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Gall bladder - Dr.

Al-Matary



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congenital anomalies
Choledochal cyst biliary atresia
Biliary atresia written
biliary atresia written case presentation
Chol edochal Cyst
Choledochal cyst
MCQ
choledochal cyst
rare condition
rare condition
Incidence
rare
MCQ
Choledochal cyst rare
Gall bladder - Dr. Al-Matary



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Choledochal cyst
dilatation wall bile duct
Choledochal cyst rare
More common in females
female predominance
MCQ
More common in females
bile duct
theory
congenital weakness
wall bile duct congenitally loose
intra uterine infection
pancreatic juice common bile duct
pancreatitis bile
bile
Congenital weakness
Viral infection
Pancreatic enzyme wall
Autonomic disturbance
MCQ
commonest form of Choledochal cyst
diffuse dilatation
Gall bladder - Dr. Al-Matary



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MCQ
MCQ

written
MCQ
Limited
sources MCQ sources
MCQ
Choledochal cyst
rare written
biliary atresia written MCQ
choledochal cyst MCQ
Incidence
More common in females
incidence MCQ
MCQ
commonest form
diffuse dilation
MCQ
commonest form diffuse dilatation
Gall bladder - Dr. Al-Matary



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Liver bile duct dilated
Intra hepatic extra hepatic

dilated bile duct
Intra hepatic
extra hepatic
Caroli's disease
disease
dilatation Intra hepatic
extra hepatic
clinical
obstructive jaundice
Investigations
liver function
bilirubin direct
alkaline phosphatase
Prothrombin time prolonged
hepato-renal

urine analysis
urine
dark
dark direct bilirubin
Frothy
bile salts
stool
Clay
Gall bladder - Dr. Al-Matary



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Obstructive jaundice
Intra hepatic bile duct dilatation
extra hepatic bile duct dilatation
sonar common bile duct
accurate Liver
common bile duct
stone common bile duct
Intra hepatic extra hepatic
stone common bile duct
bile duct
Intra hepatic
extra hepatic
dilatation intra hepatic bile duct
extra hepatic
Caroli's disease

Porta hepatis Intra hepatic extra hepatic

full mark
full mark
oriented to time place and time
dilated intra hepatic bile duct
extra hepatic
Caroli's disease cholangio carcinoma Porta hepatis
chalngio carcinoma Porta hepatis
Gall bladder - Dr. Al-Matary



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choledochal cyst
Jaundice childhood
biliary atresia
Jaundice Neonates
choledochal cyst
Jaundice child
biliary atresia
jaundice neonates
Obstructive jaundice neonates
choledochal cyst
Obstructive jaundice childhood
Later on in life
choledochal cyst Investigations
jaundice
obstructive jaundice
Liver functions,, kidney function,, urine,, stool,, ultra sound,, ERCP
jaundice
choledochal cyst
choledochal cyst Liver liver
choledochal cyst Liver
Liver
liver
Gall bladder - Dr. Al-Matary



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cyst
partial hepatectomy
Liver
Hepatectomy heap Oma
Hepatoma
hepatectomy
left hepatectomy right hepatectomy
Liver
dilated intra hepatic bile duct
partial hepatectomy
caroli's disease
Dilated intra hepatic bile duct
liver intra hepatic bile duct dilated
Liver transplantation
bile ducts dilated
Liver transplantation
segmental
segment

Jaundice
segmental liver transplantation
segmental liver transplantation 40,000
Gall bladder - Dr. Al-Matary



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40,000
segmental liver transplantation

kidney transplantation
liver transplantation Liver
Liver cirrhotic
segmental liver transplantation
choledochal cyst
Partial hepatectomy
dilatation liver
Liver transplantation
bile duct dilated
choledochal cyst
choledochal cyst
jejunum bile duct
jejunum distal end
hepatico-jejunostomy Roux -en - Y
anastomosis Roux
Gall bladder - Dr. Al-Matary



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Roux
Hepatico-jejunostomy Roux en Y
en Y
anastomosis Y
talent bile duct
cholecystectomy
common bile duct healed stricture
jaundice
hepatico-jejunostomy Roux-en- Y operation
cholangio carcinoma resectable
hepatico-jejunostomy Roux-en Y
Bile duct hepatico-jejunostomy choledcho jejunostomy Roux-en-Y
Liver
hepatectomy
liver transplantation
Partial hepatectomy
Liver transplantation
anastomsis
Bi l i ary atresi a
atresia atresia
Failure of re-canalization
biliary atresia incidence 10,000
Incidence
Gall bladder - Dr. Al-Matary



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MCQ incidence of biliary atresia
a 10,000
b 5,000
c 1,000
d
e Non of the above
biliary atresia
biliary atresia failure of re-canalization
biliary atresia
jaundice

obstructive jaundice
general scratch marks
Local examination
gall bladder
atresia
Gall bladder - Dr. Al-Matary



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atresia gall bladder gall bladder
atresia gall bladder gall bladder
atresia gall bladder gall bladder
atresia gall bladder gall bladder
obstructive jaundice
general examination scratch marks
Courvoisier
Virchow's
stone gall bladder contracting
obstructive jaundice
scratch marks Courvoisier
calcular malignant
biliary atresia investigations
Liver functions
biliary atresia investigations
biliary atresia liver function direct bilirubin
alkaline phosphates
prothrombin time prolonged
liver function
kidney function
Gall bladder - Dr. Al-Matary



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kidney function
Urine stool
urine dark frothy
Dark
Direct bilirubin
Frothy
bile salts
frothy test
Sulpher test
sonar
dilated intra hepatic bile duct
atresia intra hepatic
dilated intra hepatic bile duct
Unless atresia Intra hepatic
investigation biliary atresia
HIDA scan
ERCP
HIDA scan
Iso-toping scanning Liver
biliary atresia
iso tope
duodenum
hepatitis iso-topes
Gall bladder - Dr. Al-Matary



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HIDA scan biliary atresia
HIDA scan Iso-tope scan liver
Hydroxy Imedinodiacetic Acid
Iso-tope scanning Liver
biliary atresia sonar
Dilated intra hepatic bile duct, unless
atresia intra hepatic
HIDA scan
Liver
iso-tope duodenum
biliary atresia
liver liver
iso-tope duodenum
neonatal hepatitis
neonatal hepatitis Liver iso-tope
neonatal hepatitis Non visualization of the liver
biliary atresia visualization of the liver but, no visualization of the duodenum
Normal
Visualization liver duodenum
iso-tope duodenum
HIDA scan iso-tope scanning Liver
normal Liver duodenum
biliary atresia Liver duodenum
neonatal hepatitis Liver duodenum
Gall bladder - Dr. Al-Matary



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duodenum patent
iso-tope
biliary atresia
intra hepatic extra hepatic
Intra hepatic Liver liver transplantation
extra hepatic jejunum
Hepatico-jejunostomy Roux-en-Y operation
biliary atresia Kasai operation
hepatico-jejunostomy biliary atresia Kasai operation

Kasai operation
talented
liver cirrhosis portal hypertension
Liver transplantation
cirrhosis
liver support
Liver support
I'm buying time
Liver transplantation
treatment of choice
liver transplantation
Hepatico jejunostomy
biliary atresia

investigations
gall bladder stones
Gall bladder - Dr. Al-Matary



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Gall bladder stones
written
Gall bladder stones written
3 progressive jaundice
dark stool clay
clinical diagnosis
Biliary atresia
differential diagnosis
neonatal hepatitis
physiological jaundice physiological jaundice
differential diagnosis
neonatal jaundice differential diagnosis
diagnosis differential diagnosis
investigations of choice
how to investigate him
Liver function Kidney function urine stool
sonar HIDA scan
investigation of choice
HIDA scan
investigation of choice HIDA scan
8 jaundice dark urine clay stool itching
choledochal cyst
Positive family history
positive family history
differential diagnosis
biliary atresia
8 biliary atresia neonatal
Gall bladder - Dr. Al-Matary



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parasite
hepatitis blood transfusion
hemolytic hemolytic jaundice
Hemolytic jaundice
congenital
jaundice
hemolytic
Hepatitis Hepatocellular
obstructive
choledochal cyst
How to investigate him
Liver
liver
Kidney
Urine stool ultra sound ERCP
ERCP
biliary atresia Neonates
HIDA scan
ERCP
Gall bladder - Dr. Al-Matary



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biliary atresia Choledochal cyst
Gall stones
Gall stones
written
gall stones
stone
stone
stones
complications of stones
clinical pictures Investigations treatment
clinical pictures Investigations treatment
clinical pictures of gall stones
cholecystitis
common bile duct jaundice
common channel Pancreatitis
clinical pictures
investigations
Investigations
sonar
obstructive jaundice ERCP
pancreatitis amylase CT
Gall bladder - Dr. Al-Matary



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investigations
clinical
Clinical pictures investigations treatment
gall stones pathology
stone
stones complications of stones
gall stones
stones complications of stones
acute cholecystitis
chronic cholecystitis
obstructive jaundice
pancreatitis
pathology
clinical
written discuss gall stones
acute cholecystitis
gall stones
stone
stones complications of stones
discuss gall stones
complications
Gall bladder - Dr. Al-Matary



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complications
stones
stones
pathology complications
gall stones
complications
stones gall bladder
stones
Primary secondary
stone kidney
stone gall bladder
stone salivary gland
stone
Primary secondary
secondary
Infection
Infection
Stones

secondary stone
Stasis
Infection
Stone
secondary stone
secondary stone
infection
Infection stasis stone
Gall bladder - Dr. Al-Matary



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infection bile
provide nidus
nidus
Nidus
PH
PH
stone urinary system
Primary secondary
secondary
infection
Infection stones
infection stone
Provide nidus PH
PH
gall bladder Infection
Infection stones
Infection
infection
Predisposing factor stone
stone stone
chronic inflammation
I can't eradicate infection
stone eradication of infection stone
chronic infection
Gall bladder - Dr. Al-Matary



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chronic infection acute
Infection stones
stones infection
Vicious circle infection stone
stone Infection multiple
Episodes, episodes, episodes of infection
primary stones
primary stone Metabolic error
metabolic error
bile
bile bile salts bile pigments cholesterol
Mucous
bile salts bile pigment cholesterol
bile
bile salts bile pigments
bile pigment RBCs
RBCs Hemoglobin haem globin
globin bilirubin
bile pigment
bile salts
bile salts fat
emulsion
bile salts bile pigment
bile salts bile pigment
bile salts bile pigment
Gall bladder - Dr. Al-Matary



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bile salts bile pigment
bile pigment bilirubin
RBCs
bile salts
bile salts emulsion fat
fat
fat
emulsion
emulsion
bile salts
emulsion fat
bile salts
fat
fat fat
fat bile
bile bile salts
bile salts
bile salts
bile
bile salts
balance
bile salts
Gall bladder - Dr. Al-Matary



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balance
Balance bile salts
bile salts
bile bile salts bile pigment cholesterol
stones
bile pigment
bile pigment
Hemolytic anemia
bile pigment
bilirubin RBCs
spherocytosis sickle cell anemia
thalassemia major thalassemia intermedia
Hemolytic anemia
RBCs Bilirubin
bilirubin
bile
Liver
bilirubin
conjugation
bile
bilirubin
capacity
Liver
Gall bladder - Dr. Al-Matary



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bilirubin conjugated bile
bilirubin Unconjugated bilirubin
conjugated bilirubin bile
stool dark
hemolytic anemia
Unconjugated conjugated
Unconjugated Jaundice
conjugated bilirubin bile stool
hemolytic anemia stool
bilirubin
capacity Liver
bilirubin conjugated
bile conjugated bilirubin
conjugated bilirubin
Mud stones
Pigment stone
metabolic Infection
hemolytic anemia
X syndrome
X syndrome
metabolic syndrome
gout
ischemic heart disease diabetes
Gall bladder - Dr. Al-Matary



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X syndrome
X syndrome
X syndrome
Metabolic error hyper cholesterolemia
Hyper cholesterolemia bile
bile
bile cholesterol
stone cholesterol stones
Metabolic errors
Crohn's disease right hemicoloectomy
terminal ileum
terminal ileum terminal ileum
entero-hepatic circulation
entero-hepatic circulation bile salts
entero-hepatic circulation
bile salts
cholesterol

bile salts
bile salts
cholesterol stones
Gall bladder - Dr. Al-Matary



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cholesterol stones

bile salts
The same
bile salts cholesterol
1: 25
13
25
13
stone gall bladder
stone
Primary
secondary
secondary
Infection
infection stone
infection stone
Provide nidus PH
metabolic errors stones
cholesterol
bile salts
bile pigment
Liver disease Liver cirrhosis
Liver bile salts
stones gall bladder
cholesterol pigment mixed
Cholesterol stone Pigment stone mixed stone
Gall bladder - Dr. Al-Matary



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Pigment stone
pigment stone
hemolytic anemia
bilirubin
uncojugated bilirubin Indirect
direct bilirubin
bile
bile mud
bile Mud
Dark in color
Pigment stone
cholesterol stone
hypercholesterolemia
hyper cholesterolemia
X syndrome
hyper cholesterolemia bile
stones
cholesterol crystals
Solitaire
Solitaire solitary
crystals
cut surface radiating
Gall bladder - Dr. Al-Matary



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Fat
fat
cholesterol
cholesterol stones single
Whitish in color
cut surface
Radiating
surface mamilated
Mamilated
Mamilated

mamilated
mamilated
cut surface radiating
single
basics

crystals
cholesterol crystals
radiating
In radial manner
stone
Gall bladder - Dr. Al-Matary



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cholesterol stone
gall bladder healthy inflamed
Healthy
Healthy
primary infection
cholesterol stone Infection
stone
stone infection
stone healthy gall bladder
cholesterol stone Inflammation
Inflammation stone
stone Inflammation
Mixed stones
Mixed
Mixed bile pigment bile salts
bile
Mixed cholesterol bile pigment bile salts
bile
Gall bladder - Dr. Al-Matary



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Mixed stone
Infection
infection
Provide nidus PH
Mixed stone gall bladder
stone
stone
stones
Nidus laminated
PH
PH
Nidus laminated
gall bladder
gall bladder shrunken fibrotic
stones
stones
stones
gall bladder shrunken fibrotic
stones stones
stones
episodes of infection
Laminae
episodes of infection
Gall bladder - Dr. Al-Matary



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two laminae
two episodes of infection
episode
Laminae
groups group
Nidus laminae
episode of infection PH laminae
Mixed stones
Faceted
faceted
faceted
cholesterol stone single rounded
Mixed stone multiple faceted
single faceted stone
common bile duct
single faceted stone common bile duct
faceted
common bile duct
stones
stone stones
gall stones
complications gall stones
complications gall stones OMUMI
Gall bladder - Dr. Al-Matary



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OMUMI
Obstruction
Migration
Ulceration
Metaplasia
Infection
Obstruction
obstruction
Chronic calcular cholecystitis
chronic cholecystitis
Shrunken fibrotic
calcular
stones

start point
normal
X syndrome
hyper cholesterolemia
cholesterol stones
hyper cholesterolemia
Hyper cholesterolemia
Hyper cholesterolemia
complications
Gall bladder - Dr. Al-Matary



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atherosclerosis
Ischemic heart disease
Hyper cholesterolemia

by aging atherosclerosis Ischemic heart disease

procedure
Gall bladder - Dr. Al-Matary



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petit mal epilepsy
hyper cholesterolemia
cholesterol stones
cholesterol stones
cystic duct
gall bladder
cholesterol stone
hyper cholesterolemia
fatty meal
Pain
Biliary colic
biliary colic
12 stasis followed by infection
gaurding rigidity rebound tenderness
acute cholecystitis
biliary colic acute cholecystitis
renal colic pyelonephritis
biliary colic gaurding rigidity rebound tenderness
biliary colic
biliary colic
stasis acute cholecystitis
common bile duct
Gall bladder - Dr. Al-Matary



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Obstructive jaundice
gall bladder biliary colic acute cholecystitis
common bile duct calcular obstructive jaundice
common channel
Acute pancreatitis
common channel
reflex of bile pancreatitis
Obstructive manifestations
cystic duct biliary colic
acute cholecystitis
common bile duct obstructive jaundice
pancreatic duct pancreatitis
cystic duct biliary colic
acute cholecystitis
Catarrhal
suppurative
gangrenous
catarrhal mucous Mcuocele
pus Pyocele
gangrenous
fundus
blood supply
case of the appendix fundus
appendix catarrhal inflammation
Gall bladder - Dr. Al-Matary



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Mucous Mucocele
Suppurative inflammation pus pyocele
Ganagrenous
tip base
base
Fricture obstructive
Harmanns pouch
Friction and obstructive agent
gall bladder GIT
stone cystic duct
Biliary colic
acute cholecystitis complicated Mucocele pyocele
common bile duct
Obstructive jaundice
Obstructive jaundice biliary cirrhosis
Liver
Liver bile
bile
liver bile
bile
white bile
white bile bile
Obstruction Migration
Migration
gall bladder cystic duct
Biliary colic
Migration
Colic
Gall bladder - Dr. Al-Matary



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common bile duct colic
gall bladder smooth muscle
common bile duct smooth muscle
common bile duct dull aching pain
gall bladder colicy
gall bladder smooth muscles
common bile duct smooth muscles
gall bladder colic
common bile duct dull aching pain
Ulceration
gall bladder common bile duct
Bile

common bile duct
bile
Urine
Hematuria
bile
Hemobilia
Urinary system hematuria
biliary system hemobilia
hematuria
bile
bile urine stool
bile stool
Gall bladder - Dr. Al-Matary



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stool
bleeding per rectum
melena
bleeding per rectum Melena
Obstruction, ulceration, migration
Metaplasia
Metaplasia
epithelium
epithelium bile duct
Columnar
GIT
GIT columnar
lining epithelium bile duction columnar
friction
Squamous
Metaplasia is dysplasia anaplasia
Metaplasia dysplasia anaplasia

Infection
Infection
inflammation of the liver
Hepatitis
Inflammation of the bile duct
Cholangitis
inflammation of the liver and bile duct
Cholangio-hepatitis
inflammation of the gall bladder
Cholecystitis
Inflammation of the pancreas
Pancreatitis
Gall bladder - Dr. Al-Matary



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Liver hepatitis
bile duct cholangitis
bile duct liver cholangio-hepatitis
pancreatitis
gall bladder cholecystitis

Obstruction, migration, ulceration, metaplasia and infection
fistula
complicatoins fistula
fistula formation
gall bladder distensible structure
appendix
appendix non distensible
gall bladder distensible
Distensible
gall bladder
omentum Mass
fistula
generalized peritonitis
Omentum
fistula gall bladder appendix
appendix not distensible
gall bladder
gall bladder distensible structure
Gall bladder - Dr. Al-Matary



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Omentum Mass
mass
generalized peritonitis
fistula
fistula
fistula
anatomically
appendicitis fistula
non distensible
gall bladder
distensible
48
omentum
fistula
near by structure
gall bladder structures
fistula
gall bladder
gall bladder common bile duct
fistula gall bladder common bile duct
gall bladder common bile duct
Fistula common bile duct
Mirizzi syndrome
fistula common bile duct Mirizzi syndrome
Gall bladder - Dr. Al-Matary



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Mirizzi syndrome
Fistula
common bile duct
Mirizzi syndrome
stone common bile duct
fistula
stone common bile duct Mirizzi
fistula Mirizzi
stone common bile duct Mirizzi
fistula Mirizzi
gall bladder common bile
Mirizzi
fistula duodenum
stone gall bladder duodneum
stone gall bladder duodenum
duodenum
stone gall bladder duodenum
gall bladder duodenum
Gall bladder - Dr. Al-Matary



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duodenum
Meckels diverticulm
ileo-cecal junction
Meckels diverticulum ileo-cecal junction
gall stone ileus
gall stone ileus
fistula common bile duct Mirizzi
Fistula duodenum gall stone ileus
gall bladder duodenum
bile periton
omentum
fistula generalized pertonitis
Omentum
mass
Gall bladder mass
stone duodenum
gall stone ileus
acute cholecystitis gall stone ileus
Intestinal obstruction
clinically
Intestinal obstruction
Pain vomiting constipation distention
already pain vomiting constipation acute cholecystitis
pain
Gall bladder - Dr. Al-Matary



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vomiting constipation
acute choleycystitis gall stone ileus
severe distention
distention how to confirm investigation gall stone ileus
Palin X-ray abdomen erect and supine
erect
Multiple fluid level
supine
Air in biliary tree
biliary
Intestine biliary tree
biliary tree
40 Multi para
Female fatty
data
Pain right hypochondrium
Radiating to the back and the right should
gaurding rigidity
severe abdominal distention
What is your diagnosis
Acute cholecystitis
investigations of choice
Ultra sound
treatment
urgent choelcystecotmy

acute cholecystitis complicated by gall stone ileus
Investigations of choice plain x ray abdomen
treatment resuscitation Laparotomy obstruction mass
Gall bladder - Dr. Al-Matary



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mass
obstruction stone mass
conservative omentum
gall bladder
N.B.
acute cholecystitis severe abdominal distention
gall stone ileus
gall stone ileus Investigation of choice ultra sound
Intestinal obstruction Ultra sound
Investigation of choice plain x-ray abdomen
cholecystitis
acute cholecystitis investigation of choice ultra sound
plain x ray
acute cholecystitis acute cholecystitis complicated by gall stone ileus
gall stone ileus
stone
mass
Mass omentum
stone
ryle line catheter fluid omentum
gall bladder
mass
acute cholecystitis fatty , fertile, forty
Pain right hypochondrium
Gall bladder - Dr. Al-Matary



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Radiating to the back and to the right shoulder
39 gaurding rigidity rebound tenderness
jaundice
Mirizzi syndrome
cholangitis
gall bladder common bile duct cholangitis
acute cholecystitis complicated by Mirizzi syndrome or cholangitis
acute cholecystitis jaundice unless cholangitis or Mirizzi
acute cholecystitis jaundice unless cholangitis Mirizzi
acute cholecystitis jaundice
Unless cholangitis Mirizzi
Mirizzi stone common bile duct fistula
acute cholecystitis
investigation of choice
ultra sound
Mirizzi syndrome Investigation of choice
ERCP
Obstructive jaundice
acute cholecystitis
Investigation of choice
Ultra sound
Mirizzi Synddrome acute cholecystitis obstructive jaundice
investigation of choice
ERCP

Gall bladder - Dr. Al-Matary





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as regard dermoid cyst


sequestrated dermoid cyst
dermoid cyst
Sequestration inclusion tubuo dermoid implantation teratomatous
female, fatty, fertile , forty
pain right hypochondrium radiating to the back and the right shoulder
37 gaurding rigidity Mild gaurding
biliary colic
biliary colic
acute cholecystitis
40
gaurding rigidity rebound tenderness
biliary colic acute cholecystitis
cases colic
acute cholecystitis
fever gaurding rigidity rebound tenderness
fistula colon
cholecysto colic fistula
gall bladder fistula
gall bladder distensible
omentum
Gall bladder - Dr. Al-Matary



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complications
gall stone
Primary
secondary
primary
Metabolic errors
secondary
Infection
infection stone
Provide nidus PH
stones
Cholesterol, pigment and mixed
commonest
Mixed
MCQ
commonest stone mixed
Infection gall bladder common stones
infection stone
stone infection
mixed stone

Mixed stone
Infection stone
cholesterol stone infection Mixed stone
commonest stone mixed
complications stone formation
OMUMI
Gall bladder - Dr. Al-Matary



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Obstruction
Migration
Ulceration
Metaplasia
Infection
clinical pictures of gall stone
stone
cholesterol stone healthy gall bladder
asymptomatic
cholesterol stone healthy gall bladder asymptomatic
Stone cystic duct
biliary colic acute cholecystitis
Fever rigidity gaurding rebound tenderness
Stone common bile duct
Calcular obstructive jaundice
Stone common channel
Acute pancreatitis
clinical pictures
asymptomatic pancreatitis
Investigations of choice gall stone
asymptomatic gall stone
Urinary tract infection
sonar
gall stone
biliary colic
Gall bladder - Dr. Al-Matary



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Investigation of choice
Ultra sound
gall bladder
99
ultra sound
ERCP
ultra sound
ERCP
Investigation of choice
Ultra sound biliary colic acute cholecystitis
chronic cholecystitis
asymptomatic
biliary colic acute cholecystitis chronic cholecystitis
ultra sound
asymptomatic
biliary colic acute cholecystitis chronic cholecystitis
Ultra sound
common bile duct
ERCP
accuracy ultra sound common bile duct
70 %
accuracy ultra sound common bile duct
Investigation of choice
ERCP
ERCP PTC
obstructive jaundice role dilated intra hepatic bile duct
sonar obstructive jaundice role
Dilated intra hepatic bile duct
Gall bladder - Dr. Al-Matary



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Investigation of choice obstructive jaundice
ERCP
failed PTC
Investigation of choice Pancreatitis
serum amylase CT scan
serum amylase 300 1000
Pancreatitis arterial blood gases chest x ray
complications

gall bladder
asymptomatic biliary colic acute cholecystitis chronic cholecystitis
asymptomatic biliary colic acute cholecystitis chronic cholecystitis
common bile duct equal
Obstructive jaundice
common channel
Acute pancreatitis
gall bladder
Gall bladder - Dr. Al-Matary



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gall bladder
Investigation
Ultra sound
ultra sound
common bile duct
ERCP
PTC
pancreatitis
serum amylase
acute cholecystitis
rest
Rest
discussion
Acute chol ecysti ti s
acute cholecystitis
micro organism
E-coli
route of infection
direct
predisoposing factors
bad general condition
Gall bladder - Dr. Al-Matary



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stasis bad hygiene
bad hygiene
predisposing factor
stasis
90 % acute cholecystitis
calcular obstructive
2/3 acute appendicitis obstructive
predisposing factor
Obstruction
obstruction stasis
2/3
90 % acute cholecystitis obstructive
Non obstructive acute cholecystitis rare
obstructive acute cholecystitis
predisposing factor acute cholecystitis obstruction
predisposing factor
bad hygiene
pathologically acute cholecystitis
Catarrhal, suppurative and gangrenous
catarrhal
Mucous
Mucocele

Gall bladder - Dr. Al-Matary



P a g e | 53


suppurative pus
Pyocele
gangrenous
fundus Hartmanns pouch
fundus
blood supply
Hartmanns pouch
friction obstructing agent
Peritoneal laster
Lost
cystic lymph node of
lymph node
Hot tender
Pathology
pathology
Pathology
complications of acute cholecystitis
complications
General and local
General FAHM septicemia , pyemia and bacteremia
Gall bladder - Dr. Al-Matary



P a g e | 54


Local complications acute cholecystitis
stone common bile duct
Obstructive jaundice
common channel
Pancreatitis
fistula fistula
common bile duct
Mirizzi
fistula duodenum
Gall stone ileus
fistula colon
cholecysto colic fistula
complications of acute cholecystitis
clinical pictures of acute cholecystitis
Symptoms and signs
General and local
symptoms
General FAHM
local pain, swelling, disturbance of function
pain
Pain right hypochondrium
Radiating to the back and to the right shoulder
right shoulder
Phrenic
phrenic C 3, 4
L 3, 4
Gall bladder - Dr. Al-Matary



P a g e | 55


C3,4
phrenic L
L

Phrenic C3,4
Pain
swelling
disturbance of function
vomiting constipation
Peritonitis
Peritonitis
peristalsis
GIT
Peritonitis nausea vomiting
Peristalsis
signs
General fever tachycardia
Local
inspection rigidity
superficial palpation gaurding
deep palpation tenderness rebound tenderness
auscultation decreased intestinal sounds
percussion negative
Gall bladder - Dr. Al-Matary



P a g e | 56


PR Negative gall bladder
appendix PR
Unless, left appendix
gall bladder
Special sign
Hyperesthesia back
Boass sign
appendicitis
appendicitis
appendicitis gall baldder right hypochondrium
Hyperesthesia
appendicitis
gall bladder back
acute cholecystitis edema acute appendicitis
gall bladder fundus anterior abdominal wall
appendix
gall bladder anterior abdominal wall
appendix
hyperesthesia appendix
Boass
edema gall bladder
appendix
anatomy
acute cholecystitis
investigation of choice
Ultra sound
plain x ray
Gall bladder - Dr. Al-Matary



P a g e | 57


Plain x ray
Investigation 10 %
Plain X ray
plain x ray ultra sound
Investigation of choice
Ultra sound gall bladder
90 %
98 %
Gall bladder ultra sound
Gall bladder ultra sound
acute cholecystitis
Ultra sound ultra sound gall stone

thickening wall
stone cystic duct
gall bladder distended
gall bladder distended
gall bladder distended
90 %
wall edematous
Investigation of choice Ultra sound
Ultra sound
Ultra sound
Gall bladder - Dr. Al-Matary



P a g e | 58


sonar
90 % gall bladder obstructed distended wall edemaotus
gall bladder
Obstructed distended edematous
X ray
90 %
What is the major role of X ray in acute cholecystitis
To detect air biliary tree with gall stone ileus
Main value plain X - ray
Main value plain X - ray acute cholecystitis
To detect gall stone ileus
air biliary tree
Main value plain X-ray acute cholecystitis
To detect gall stone ileus
air biliary tree
HIDA scan
Liver common bile duct
duodenum
gall bladder
gall bladder
HIDA scan
Liver common bile duct duodenum
gall bladder
Investigation
written investigations
Gall bladder - Dr. Al-Matary



P a g e | 59


Investigations Ultra sound
CBC
investigations
acute cholecystitis
acute cholecystitis 48 urgent cholecystectomy
acute cholecystitis 48
Urgent cholecystecotmy
acute cholecystitis 48
Conservative
omentum
acute cholecystitis
Cholecystectomy
Mass
Conservative
mass conservative
Conservative
Ryle line catheter fluid
conservative treatment acute cholecystitis
analgesic
Gall bladder - Dr. Al-Matary



P a g e | 60


antibiotic
analgesic morphine
spasm sphincter of oddi
acute cholecystitis
morphine
spasm sphincter of oddi
spasm
gall bladder bile gall bladder
sphincter of oddi
duodenum gall bladder
liver bile
gall bladder duodenum
Liver
acute cholecystitis
acute cholecystitis
anti biotic bile
gall bladder bile

gall bladder
Gall bladder - Dr. Al-Matary



P a g e | 61


bile
bile
gall bladder
gall bladder
90 %
antibiotic bile
antibiotic serum
acute cholecystitis
48 Urgent cholecystectomy
48
Conservative
Semi-sitting position ryle Line catheter fluid
analgesic
anti biotic
analgesic
antibiotic serum
conservative treatment
Oschner Sherrens
Oschner Sherrens
analgesic
chronic cholecystitis
Chroni c chol ecysti ti s
chronic cholecystitis
chronic cholecystitis
management
Management of chronic calcular cholecystitis
mangement
Clinical pictures, investigations and treatment
Gall bladder - Dr. Al-Matary



P a g e | 62


Mangement of chronic calcular cholecystitis
gall bladder shrunken fibrotic
Loss of luster
Lymph node of
multiple stones
gall bladder
gall bladder
clinical pictures chronic cholecystitis
chronic cholecystitis
Target
chronic cholecystitis
Fat dyspepsia
Murphys sign

complications
complications
chronic cholecystitis
Fat dyspepsia Murphys sign
chronic cholecystitis
female, fatty, fertile, forty
Gall bladder - Dr. Al-Matary



P a g e | 63


fat dyspepsia
chronic cholecystitis
Murphys sign
chronic cholecystitis
Fat dyspepsia positive Murphys sign

biliary colic
Followed by acute cholecystitis
clinical pictures of complications
clinical pictures of complications
Gall bladder - Dr. Al-Matary



P a g e | 64


chronic cholecystitis
Fat dyspepsia
positive Murphys sign
Choroni c chol ecysti ti s
gall bladder shrunken fibrotic
multiple stones
Multiple stones gall bladder
acute chronic
acute stone gall bladder
chronic stones gall bladder
chronic cholecystitis
gall bladder shrunken fibrotic
stones gall bladder

dynamic ultra sound
ultra sound dynamic ultra sound
ultra sound dynamic ultra sound

sonar gall bladder
shrunken fibrotic
gall bladder
Gall bladder - Dr. Al-Matary



P a g e | 65


fibrotic dynamic ultra sound
ultra sound dynamic ultra sound
ultra sound
Ultra sound
gall bladder shrunken fibrotic stones
dynamic ultra sound
gall bladder
ultra sound dynamic ultra sound
Investigation
investigations for complications
obstructive jaundice ERCP
pancreatitis serum amylase CT scan
Investigations
investigations for complications
chronic cholecystitis
chronic calcular cholecystitis cholecystectomy
chronic calcular cholecystitis cholecystectomy
Non calcular cholecystitis medical conservative
chronic calcular cholecystitis cholecystectomy
Gall bladder - Dr. Al-Matary



P a g e | 66


Mangement of obstructive jaundice
Management of calcular obstructi ve jaundi ce
data
calcular obstructive jaundice
female, fatty, fertile, forty episodes of biliary colic
fat dyspepsia
positive Murphys sign
calcular obstructive jaundice
Female, fatty, fertile, forty
fat dyspepsia Murphys sign
calcular obstructive jaundice
Female, fatty, fertile, forty


data obstructive jaundice
type of patient
female, fatty, fertile, forty fat dyspepsia
Urine
stool
Gall bladder - Dr. Al-Matary



P a g e | 67


general examination
scratch marks
Virchows
malignant
local examination
gall bladder

calcular obstructive jaundice common bile duct
cholesterol mixed
Mixed
cystic duct
Mixed
Infection
common bile duct ascending cholangitis
Charcots triad
Charcots triad
Triad
pain biliary colic
jaundice
Fever
infective calcular obstructive jaundice
Equal Charcots triad
Infective calcular obstructive jaundice = Charcots Triad
Infection stone malignancy
stone infection
common bile duct
Charcots triad calcular obstructive jaundice
Gall bladder - Dr. Al-Matary



P a g e | 68


pain
pain biliary colic
Jaundice
cholecystitis Obstructive jaundice
Pain
Jaundice

complicated by infection Charcots triad
ascending cholangitis cholangio-hepatitis
septicemia
septic shock
Hypotension disorientation renal failure
Reynolds pentad
chronic calcular cholecystitis

fat dyspepsia
fat dyspepsia

cholecystectomy
fat dyspepsia
obstructive jaundice
Gall bladder - Dr. Al-Matary



P a g e | 69


Infection
Charcots triad
Reynolds pentad

fat dyspepsia
calcular obstructive jaundice
Reynolds pentad
Charcots triad
calcular obstructive jaundice ascending cholangitis
Charcots triad
cholangitis septic shock
Reynolds pentad
calcular obstructive jaundice fluctuating in course
jaundice

common bile duct bile


ball valve effect
ball valve effect
jaundice
calcular obstructive jaundice
Charcots triad Reynolds pentad Intermittent jaundice
Gall bladder - Dr. Al-Matary



P a g e | 70


Charcots triad Reynolds pentad jaundice fluctuating
Reynolds pentad
Charcots triad altered mental state and shock
calcular obstructive jaundice
type of patient

Female, fatty, fertile, forty
Just
Biliary colic pain

obstructive jaundice
Infected Charcots triad
Reynolds pentad

Charcots triad Reynolds pentad
stone ball - valve effect
Intermittent obstructive jaundice
malignant obstructive jaundice
Male
Gall bladder - Dr. Al-Matary



P a g e | 71


general examination
Scratch marks Virchows
Local examination
Gall bladder Courvoisier
Courvoisier Courvoisiers law
malignant obstructive jaundice gall badder
healthy
Malignant obstructive jaundice
gall bladder healthy
distensible
gall bladder healthy
distensible
Malignant obstructive jaundice gall bladder
myocardial infarction
gall bladder congenitally absent
surgically removed
fibrotic shrunken

Malignant obstructive jaundice gall bladder


congenitally absent
Surgically removed
Inflamed fibrotic

Klatskin tumor
carcinoma Porta hepatis
Klatskin tumor
Open the door
Gall bladder - Dr. Al-Matary



P a g e | 72

calcular obstructive jaundice


gall bladder
shrunken
gall bladder calcular obstructive jaundice gall bladder
rare stone cholesterol
gall bladder Healthy
stone cholesterol stone
gall bladder Healthy
Mucocele pyocele
mucocele pyocele
mucocele Pyocele Mirizzi syndrome
Mirizzi syndrome gall bladder Mucocele Pyocele
fibrotic
gall bladder distended calcular obstructive jaundice
cholesterol stone Healthy gall bladder
Mirizzi syndrome
cholesterol stone Mirizzi syndrome
Mirizzi syndrome common bile duct
fistula
Mucocele Pyocele gall bladder
obstructive jaundice
fatty, fertile
Gall bladder - Dr. Al-Matary



P a g e | 73


biliary colic
equal
Charcots triad Reynolds pentad
ball valve effect
malignant obstructive jaundice
scratch marks
Virchows Courvoisier
malignant obstructive jaundice Courvoisier
Malignant obstructive jaundice painless except late
late
Malignant obstructive jaundice painless condition except late
Malignant jaundice painless except late
Malignant obstructive jaundice Progressive
progressive
Rare
peri ampulla carcinoma
slaughing necrosis
Malignant obstructive jaundice
painless peri ampulla carcinoma slaughing
Painless peri ampulla carcinoma slaughing
Investigations obstructive jaundice
Liver function
Gall bladder - Dr. Al-Matary



P a g e | 74


direct bilirubin alkaline phosphatase prothrombin time Prolonged
liver
Kidney
Liver Kidney
Urine
Urine
Dark frothy
dark
direct bilirubin
frothy
Bile salts
frothy
sluphar test
stool
Clay stercobilin
Ultra sound
Dilated intra hepatic bile ducts
idiot
19
Ultra sound
Dilated intra hepatic bile ducts
stones gall bladder
Investigation of choice
ERCP
Gall bladder - Dr. Al-Matary



P a g e | 75


ERCP
stone filling defect
cancer stricture biopsy
stone filling defect
cancer stricture biopsy

ERCP failed canulation
PTC Percutaneous transhepatic cholangiography
commonest complications ERCP
Ascending cholangitis
Most serious complications PTC
Biliary peritonitis

ERCP ascending cholangitis
ERCP ascending cholangitis
ERCP prophylactic antibiotic
prophylactic antibiotic
commonest complications ERCP
ascending cholangitis
ERCP PTC
PTC
needle bile duct
Needle bile
biliary peritonitis
ERCP PTC

Gall bladder - Dr. Al-Matary



P a g e | 76


ERCP
PTC biliary peritonitis
data
Investigation ERCP PTC
MRCP Magnetic Resonance Cholangio Pancreatography

diagnostic therapeutic
MRCP Magnetic Resonance Cholangio Pancreatography
MRI biliary tree
ERCP quality
bile wall stricture stone
ERCP PTC
Invasion
diagnostic therapeutic
ERCP stone
diagnostic therapeutic

PTC
stone bile
Jaundice
ERCP PTC diagnostic value therapeutic value
MRCP diagnostic
therapeutic value
CT scan
Malignant stone
Stone ERCP
malignant CT scan Is a must
Staging
Gall bladder - Dr. Al-Matary



P a g e | 77


cancer head pancreas CT is very important
staging
CT scan
Follow up
follow up
tumor marker
Carcino-embryonic antigen (CEA)
Pancreatic onco fetal antigen (POFA)
Pancreatic cancer associated antigen (PCAA)
carcino embryonic antigen
malignant obstructive jaundice
Operable
Inoperable

Operable Whipples operation
Whipple
Pancreatico duodenoectomy
duodenum head
blood supply
cancer head pancreas Inoperable
Stent
technique
Gall bladder - Dr. Al-Matary



P a g e | 78


calcular obstructive jaundice
calcular obstructive jaundice
calcular obstructive jaundice
Pre operative preperation
calcular obstructive jaundice
Ryle Line catheter fluid mannitol vitamin K antibiotic
mongol Semian crease
prolonged prothrombin time
jaundice renal failure
preparation How Perparation
calcular obstructive jaundice
Preparation
Ryle Line catheter fluid
vitamin K mannitol antibiotic
vitamin K
Prothrombin time
mannitol
hepato-renal failure
antibiotic
ascending cholangitis
Preparation
ryle Line catheter fluid vitamin K Mannitol antibiotic
pre operative preparation
supra chondylar fracture Pulse
artery
Gall bladder - Dr. Al-Matary



P a g e | 79


reduction fracture
Pre operative preparation
preparation
Ryle Line catheter fluid Mannitol antibiotic

ERCP sphincterotomy
ERCP sphincter
dormia basket stone
sphincterotomy
sphincter
sphincterotomy

stone
sphincter stone
stone
stone
sphincter
sphincter stone
sphincterotomy
sphincterotomy
Gall bladder - Dr. Al-Matary



P a g e | 80


stone dormia basket

Chronic calcular cholecystitis


Obstructive jaundice stone common bile duct
Charcots triad
anti biotic
obstructive jaundice
stone common bile duct
chronic calcular cholecystitis
laparoscope cholecystectomy

chronic cholecystitis
cholecystectomy
obstructive jaundice
ascending cholangititis
antibiotic
obstructive jaundice
stone common bile duct
chronic calcular cholecystitis
laparoscopic cholecystectomy

Gall bladder - Dr. Al-Matary





P a g e | 81


gall bladder
common bile duct stone foreceps stone

calcular obstructive jaundice
preoperative preparation
stones
common bile duct stones
obstructive jaundice
chronic calcular cholecystitis
cholecystectomy

common bile duct stone
common bile duct stone
chronic calcular cholecystitis
jaundice
chronic calcular cholecystitis
Cholecystectomy
calcular obstructive jaundice
chronic calcular cholecystitis
obstructive jaundice
Gall bladder - Dr. Al-Matary



P a g e | 82


chronic calcular cholecystitis
Cholecystectomy
calcular obstructive jaundice
cholecystectomy
common bile duct stone
Jaundice
calcular obstructive jaundice
common bile duct stone
stone
anus
common bile duct
T tube
Intra operative T tube cholangiography
Intra operative T tube cholangiography
T tube
T tube common bile duct

bile tube
400 400 ml ringer lactate
bile
bile
ringer lactate electrolyte imbalance
Gall bladder - Dr. Al-Matary



P a g e | 83


10
omentum T tube
omentum 48
gall bladder
T tube Inert
omentum
10
T tube
T tube patent
T tube
bile
Omentum heal by fibrosis
T tube
T tube
T tube track fibrosis
T tube
bile peritoneal cavity
generalized peritonitis
examiner
Gall bladder - Dr. Al-Matary



P a g e | 84


T tube
examiner
T tube radiography patent
T tube
T tube
T tube
Omentum T tube
Missed stone retained stone
Missed stone retained stone
common bile duct
stone
duodenum common bile duct duodenum
choledochoduodenstomy
common bile duct duodenum
choledochoduodenostomy
bile duodneum
stone
common bile duct
bile passive
Gall bladder - Dr. Al-Matary



P a g e | 85


common bile duct duodenum
bile duodenum
bile
duodenum common bile duct
choledochoduodenostomy bile
bile duodenum
ascending cholangitis
choledocho
common bile duct choledochal
common bile duct duodenum
choledochoduodenostomy
stricutre multiple stones
common bile duct dilated
common bile duct dilated
Healing by fibrosis
common bile duct dilated
healing
Healing fibrosis
choledochoduoenstomy dilated common bile duct
choledochoduodenostomy dilated common bile duct

common bile duct dilated choledochoduodenostomy


choledochoduodenostomy Healing by fibrosis stricture
duodenum sphincter
sphincter patulous
Gall bladder - Dr. Al-Matary



P a g e | 86


sphincter
sphincter
Sphincter of oddi
patulous
sphincter patulous
transduodenal
duodenum
Sphincteroplasty
transduodenal sphincteroplasty
bile pancreas
Pancreatitis
choledochoduodenstomy
transduodenal sphincteroplasty
20

calcular obstructive jaundice


investigation ERCP
calcular obstructive jaundice
calcular obstructive jaundice aggressive
by surgery
choledocho choledocho choledocho

Choledocho
Gall bladder - Dr. Al-Matary



P a g e | 87


cholecystectomy

cholecystectomy stone
calcular obstructive jaundice
pre operative preparation
ryle Line catheter fluid vitamin K Mannitol antibiotic
Prothrombin time prolonged vitamin K
antibiotic ascending cholangitis
Mannitol wash to avoid hepato-renal failure
according to technical support
ERCP with sphincterotomy stone dormia basket
Later on,
Laparoscopic cholecystectomy
laparoscopic cholecystectomy Open
ERCP sphincterotomy stone dormia basket
technical support laparoscopic cholecystectomy

technical support
techincal support cholecystectomy duct
T tube


common bile duct stones dilated
common bile duct dilated
stricuture
Gall bladder - Dr. Al-Matary



P a g e | 88


choledochoduodenostomy end to side side to side
choledochoduodenostomy end to side side to side
common bile duct
duodenum
end common bile duct side duodenum
end to side
common bile duct
duodenum
side to side
choledochoduodenostomy
side common bile duct side duodenum
end common bile duct side duodenum
choledochoduodenostomy
choledochoduodenostomy
side to side end to side
Preparation
vitmain K mannitol antibiotic
ERCP stone dormia basket
Later on, laparoscopic cholecystectomy
Gall bladder - Dr. Al-Matary



P a g e | 89


cholecystectomy choledochoduodenstomy
discussion
T tube
discussion T tube
T tube
10
Omentum
T tube
Bile
bile ringer lactate
discussion T tube
common bile duct dilated Multiple stones
choledochoduodenostomy
common bile duct dilated multiple stones
trans duodenal sphincteroplasty
treatment
treatment calcular obstructive jaundice
Cancer head of pancreas
Operable inoperable
system
operable
Operation
Whipples operation pancreatico duodenoectomy
Gall bladder - Dr. Al-Matary



P a g e | 90


duodenum head pancreas
same blood supply
blood supply
Superior and inferior pancreatico duodenal artery
Operable
Whipples operation
inoperable
stent
triple anastomosis
Minimal invasive surgery stent
stent Inoperable
Cancer head of pancreas
inoperable
inoperable cancer head of pancreas
Inferior vena cava
cancer head of pancreas Inoperable
stent
stent
cancer head of pancreas inoperable Not resectable
stent
stent
duodenum
waiting for death to palliate the patient
Gall bladder - Dr. Al-Matary



P a g e | 91


duodenum
gastro jejunostomy
cancer head of pancreas Inoperable
Jaundice
Jaundice
Jejunum
gall bladder common bile duct
cholecysto-jejunostomy
choledochojejunostomy bile
bile
gall bladder
Jejunum
Jejunum gall bladder
gall bladder
gall bladder
jejuno-jejunostomy
Gall bladder - Dr. Al-Matary



P a g e | 92


Jejuno-jejunostomy

gastro jejunostomy
jejunum gall bladder
cholecysto jejunostomy
gall bladder
cholangitis
Jejunum jejuno-jejunostomy
gall bladder
Jejuno-jejunostomy
anastomosis
Gasto-jejunostomy
Cholecysto jejunostomy choledocho jejunostomy
jejuno jejunostomy
Whipples operation
Whipples operation duodenum
Whipples operation Operable
operable Whipples
duodenum
inoperable
Gall bladder - Dr. Al-Matary



P a g e | 93


stent
triple anastmosis
Stent
triple anastmosis


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