Lecture: Surgical diseases of liver. Cholelithiais. Acute and chronic calculous cholecystitis. Portal hypertension. Etiology, pathogenesis, clinic diagnostic and treatment. - PowerPoint PPT Presentation

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Lecture: Surgical diseases of liver. Cholelithiais. Acute and chronic calculous cholecystitis. Portal hypertension. Etiology, pathogenesis, clinic diagnostic and treatment.

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Title: Lecture: Surgical diseases of liver. Cholelithiais. Acute and chronic calculous cholecystitis. Portal hypertension. Etiology, pathogenesis, clinic diagnostic and treatment.


1
Lecture Surgical diseases of liver.
Cholelithiais. Acute and chronic calculous
cholecystitis. Portal hypertension. Etiology,
pathogenesis, clinic diagnostic and treatment.

  • Author reader R.Ya. Kushnir

2
Acute cholecystitis
Acute cholecystitis is inflammation of
gall-bladder.
3
Acute cholecystitis
4
Classification
  • Acute cholecystitis is divided into
  • I. Acute calculous cholecystitis
  • II. Acute non-calculous cholecystitis
  • 1. Catarrhal.
  • 2. Phlegmonous.
  • 3. Gangrenous.
  • 4. Perforated.

5
Classification
  • 5. Complicated
  • a) Hydropsy
  • b) Empyema
  • c) Pancreatitis
  • d) Icterus

6
Classification
  • e) Hepatitis
  • f) Cholangitis
  • g) Infiltrate
  • h) Abscess
  • i) Hepatic-kidney insufficiency
  • j) Peritonitis (local, poured out, general).

7
Gangrenous cholecystitis
8
Symptoms
  • Murphy's symptoms is a delay of breathing during
    palpation of gall-bladder on inhalation.
  • Kehr's symptom is strengthening of pain at
    pressure on the area of gall-bladder, especially
    on deep inhalation.
  • Ortner's symptom painfulness at the easy
    pattering on right costal arc by the edge of palm.

9
Symptoms
  • Mussy's symptom painfulness at palpation
    between the legs (above a collar-bone) of right
    nodding muscle.
  • Blumberg's signs are the increases of painfulness
    at the rapid taking away of fingers by which a
    front abdominal wall is pressed on. This symptom
    is not pathognomic for cholecystitis but matters
    very much in diagnostics of peritonitis

10
Diagnosis program
  • 1. Anamnesis and physical methods of inspection.
  • 2. Survey sciagraphy of organs of abdominal
    cavity.
  • 3. Sonography.
  • 4. General analysis of blood and urine.

11
Diagnosis program
  • 5. Diastase urines.
  • 6. Biochemical blood test (bilirubin, amylase,
    alanine aminotransferase, asparaginase, alkaline
    phosphatase, remaining nitrogen, creatinine).
  • 7. Coagulogram.

12
Conservative treatment
  • It must include
  • 1. Bed rest.
  • 2. Hunger of 13 days, in the following table ? 5
    by Peuzner.
  • 3. Cold on right hypochondrium.
  • 4. Spasmolytics (sulfate of atropine,
    platyphyllin, papaverine, ni-shparum, baralgin).

13
Conservative treatment
  • 5. Antibacterial therapy
  • ?) semisynthetic penicillin (ampicillin,
    oxacilline, ampiox)
  • ?) cephalosporin (kefzol, klaforan)
  • ?) nitrofurans (nitrofurantoin, furazolidon)
  • g) sulfanilamides (biseptol, ethazzole,
    norsulfazole).

14
Conservative treatment
  • 6. Inhibitors of protease (contrical, trasilol,
    gordox, antagosan).
  • 7. Desensitizing preparation (dimedrole,
    pipolphen, tavegile).
  • 8. Disintoxication therapy (neohemodes,
    reopolyglucine).
  • 9. Vitamins (?, ?1, ?6, ?12 vitamins).

15
Indication to surgical treatment.
  • All forms of acute calculous cholecystitis,
    destructive and complicated forms of noncalculous
    cholecystitis (except for infiltrate?), and also
    acute catarrhal cholecystitis conservative
    treatment of which was uneffective are subject to
    surgical treatment.

16
Chronic cholecystitis
  • Inflammation of gall-bladder, that gained
    protracted chronic character, is considered
    chronic cholecystitis.

17
Classification
  • Chronic cholecystitis is divide into
  • 1) chronic calculous
  • 2) chronic non-calculous.

18
Chronic calculous cholecystitis
19
Division of chronic cholecystitis
  • primary
  • recurrent
  • complicated.

20
Diagnosis program
  • 1. Anamnesis and physical examination.
  • 2. Survey sciagraphy of organs of abdominal
    cavity.
  • 3. Peroral and intravenous cholegraphy.
  • 4. Sonography.
  • 5. General analysis of blood and urine.

21
Diagnosis program
  • 6. Analysis of urine on diastasis.
  • 7. Biochemical blood test (bilirubin, amylase,
    hepatic tests).
  • 8. Coagulogram.
  • 9. Duodenal intubation.
  • 10. Endoscopy.

22
Conservative treatment
  • Conservative treatment must be basic at for
    patients with non-calculous chronic cholecystitis
    It includes
  • table ? 5 by Peusner
  • choleic preparations (alohol, holagol,
    holenzyme, holosas, olimetyn)

23
Conservative treatment
  • cholekinetics (sulfate of magnesium,
    cholecystokinin, pituitrin)
  • spasmolytics (sulfate of atropine,
    platyphyllin, methacin, aminophylline)
  • duodenal intubation
  • antibacterial preparations (during acuteening).

24
Obturative icterus
  • A obturative icterus is the type of icterus the
    reason of which is violation of patency of
    bilious ways as a result of their obstruction
    from within or external compression, or cicatrix
    narrowing.

25
Classification (by ?.?. Shalimov, 1993)
  • Obturation icteruses are divided into
  • I. According to the level of barrier
  • 1) obstruction of distal parts of general bilious
    duct
  • 2) obstruction of supraduodenal part of general
    bilious duct
  • 3) obstruction of initial part of general hepatic
    duct and fork of hepatic ducts.

26
Classification
  • II. According to the etiologic factor
  • 1) conditioned by obturation by bilious
    concrement, strange bodies, grume of blood during
    hemobilia, parasite, iatrogenic influence during
    operation
  • 2) obstruction at the diseases of wall of bilious
    ways innate anomalies (hypoplasia, cysts and
    atresia), inflammatory diseases (obstructing
    papillitis and cholangitis), scar strictures
    (posttraumatic and inflammatory), bilious ways
    tumours of high quality

27
Classification
  • 3) obstruction caused by the out-of-ducts
    diseases, that pull them in the process (tubular
    stenosis of general bilious duct of pancreatic
    genesis, ulcerous disease of duodenum,
    paracholedocheal lymphadenitis, peritoneal
    commissures).

28
Classification
  • . Except that, according to the duration the
    disease is distinguished
  • 1) acute obturative icterus, that to 10 days
    last
  • 2) protracted, that proceeds from 10 to 30 days
  • 3) chronic, that more than a month lasts.

29
An icterus of sclera.
30
Diagnosis program
  • 1. Anamnesis and physical methods of examination.
  • 2. General analysis of blood and urine.
  • 3. Analysis of urine on diastasis.
  • 4. Biochemical blood test (bilirubin, urea,
    albumin-globulin coefficient, blood on an
    australian antigen, amylase, alanine
    aminotransferase, asparaginase, alkaline
    phosphatase).
  • 5. Coagulogram.

31
Diagnosis program
  • 6. Sonography.
  • 7. Endoscopy.
  • 8. Retrograde cholangiopancreatography.
  • 9. Laparoscopy with biopsy.
  • 10. Percutaneous transhepatic cholangioduodenograp
    hy.
  • 11. Computer tomography.

32
Cirrhosis of liver, intrahepatic portal
hypertension
  • The cirrhosis of liver is a chronic progressive
    disease, the characteristic signs of which are
    the defeats of parenchymatous and interstitial
    tissue of organ, necrosis and dystrophy of
    hepatic cells, with the subsequent node
    regeneration as diffuse excrescence of connecting
    tissue.

33
Classification
  • According to Havana classification (1956),
    cirrhosises are divided into
  • 1) portal 2) bilious 3) postnecrosis 4)
    mixed.
  • According to the stages of development
  • 1) initial 2) formed cirrhosis 3) dystrophic.

34
Classification
  • According to the degree of weight
  • 1) easy 2) middle 3) heavy.
  • According to passing
  • 1) progressive 2) stable 3) regressing

35
Diagnosis program
  • 1. Anamnesis and physical examination.
  • 2. General analysis of blood and urine.
  • 3. Biochemical blood test (albuminous factions,
    bilirubin, glucose, AlAT, ASAT, alkaline
    phosphatase, cholesterol, reaction of Takata-ara,
    the Veltmann test electrophoresis albumens).
  • 4. Coagulogram.

36
Diagnosis program
  • 5. Endoscopy.
  • 6. Contrasting sciagraphy of oesophagus, stomach.
  • 7. Sonography.
  • 8. Scanning of livers.
  • 9. Splenoportography.
  • 10. Laparoscopy.

37
Surgical treatment
  • Operative treatments are divided into two groups
  • 1) radical, that can liquidate portal stagnation
  • 2) palliative, which are able only to level the
    separate signs of this pathology.
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