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APPENDIX
Identifying points:
It is a tubular structure.
Two borders
appendicitis.
Important points:
Average length of appendix is 7.5-10 cm.
Pathophysiology-
Ulceration
Obstruction
Infection
Appendicular lump- Greater omentum,loops of small intesine
App abscess
Gangrene
Perforation
Localised or generalised peritonitis
Portal pyemia
Liver abscess
Treatment-
Appendicectomy( within 24h of onset,no lump on
examination, diagnosis confirmed)
App lump- Ochsner-Sherren regimen
Contraindications of OS regimen:
Extremes of ages- children: less devt of omentum
elderly: chances of art thrombosis.
Diagnosis not confirmed
Immunocompromised patients.
What is retrograde appendicectomy?
= Usually meso appendix is cut starting from the free end but here it is cut starting
from the base. It is done in case of-
Presence of adhesion in the free end
If free end is not clearly visible.
Why base of the Appendix is crushed?
Complications of anaesthesia.
GALLBLADDER
Identifying points:
This is a split open hollow viscous.
Two ends-
Mucosal surface
Serosal surface
Why it is not a testis
Fibro fatty tissue is present, vas deferens is absent, surface is not
smooth.
Size/capacity of GB: 50ml, it can enlarge up to 10 times larger
Peritonitis
Pericholecystitic abscess
Empyema GB
Gangrenous GB
Cholangitis
Septicaemia
Chronic cholecystitis :
CBD stone
Cholangitis
Pancreatitis
Mirizzis syndrome
Complications of stone in the GB:
Acute/chronic cholecystitis.
Mucocele of GB
Empyema
Gangrene
Mirizzi syndrome
Perforation.
Fibrosis
Cholecystoduodenal fistula
Thickening of wall.
Complications of stone in the CBD:
Obstructive jaundice
Pancreatitis
Perforation
Peritonitis
Hepatorenal Failure
Obstructive jaundice :
Causes: Non malignant & malignant
Non malignant causes-
Choledocolithiasis
Sclerosing cholangitis
Pancreatitis
Choledocal cyst
Malignant causes-
Ca head of the pancreas/ Ca periampullary region.
Cholangiocarcinoma
Ca gallbladder
Multivitamins
Lactulose
IV Calcium chloride ?
Correction of hyponatraemia,coagulopathy.
Important points:
Mirizzi syndrome :
Gallstones impacts in the GB wall and compresses it
causing pressure necrosis and further get adherent to CBD
wall. It forms cholecystocholedochal fistula.It occurs either
from Hartmanns pouch or fundus of GB.
Surgical/White bile:
In prolong obstructive jaundice bile secretion from the
liver is reduced due to increased intraductal pressure, causing
secretion of mucous into the biliary canaliculi. This is called
white bile.
Hepatorenal syndrome:
Bile salts are nephrotoxic
Deposited in kidney
|
Endotoxaemia
|
Renal ischaemia
|
Release of pressure substance renin
|
Hypotension in the glomeruli
|
Renal failure
Mullberry stone: found in Acalculous cholecystitis
Adenosis, Aschoffs nodule ,mucosal polyp fall down from the
wall and cholesterol deposited over it. It causes a calculus
which is known as mullberry stone.