Acute cholecystitis and its complications 2 Actually of

Acute cholecystitis and its complications 2 Actually of

Acute cholecystitis and its complications 2 Actually of problem explanted with prevalence of gall stone disease, determinate at the republic of industrial development, where 12% man and 25 % woman have gallstone disease and they are reason for important cropped of acute cholecistites and its complication

Frequency complication and fatal outcomes Authors Frequency complication and fatal outcome Year 1. ripov U.A.

25,8% 7,0% 1993 2. rimov Sh.I. 27,4% 6,9%

1998 3. Talman R.Y. 26,4% 6,3% 1999 4.

Borodach V.. 17,4% 0,9% 2008 5. Sotnochehko B.. 22,4%

1,0% 2009 6. Gostishev V.. 33,4% 0,8% 2010

7. Sandakov P.Ia. - 0,5% 2011 8. Kuznetstov N..

27,3% 0,7% 2011 Development the researches of acute cholecystites

On the began develop of surgery by bile duct depended with ending XIX c. Till this time was solitary experience of surgical manipulation on the gall bladder. in 1618 y. surgeon from England, Fabricus opened of gall bladder and remove two stones to patient who 70 years old. Bobbs on the first was establish fistula to patient with emphiem of bladder in 1867 y. Blodgett Rosenbach u Sims cholecistostomy was performed in 1878 y. In Russian studying develop of surgery of bile duct depended with scientists, as Federov S.P., Martinov

A.V., Dobrotvorskiy V.I. and in the Europe Kehr Korte (German), Doyen Gosset (France), Mayo Robson (England) In Uzbekistan was performed difficult research investigation and improve surgical miniinvazive treatment of acute cholecistites and its complication under the chef academic Karimov Sh.I. Anatomy of Gall bladder 1 - ductus hepaticus sinister; 2 ductus hepaticus dexter;

3 ductus hepaticus communis; 4 ductus cysticus; 5 ductus choledochus; 6 ductus pancreaticus; 7 duodenum; 8 collum vesicae felleae; TOPOGRAPHY of the CONTENTS CONTAINED IN HEPATODUODENAL LIGAMENT . 1 ductus hepaticus communis;

2 ramus sinister a. hep. propriae; 3 ramus dexter a. hep. propriae; 4 a. hepatica propria; 5 a. gastrica dextra; 6 a. hepatica communis; 7 ventriculus; 8 duodenum; 9 a. gastroduodenalis; 10 v. portae; 11 ductus choledochus; 12 ductus cysticus; 13 vesica fellea.

Classification of acute cholecystitis (Fedorov S.P. 1934)

I. Acute cholecystitis with primary outcome a) recovery, and b) a primary water-cooled, and c) a secondary inflammatory dropsy. II. Chronic recurrent uncomplicated cholecystitis III. Complicated recurrent cholecystitis. a) purulent b) in ulcerative) gangrenous g) empyema IV. Sclerosis bladder V. Actinomycosis bubble VI. Tuberculosis VII. Inflammation of the bile ducts. 1) subacute, 2) acute, 3) suppurative cholangitis Classification of acute cholecystitis

Etiology: A) acalculous B) calculous. According to the degree of inflammation. a) Simple b) Destructive The morphological features a) catarrhal

b) abscess a) gangrenous e) gangrenosum-ruptured. Complications of acute cholecystitis - Perforation of the gallbladder and peritonitis, - Suppurative cholangitis, - Mirizzis syndrome, - Fistulas biliodigistivnye, - Choledocholithiasis, - Jaundice, - Acute pancreatitis, - Hepatic failure. Complication of acute

cholecystitis Peritoneal form - Flegmonous cholecystitis - Gangrenous cholecystitis - Acute empyema of the gallbladder - Ruptured cholecystitis Obstructive form - Obstructive cholecystitis (Obstruction of the cystic

duct, gallbladder hydrops bladder) Obstruction of bile duct (choledocholithiasis, stenosis of a large duodenal papilla, pancreatitis) Ethio pathogenesis of acute cholecystitis

Hypertension (stones, a block from outside) Infection Cystic artery thrombosis Injury Secondary inflammation Pathogenesis of acute cholecystitis bturation of neck and duct of gallbladder Pressure of the bile in gall bladder ( 700 mm.Hg.) Developing of the infectious process in gall bladder

Local or diffuse peritonitis developing of the stasis in blood vessels Destruction of the wall of the gall bladder Role of infectius causes in acute cholecystitis Esherichia coli Streptococcus

faecalis Klebsiella Bacteroides Clostridia Purulent complications 9-20% sepsis 3-10% First stroke till 48 hours sterile, after 72 hours - infection Correlation positive

and negative results of microbiological researches: First stroke 1:2 Recurrent 4:1 Morfological changes in gall bladder - Catharal cholecystitis - Flegmonous cholecystitis - Gangrenous cholecystitis - Acute empyema - Perforative cholecystitis

(perivesical infiltration, Perivesical abscess, Local peritonitis, diffuse peritonitis) Localisation of the pain in acute cholecystitis Clinic of acute cholecystitis Subjective symptoms

Pain in right hypochondrium Irradiation of pain Nausea and belching Bitterness and dryness in the mout mou Heartburn Vomiting

Relationship of pain with food inta Abdominal distention Objective evidence Enlarged gallbladder Tension of the abdominal wall Symptoms: Murphy, Musso, Grekov-Ortner, Reflex angina Temperature rise Leukocytosis Elevated ESR Instrumental diagnostics

Noninvasive Ultrasonography X-ray Computed tomography Magnetic resonance imaging Invasive Cholangiography Laparoscopy Ultrasonography stones in the

bladder neck Thick walls and a pair of vesicular exudate Complications of the acute cholecystitis A pair of vesicular infiltration A pair of vesicular abscess Gall bladder

Concrement Laparoscopic picture of acute cholecystitis Gangrenous cholecystitis Indications for ERPChG

Icteritiousness or signs of cholangitis in anamnesis Increasing bilirubin and transaminases Pancreatitis in anamnesis Expansion ductus choledochus more than 8 mm Small stones in gall bladder and dilation diameter of bile ducts RPChG Percutaneus transhepatic cholecystostomy and

cholangiography Active-waiting tactic Perforation, peritonitis Emergency operation Acute cholecystitis Conservative treatment

Negative dynamics Positive dynamic Delayed operation Elective operation Treatment of the acute cholecystitis

Conservative Antispasmodi cs Antibiotics Infusion Detoxication Symptoms

Signs of inefficient conservative therapy Increasing or serving pain syndrome; Leucocytosis, increasing ESR; Increasing or serving body high

temperature; Sonography inefficiency of conservativ therapy Sonography signs inefficiency conservative tharepy Increasing of perivesical fluid Doubling wall of GB Non homogen content

enlargement of sizes of GB Treatment of the acute cholecystitis Operational Laparoscopic cholecystectomy Open cholecystectomy Cholecystostomy Papillae sphincterotomy Endo biliary intervention

Laparoscopic cholecystectomy Laparoscopic cholecystectomy Instruments for mini access cholecystectomy Open cholecystectomy Cholecystectomy from the bottom Cholecystectomy from the cervix Types of cholecystostomy Laparoscopic

PTChS under X-ray PTChS under sonography with mini laparotomy Treatment methods in patients with high operational risk 1 stage PTChS, drainig and sanation of GB

2 stage Cholecystectomy ucoclasia Cholecystostomy PCCHCSRS (PC) by method ig tail Sanation of GB

With antiseptic, physiotherapeutical method Coagulational obstruction and mucoclasia of the GB Before coagulational obstruction After coagulational obstruction After mucoclasia

Treatment tactics in acute cholecystitis Perforation, peritonitis Acute obturated cholecystitis Combination of choledocholitiasis with mechanical jaundice Open operation Conservative therapy till

12-24 hours Relief of status In case of ineffectiveness PTCH In none-cupied LCE Relief of high risk groups assault Continue of conservative

therapy In cases of impossibility PTCH LCE LCE Group of high risk

PTCH LCE after 4-6 weeks In necessary cases LCE after 6 weeks In impossiblity LCE after 6-8 weeks

Open surgeric manipulations Decompensation states Mucoplasia In impossibility

sanation of choledochus Complications of the acute cholecystitis Perforation and biliary peritonitis, Suppurative cholangitis Mirizzis syndrome, Biliodigestiv fistula, Choledocholithiasis, Jaundice, Acute pancreatitis Hepatic failure.

Application of the drainages in biliar peritonitis Drainig of the abdominal cavity Intestinal decompression Choledocholithiasis. Obstructive jaundice Choledocholithyasis is the localization of the concrements in extra- and intrahepatic bile ducts, appears more frequently as a result of migration of the

concrements from the gall bladder at the calculous cholecystitis Mirizzis syndrome 1 type the concrement, wedging to the neck of gall

bladder, Hartmans pocket or bladders duct, compresses the common bile duct from the outside 2 type- development of the bedsore with the formation of

cholecystocholedochial fistula the Extrahepatic duct stricture Cholecystostomy Endoscopic retrograde papillosphincterotom y

Retrograde papilosphincterotomy Under After Third day after EPST Types of retrograde papillosphincterotomy Papilloto my Limited

papillosphincterotomy Subtotal or total papillosphincterotomy baskets of Dormia Removal with help of the Fogartys probe Removing stones with a loop Dilatation of the terminal part

of choledoch with his stricture Percutaneous transhepatic cholangiography and holangiostomy Ways to drain the bile ducts (external and internal) The way of dosed decompression to 5-6 hours decompression on 35-40 mm hyd. pole. Choledochoduodenosto

my By Yurash By Flerken By Finsterer Surgeries for choledochal stricture Method Geynico-Miculich Resection with

anastomosis "end - the end" Choledochal drainage ways Keru Vishnevsiy Xolsted Kerte Responsibility of PhGP:

PhGP must have concepts about clinical characters of acute cholecistites and its complication To explain complication of gallstone disease whom have GSD Feature shepherd clinical instrumental investigation

To sent of patient to the surgical stationary. Shepherd rehabilitation after surgical treatment.

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