 ANCA + ; IgM 

  21. Complications 5 – C • Cholestasis • Cirrhosis • Cholangitis • Cholelithiasis • Cholangiocarcinoma

  22. Therapy • AB • Cholestyramine • Ursodeoxycholicacid • Surgical : Liver Transplantation !

  23. Primary Biliary Cirrhosis • İnterlobuler and septal bile ducts • Middle aged population • 100-150/1 million

  24. Clinics • Fatigue • Piruritis • Asymtomatic • Jaundince • Variciel bleeding • ascites

  25. Assosiated Disease • keratoconjuctivites sikka (50%) • Thyroid disease (15%) • Artrithes (10%) • Reynaud (9%) • Scleroderma • Renal stones • Breast cancer

  26. Diagnosis • AMA >1/40 (M2 band) 95% • AST, ALT high • IgM high • Biluribune high • Hypercholesterolemia 80% • Pathology: florid duct lesions

  27. Complications • Osteopenia • Fat soluble vit. Deficiency • hypercholesterolemia

  28. Treatment • Ursodeoxycholic acid • Corticosteroids • Azothioprine • Cyclosporine • Methotraxate • Penicilamine,colhicine no benefit • Transplantation

  29. TUMORS • BENIGN • Polips • Adenomyomatosis • Cholesterosis • MALIGN • Carcinoma • Adeno • Squamous • Ductus Carcinoma • Pat 60 Years

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