Gallbladder Stones in Sickle Cell Anemia - PowerPoint PPT Presentation

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Gallbladder Stones in Sickle Cell Anemia

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Gallbladder Stones in Sickle Cell Anemia SCA Complications Anemia Aplastic crisis Sequestration crisis Hemolytic crisis Dactylitis Painful crisis. – PowerPoint PPT presentation

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Title: Gallbladder Stones in Sickle Cell Anemia


1
Gallbladder Stones in Sickle Cell Anemia
2
SCA Complications
  • Anemia
  • Aplastic crisis
  • Sequestration crisis
  • Hemolytic crisis
  • Dactylitis
  • Painful crisis. VOC
  • Acute chest syndrome
  • Chronic lung disease
  • priapism

3
  • CVA
  • Ocular
  • Gallbladder disease
  • Renal
  • Cardiomyopathy
  • Skeletal
  • Leg ulcers
  • Infections
  • Growth failure , delayed puberty
  • psychological

4
Causes of GB stones in pediatric
  • Hemolytic ds ( sickle , spherocytosis )
  • Obesity
  • Ileal resection
  • CF
  • Chronic liver ds
  • Crohn ds
  • Prolonged TPN
  • ..

5
Gallstones types
  • Pigment stones gt70, black-brown pigment , Ca
    bilirubinate glycoprotein ,
  • Cholesterol stones 15-20

6
  • CHOLELITHIASIS is very common in patients with
    sickle cell anemia
  • 17-33 of SCA complications
  • incidence is much lower in patients with HbSC and
    HbS-beta thalasemmia
  • Mainly Pigment
  • Associated with the promoter of uridine
    diphosphate (UDP) glucoronosyltransferase 1A1
    ?unconjugated hyberbili.

7
  • C/P acute Rt, UQ sever colicky pain , fever ,
    jaundice fat intolerance, Rt, shoulder pain ,
    leukocyosis
  • Symptomatic(mainly) and asymptomatic
  • Complications cholycystitis ,cholangitis,
    jaundice , pancriatitis and gallstone ileus .

8
Diagnosis
  • CBC ? WBC
  • ? amylase
  • ? Bilirubine
  • ? ALP
  • X-ray 50 of pigment stones are radiopaque
  • U/S
  • MRCP
  • ERCP

9
Intervention
  • conservative preoperative transfusion is
    recommended ..
  • Cholecystectomy is the most frequently performed
    surgical procedure in SCA
  • In order to avoid the subsequent confusion of
    acute cholecystitis pain and acute VOC,
    cholecystectomy has become a feasible approach in
    the management of gallstones

10
  • one study has recommended caution with regards to
    laparoscopic cholecystectomy due to perioperative
    complications in the context of sickle cell
    disease, advocating open cholecystectomy instead.
  • another showed ,morbidity is the same in the open
    and laparoscopic in SCA,may reflect the
    importance of the underlying disease, rather than
    the procedure, in determining perioperative
    outcome.
  • Open Vs lap chole is still debatable..
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