Cholelithiasis - By Sir Faisal Ghani

Cholilithiasis ! by Sir Faisal Ghani, Lumhs !

1. Gallstones FAISAL GHANI SIDDIQUI MBBS ; FCPS; PGD-BIOETHICS; MCPS –HPE PROFESSOR OF SURGERY, IN CHARGE, MINIMAL INVASIVE SURGICAL CENTRE, & & IN CHARGE, BIOETHICS PROGRAMME AT LIAQUAT UNIVERSITY OF MEDICAL & HEALTH SCIENCES [email protected] www.lumhs /faculty/surgery

2. Preamble Why gall bladder? Surgical anatomy & physiology of gall bladder Why gallstones form? How do gallstones present? How to manage a patient with gallstones?

3. Functions of Gall Bladder Reservoir for bile Concentration of bile Secretion of mucus

4. Anatomy of Gall Bladder

5. Fundus Body Neck Infundibulum Cystic duct

6. Parts of Gall Bladder Fundus Body Neck Infundibulum

7. Bile Ducts Common hepatic duct Cystic duct Common bile duct

8. Common Bile Duct Supraduodenal Retroduodenal Infraduodenal Intraduodenal

9. Calot’s Triangle kah -lō ′

10. Moynihan’s Hump

11. Gallstones ( Cholelithiasis )

12. Types of Gallstones Cholesterol Pigment Mixed

13. Causes -Cholesterol Stones Supersaturated bile Obesity High caloric diet Oral contraceptives Resection of terminal ileum

14. Causes -Pigment Stones Hemolysis Hereditary spherocytosis Sickle cell disease

15. Causes -Mixed Stones Infected bile Foreign bodies in the CBD (stents, parasites e.g. Clonorchis sinensis )

16. Clinical Features Asymptomatic Pain Complications

17. Complications Acute cholecystitis Mucocele Empeyema Choledocholithiasis Acute pancreatitis Intestinal obstruction

18. Treatment for Cholelithiasis

19. Treatment -Indications Symptomatic gallstones Complicated gallstones Silent gallstones Diabetics Patients undergoing bariatric surgery

20. Procedures Open cholecystectomy Laparoscopic cholecystectomy

21. Laparoscopic Cholecystectomy Supine/reversed Trendelenburg’s General anesthesia Preparation of abdomen / toweling Creation of pnemoperitoneum Closed technique ( Veress ’ needle) Open technique (Hassan’s) Additional ports