1、Cholecystitis Jing Gao Department Of Hepatobiliary Surgery The 2nd Affiliated Hospital of WMC Email:GJ_Teaching Design PresentationFatEFoodFamily CholecystitisFortyFemale01020304Textbook Study EnviromentStudy ObjectivesTeaching Methodscontents05Teaching ProcedureTextbookAbout this book-4th EditionEx
2、tremely detailed and usefulstandards for trainees in hepatobiliary and upper gastrointestinal surgerya reference for practicing hepatobiliary surgeonsPage1033,Chapter 32-CholecystitisClinical PracticeMedical TheoryStudy EnviromentINTERNSEXCITEDEASY!CALM!Master keypoints of Cholecystitis How to deal
3、with a clinical case?Study ObjectivesSurgical skills:FA&CA-Teamwork Humanistic Education-Comminication two forms of cholecystitis,clinical manifestations,complications,diagnosis&treatment.Etiology,pathogenesis,laboratoryfindings&differential diagnosis How to deal with cases&scrub in surgeries AMAPTe
4、aching RequirementsMasterUnderstand Epidemiology&pathologyFamiliar Practice STUDENTS are the KITES,not homeless because the STRING is HELD by TEACHERS.TeachersStudentsCBL-Case-based learningPBL-problem-based learningRehearsal-PreviewCase-Role-PlayingStudy GroupsTeaching MethodsMultimedia teaching Te
5、aching Procesures Case Question CholecystitisCase based learningProblem-based learningDiscussionMedical Practice-A Case for RealTeaching ProcesuresStep 1 Warming-UpCASEMr Pan,25 yr old,No past history.He got abdominal pain for 1 hour,which was located in right epigastric area.Also he described the p
6、ain as intermittent,very sharp with a radiation to the subscapulara.What is your diagnosis?How to diagnose?ClassificationCalculous Cholecystitis1Acalculous Cholecystitis2 Teaching ProcesuresStep 2Lets roll95%5%FFFF40 yr oldfemale mostlyfatty peoplefamily genetic factorsFfood junky-yummy Incidence&Ep
7、idemiologyStep 2Lets rollEtiology&Pathogenesis Gallstones ObstructionRetroinfectionDistention&EdemaVenous StasisIschemia&NecrosisCholecystitisSymptom1Clinical Manifestations2Digestive systems:abdominal painnausia,vomitting,diahrra,etc.General:Jaundice fever,anorexia,fatig-ue,exhausted,etc.Physical E
8、xaminationRight epigastric tenderness,Rebound tenderness,Murphys sign(+),Total vital signs.3Accessory ExaminationLaboratory test:CRPWBC NEUImage Exa:B UltrosoundCT scan,MIRboring!Clinical Manifestations LGLife is so GoodLocalsymptomsGeneralsymptomsabdomianl painRight epigastric areaRadiationwhere?wh
9、y?&infectionFeverJaundiceFor?reasonsMirizz Syndromea Special manifesticationDefinitionStonesDuctuli hepaticus communisCommon bile ductJaundiceMirizz Syndromea Special manifesticationCsendess ClassificationType I lesions are those with external compression of the CBD.Type II lesions a cholecystobilia
10、ry fistula is present with erosion of less than one-third of the circumference of the bile duct.Type III lesions the fistula involves up to two-thirds of the duct circumferenceType IV lesions there is complete destruction of the bile duct.OUT0.3CM;Thicken-ing，Eedema，RoughCavity:components (stones)Hy
11、perechogenicityInsideST How to diagnose?1.So what will you do next?Step 3PracticeBYGroupAbout this case?History of InquiryPhysical ExaminationAnatomy LocationBasical Diagnosis2.Then how to make sure your final diagnosis?QuestionsHow will you deal with the treatment if you are in charge of this case?
12、How will youcommunicate with the patient and his families?About this caseAModifyLifestyleBMedicineCSurgeyTreatmentPatients ConcernIndicationsCSurgeySurgeons ConcernTime:24-72h Complication:Suppurative Gangrenous PerforationRecurrent symptoms despite medical therapySelective2 2 Attacting neighbors Ma
13、lignance transformationEmergency1 1Surgerical TechniquesClassy from 1882 by LangenbuchCholecystectomyLC Laparoscopic CholecystectomyOpen for yrs1980sgold standardNowPTGD Percutaneous Transhepatic Gallbladder DraingeCholecystostomy CT&B-sound Summary of CholecystitisWhat kind of management next?What
14、clinical features?5F+Abdominal pain+ImageWhat make you do the final diagnosis?Diagnosis&Differential Diagnosis Symptoms+Physical Examination&Image (perforation of digestive tract;pancreatitis;appendicitis;liver diseases;lung disease)How will you treat this patient?Back to this caseInteractive Discus
15、sion3W+1HSurgerical Skills(LC)Postion:(Patient&Doctor)Revers Trendelenberg,right side up 30Trocar spots:A,B,D A-subxyphoid B-right costal margin D-supraumbilicalStep1:Camera Assistant(CA)Trocars locationLOREM1 1 Disection of Calots trangle2 2 Resection of gallbladder3 3 Hemostasis of the liver bed4
16、4 Specimen retraction5 5 Surgery ProcesuresSurgerical DetailsFundus of gallbladderRight abdominal wallLiver horizental lineSuperior abdominal wallSurgerical DetailsTrocarSubxyphoid Ligamenta teresSurgerical DetailsRetraction of Hartmanns pouchCystic ductCalots triangleCBDSurgerical DetailsClosure of cystic ductSurgerical Details Resection of gallbladderSurgerical DetailsSpecimen retraction
