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Gallstone (Clinical manifestation of cholelithiasis (Jaundice (yelowish…

- - - - forming pericholecystic abscess
    - - biliary peritonitis
  - - - pneumobilia
      - intestinal obstruction
      - gall stones
- - - - congenital
        
        sickle cell anemia, thalasemia, G6PD
      - infection
        
        malaria
      - blood transfusion gone wrong
      - dissolution of large hematoma
      - :arrow_up: blood unconjugated, excess excreted in tea urine, normal blood conjugated & feces color
  - - - paracetamol toxicitiy
- - - - docho : common bile duct
    - - risk factor
        
        pigment stone
        
        female> male, use of contraceptives
        
        age > 40
        
        obesity
        
        DM
        
        cholesterol stones
  - - - cause
        
        :arrow_up: intraluminal pressure due to gallstone obstruction @ neck/ cystic duct
    - - thickened & fibrotic gall blader
        
        cause
        
        repeated cholecystitis
        
        calculi
        
        chronic irritation
      - poor contractility & dysfunction
- - - - oral therapy
        
        UDCA Ursodeoxycholic acid
      - local infusion
        
        PTBD
      - Gallstone dissolution
    - - acute cholecysitis
        
        laparoscopic cholecystectomy LC
        
        Convetional open cholecystectomy
        
        indication
        
        symptomatic cholelithiasis
        
        gallbladder polyps > 0.5cm
      - choldedocholithiasis & cholangitis
        
        ERCP with endoscopic papillotomy
        
        followed by laparoscopic cholecystectomy to extract stone
        
        LC+ LCBDE + LUS/LOC Laparoscopic common bile duct exploration
        
        exploration of CBD common bile duct followed bhy open cholecystectomy
        
        Palliative percutaneous biliary drain PTBD
        
        6-12 wks
        
        PTC to insert tube
        
        nursing care
        
        care of round drain
        
        care of NG tube
        
        care of T-Tube
        
        for 10 days
        
        watchout for stricture
        
        bile peritonits bile leaks @ anastomosis
        
        tube dislodge
        
        note for exit site
        
        hemorrhage
        
        infection
        
        bile leakage
        
        no milking
        
        post op few hrs
        
        may have blood
        
        no bile due to decompression done
        
        :arrow_down: drainage indicate obstruction of tube
        
        clamp t-tube when assess food tolerance & color of stool
        
        bile peritonits
        
        RUQ pain
        
        ab distension
        
        fever
        
        jaundice
        
        N&V
        
        change in drains color
        
        insert normal drain when removal tube
        
        laprascopic dont really need drain
  - - - anti-emetic: stemetil, Maxolon
      - anti-puritic & anti diarrheal: cholestyramine
      - antihistamine for piruitus
        
        piriton
    - - cephalosporin zinacef: Q6-8H
      - metronidazole : Flagyl Q8H
      - ampicillin
      - gentamycin
      - clindamycin
- - - - total
        
        0.1-1.2 mg/dL
        
        liver-biliary dysfunction
      - Conjugated
        
        0-0.3mg/dL
        
        obstructive jaundice
      - Unconjugated
        
        0-1mg/dL
        
        poor uptake/ conjugation problem/ hemolysis
    - - urine bilirubin
        
        NIL
      - urine urobilinogen
        
        <1 mg/2hr
        
        0.5-4mg/dL in 24hrs
      - both test indirectly shown serum bilirubin
    - - gall stone will be opaque
    - - check if there is dilation of bile duct
      - check if there is obsturction in gallbladder/ common bile duct
      - result
        
        thickening / edema gallbladder wall
        
        pericholecystic fluid
        
        chornic inflammation
        
        color flow doppler USG show hyperaemic pericholecystic and acute inflammation
    - - HIDA Scan Hepatobiliary System Scintigraphy
    - - indication
        
        intrahepatic obstruction
        
        caculi
        
        sstrictures
        
        tumor
        
        extrapheatic obsturction
        
        calculi
        
        tumor
        
        pancreatitis
        
        pancreatic duct abnormalitites
      - therapeutic
        
        lithotripsy
        
        stent placement for stricture
        
        sphincterotomy ST
        
        choledochostomy
        
        Nasoduodenal drain
        
        for acute cholecystiic
        
        evacuation of stone & drainage till inflammation subside