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التهاب المراره, AND - Coggle Diagram
التهاب المراره
Treatment
Laproscopic cholecystectomy (gallbladder removal)
The treatment of choice for all symptomatic gall bladder stones
Stone dissolution
For pure or near-pure cholesterol stones these can be solubilised by increasing bile salt content of bile
Can also give cholesterol lowering agents such as statins
Give oral ursodeoxycholic acid
Shock wave lithotripsy
However the cystic duct requires latency for fragments to pass
Shock wave directed on to gallbladder stones to turn them into fragments so that they can be passed
Acute cholecystitis
Nil by mouth
Cholecystectomy after a few days to allows symptoms to subside
IV fluids
IV antibiotics - bacteria associated with cholecystitis (Klebsiella, Enterococcus and E.coli)
Opiate analgesia
DD
MI ECG
DKA RBG
PERFORATED P U
Treatment
Laproscopic cholecystectomy (gallbladder removal)
The treatment of choice for all symptomatic gall bladder stones
Stone dissolution
For pure or near-pure cholesterol stones these can be solubilised by increasing bile salt content of bile
Can also give cholesterol lowering agents such as statins
Give oral ursodeoxycholic acid
Shock wave lithotripsy
However the cystic duct requires latency for fragments to pass
Shock wave directed on to gallbladder stones to turn them into fragments so that they can be passed
Acute cholecystitis
Nil by mouth
Cholecystectomy after a few days to allows symptoms to subside
IV fluids
IV antibiotics - bacteria associated with cholecystitis (Klebsiella, Enterococcus and E.coli)
Opiate analgesia
Management
small frequent meals, diet low in saturated fats and high in fiber & calcium.
Diagnostic
Ultrasonography, ERCP, percutaneous transhepatic cholangiography, liver studies, white blood cell count, serum bilirubin
Medication
analgesics, anticholinergics, fat-soluble vitamins, bile salts, morphine,
Diagnosis
Acute cholecystitis
Abdominal ultrasound
Stones
Pericholecystic fluid
Thick walled, shrunken gallbladder
Examination
Murphy's sign: pain on taking a deep breath when examiner plays two fingers on right upper quadrant (location of gallbladder)
Right upper quadrant tenderness
Blood tests
Raised white cell count (due to inflammation) and CRP (C-reactive protein)
Raised serum bilirubin, alkaline phosphatase and aminotransfrase levels
Biliary colic
Unlikely to be associated with significant abnormality of laboratory tests
Abdominal ultrasound scan is MOST USEFUL for diagnosing gall stone disease
الاسباب
Prolonged immobility, fasting, prolonged parenteral nutrition, diabetes mellitus, E. coli, streptococci, salmonellae, adhesions, neoplasms, anesthesia and opioids.
https://www.youtube.com/watch?v=9L7N89sOSuc&ab_channel=MDforAll
AND
pancreatitis
peptic ulcer disease
acute hepatitis
liver abscess
sub-hepatic appendicitis RARE
choledocholithiasis