肝胆外科 胆囊炎说课课件

Cholecystitis,Jing Gao Department Of Hepatobiliary Surgery The 2nd Affiliated Hospital of WMC Email: GJ_5000126.com,Teaching Design Presentation,Fat,E,Food,Family,Cholecystitis,Forty,Female,01,02,03,04,Textbook,Study Enviroment,Study Objectives,Teaching Methods,contents,05,Teaching Procedure,Textbook,About this book-4th Edition Extremely detailed and useful standards for trainees in hepatobiliary and upper gastrointestinal surgery a reference for practicing hepatobiliary surgeons Page1033,Chapter 32-Cholecystitis,Clinical Practice,Medical Theory,Study Enviroment,INTERNS,EXCITED,EASY! CALM!,Master keypoints of Cholecystitis,How to deal with a clinical case?,Study Objectives,Surgical 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 AMAP,Teaching Requirements,Master,Understand,Epidemiology & pathology,Familiar,Practice,STUDENTS are the KITES, not homeless because the STRING is HELD by TEACHERS.,Teachers,Students,CBL-Case-based learning,PBL-problem-based learning,Rehearsal-Preview,Case-Role-Playing,Study Groups,Teaching Methods,Multimedia teaching,Teaching Procesures,Case,Question,Cholecystitis,Case based learning,Problem-based learning,Discussion,Medical Practice-A Case for Real,Teaching Procesures,Step 1 Warming-Up CASE,Mr 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 pain as intermittent, very sharp with a radiation to the subscapulara.,What is your diagnosis? How to diagnose?,Classification,Calculous Cholecystitis,1,Acalculous Cholecystitis,2,Teaching Procesures,Step 2 Lets roll,95%,5%,F,F,F,F,40 yr old,female mostly,fatty people,family genetic factors,F,food junky-yummy,Incidence & Epidemiology,Step 2 Lets roll,Etiology&Pathogenesis,Gallstones,Obstruction,Retroinfection,Distention &Edema,Venous Stasis,Ischemia&Necrosis,Cholecystitis,Symptom,1,Clinical Manifestations,2,Digestive systems : abdominal pain nausia, vomitting, diahrra,etc. General: Jaundice fever,anorexia,fatig-ue,exhausted,etc.,Physical Examination,Right epigastric tenderness, Rebound tenderness, Murphys sign(+), Total vital signs.,3,Accessory Examination,Laboratory test: CRPWBC NEU,Image Exa: B Ultrosound CT scan, MIR,boring ! ! !,Clinical Manifestations,LG,Life is so Good,Local,symptoms,General,symptoms,abdomianl pain,Right epigastric area,Radiation,where?,why?,&,infection,Fever,Jaundice,For ? reasons,Mirizz Syndrome,a Special manifestication,Definition,Stones,Ductuli hepaticus communis,Common bile duct,Jaundice,Mirizz Syndrome,a Special manifestication,Csendess Classification,Type I lesions are those with external compression of the CBD. Type II lesions a cholecystobiliary 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 circumference Type IV lesions there is complete destruction of the bile duct.,OUT,1/3,1/3-2/3,IN,TOTAL,Clinical Manifestations,Tenderness,Vital Signs,Pathological typing,Right epigastric area,Suppurative cholecystitis,Rebound,Acute cholecystitis,Gangrenous cholecystitis,Perforation,Tightness,Local OR,Total,Murphys sign,Accessory Examnation,CRP,WBC,NEU,ALT,AST,AM,Lab,Lab Findings,Accessory Examnation,Radiaology-B Ult & CT Scan,GB,Size:?CM*?CM*?CM,Morphology: Enlargment Atrophy Absence,OUT,Wall:0.3CM;Thicken-ing，Eedema，Rough,Cavity:components (stones) Hyperechogenicity,Inside,ST,How to diagnose?,1.So what will you do next?,Step 3 Practice BY Group,About this case?,History of Inquiry,Physical Examination,Anatomy Location,Basical Diagnosis,2.Then how to make sure your final diagnosis?,Questions,How will you deal with the treatment if you are in charge of this case? How will you communicate with the patient and his families?,About this case,A,Modify Lifestyle,B,Medicine,C,Surgey,Treatment,Patients Concern,Indications,C,Surgey,Surgeons Concern,Time:24-72h Complication:Suppurative Gangrenous Perforation,Recurrent symptoms despite medical therapy,Selective,2,Attacting neighbors,Malignance transformation,Emergency,1,Surgerical Techniques,Damage,Control,Patients,Surgery,Classy from 1882 by Langenbuch,Cholecystectomy,LC Laparoscopic Cholecystectomy,Open for yrs,1980s,gold standard,Now,PTGD Percutaneous Transhepatic Gallbladder Drainge,Cholecystostomy,CT&B-sound,Summary of Cholecystitis,What kind of management next ? What clinical features? 5F+Abdominal pain+Image What make you do the final diagnosis? Diagnosis lung disease) How will you treat this patient?,Back to this case,Interactive Discussion,3W+1H,Surgerical Skills(LC),Postion: (Patient & Doctor) Revers Trendelenberg, right side up 30 Trocar spots:A,B,D A-subxyphoid B-right costal margin D-supraumbilical,Step1 :Camera Assistant (CA),Trocars location,LOREM,1,Disection of Calots trangle,2,Resection of gallbladder,3,Hemostasis of the liver bed,4,Specimen retraction,5,Surgery Procesures,Surgerical Details,Fundus of gallbladder,Right abdominal wall,Liver horizental line,Superior