The and Gallbladder Cholecystiti s Brick Laboratories What

The and Gallbladder Cholecystiti s Brick Laboratories

What is Cholecystitis ? By definition, Cholecystitis, is an inflammation of the GALLBLADDER wall and nearby abdominal lining.

The Gallbladder The gallbladder is a small pear-shaped muscular sack that acts as a storage tank for bile. The gallbladder is a hollow system that sits just beneath the liver. In adults, the gallbladder measures approximately 8 centimeters (3. 1 in) in length and 4 centimeters (1. 6 in) in diameter when fully distended, Walls thickness : 2~3 mm.

The Gallbladder The old red blood cells are recycled in the SPLEEN, platelets and white blood cells are also stored there. Spleen filters these out and breaks them down and turns them into bile salts and other things. So we have bile salts floating around in our bodies. The liver filters these bile salts out of our system, collects them and sends them to the gallbladder. The liver also sends waste products down too.

The Gallbladder The gallbladder collects the liquid, extracts water, and concentrates it. The end result is bile, a green, strongly alkaline, bitter, corrosive liquid. When fat globules arrive in the upper reaches of the small intestine, the duodenum. , it triggers a hormone (responsible for stimulating the digestion of fat and protein). Cholecystokinin. This hormone tells the gallbladder that bile is needed, so the gallbladder does a muscular contraction and dumps a large quantity of bile into the duodenum to deal with the fat.

Ø Bile (Produced & by the Hepatocytes) o Water (80%) o Bile acids (10%) o Lecithin & other phospholipids (4 -5%) o Cholesterol (1%) o Conjugated Bilirubin o Electrolytes o Mucous o Various proteins Ø Cholecystokinin: (CCK) is stimulus for release of bile into small intestine

Composition of bile: Bilirubin: (A by-product of haem degradation) Cholesterol (kept soluble by bile salts and lecithin) Bile salts/acids: (cholic acid): mostly reabsorbed in terminal ileum(entero-hepatic circulation).

Composition of bile: Lecithin : (increases solubility of cholesterol) Inorganic salts: (sodium bicarbonate to keep bile alkaline to neutralise gastric acid in duodenum) Water : (makes up to 97% of bile)

What is Gallstone ? Etiology Gallstones are small, hard deposits that can form in the gallbladder, As the liver sends more than just bile salts down to the gallbladder. It sends waste products too. Two of the waste products are calcium and cholesterol. Normally, these waste products concentrate down with the bile and are flushed into the duodenum when the gallbladder does its bile dump, Sometimes these two waste products will crystallize and form gallstones. 20% of gallstones are made of calcium, and 80% are made of cholesterol.

Gallstones Types of gallstone Cholesterol stones (20%) Pigment stones (5%) Mixed (75%) Epidemiology 4 “Fs” Fat, Fair, Female & Fourty F: M = 2: 1 10% of British women in their 40 s have gallstones Genetic predisposition –

Types of Gall Stones Cholesterol: • Radiolucent (calcium content lower here) Imbalance between bile salts/lecithin and cholesterol allows cholesterol to precipitate out of solution and form stones Pigment: • Black (e. g. Haemolytic d/o anaemia) • Brown bacterial/parasitic infection • Opaque (more calcium here) & Mixed: Same Pathophysiology as cholesterol stones

Gallstones. . . • The presence of gallstones in the gallbladder is called CHOLELITHIASIS.

Etiology / Pathophysiology • Rupture of the gallbladder becomes a danger, along with spread of infection of the hepatic duct and liver. • If the disease is severe and interferes with the blood supply it can cause the gallbladder to become gangrenous. Gangrenous gallbladder Gallstones

Those who are most at risk. . . o These are all adjectives to describe the person most at risk of developing symptomatic gallstones. FAT FAIR FORTY FEMALE

Something to think about. • Disorders of the biliary system are COMMON in the U. S. • They are responsible for the hospitalization of more than half a million people each year. • The two most common conditions are cholecystitis & cholelithiasis.

Signs and Symptoms. ü Increased heart and respiratory rate – causing patient to become diaphoretic which in turn makes them think they are having a heart attack. ü Complaints of indigestion after eating high fat foods. ü Localized pain in the rightupper quadrant epigastria region. ü Anorexia, nausea, vomiting and flatulence.

Signs and Symptoms. ü Low grade fever. ü Elevated leukocyte count. ü Mild jaundice. ü Stools that contain fat – STEATORRHEA. ü Clay colored stools caused by a lack of bile in the intestinal tract. ü Urine may be dark amber- to tea-colored.

Recap. Stages of Acute Cholecystitis. Gallbladder is grayish & is EDEMATOUS. There is an obstruction of the cystic duct and the gallbladder begins to swell AS ACUTE CHOLECYSTITIS progresses, the gallbladder begins to become necrotic and gets a speckled appearance as the wall begins to die. Gallbladder undergoes GANGRENOUS change and the wall becomes very dark green or black. This is the stage when perforation occurs.

Diagnostics. • HIDA scan – Imaging test used to examine the gallbladder and the ducts also referred to as cholescintigraphy. • Oral cholecystogram – The patient takes iodine-containing tabs iodine is absorbed from the intestine into the bloodstream - removed from the blood by the liver and excreted by the liver into the bile – it is concentrated in the gallbladder - outlines the gallstones that are radiolucent (x-rays pass through them). • Operative cholangiography Common bile duct is directly injected with radiopaque dye.

Diagnostics. Ø Fecal studies. Ø Serum Bilirubin tests. Ø Ultrasound of the gallbladder.

Diagnostics. o Magnetic resonance imaging o Magnetic resonance cholangiography (MRCP) o Modern multi detector computed tomography

Treatment: • • • Antispasmodic agents (Glycopyrrolate) Opiate analgesics (Meperidine) Antiemetics (Promethazine) NSAIDS (Ketorolac) NGT (if protracted vomiting) IVF’s (once hydrated, can try PO fluids). If stable and pain controlled, can arrange for output. surgical follow-up.

Various Modalities in Biliary Imaging • Ultra Sound • MRCP Magnetic resonance cholangiography • CT • ERCP • Percutaneous transhepatic cholangiography

Medical Management. ØLithotripsy • for patients with only a FEW stones. Ø If the attack of cholelithiasis is mild – • bed rest is prescribed. • patient is placed on NPO to allow GI tract and gallbladder to rest. • an NG tube is placed on low suction. • fluids are given IV in order to replace lost fluids from NG tube suction.

Medical Management. CHOLECYSTECTOMY or LAPAROSCOPIC CHOLECYSTECTOMY Removal of the G. B. is the treatment of choice. The G. B along with the cystic duct, vein and artery are legated.

Medical Management. • If stones are present in the common bile duct, an ENDOSCOPIC SPHINCTEROTOMY must be performed to remove them BEFORE a Cholecystectomy is done.

We’ll not leave you with these. Because

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