Chronic Choledocolithiasis:-

Complaints:-

-Dry Skin

-Fever

-Pain in right Hypochandriac

Anamnesis Morbi:-

-Chronic pain

-1 Week

-Analgesics

Anamnesis Vitae:-

-Fatty Food

-Fried Food

-Alcohol

Physical Examination:-

Visual inspection

-Jauinduce

Palpation:-

Pain in right hypocondrium

-Vilar’s triad : pain , Fever , Jaundice

-Reynol’s pentad : Pain , Fever , Jaundice . Hypotension , Mental confusion

Percussion:-

No change

Auscultation:-

No change

Labaratory test:-

-Leukocytosis with left shift formula

-Biochimical blood analysis: Increase bilarubin

Increase alanine

Increase phosphates amylase

Instrumintal Examination:-

#X-Ray : we inject the contstract media by 3 ways:-

1 – Exteriory by tabltes and injection intravenously

- We give patient contrast media - Then liver discharge contrast media to common bile duct - Then we can see right and left hepatic bile duct and common bile duct

2-Intragrade (Anterograde) : we use injection or tube with contstractmedia and inject it in common bile duct with contstractmedia.

3-Retrograde: we use catheter with fibrogastroscope and fullfate common bile duct with contstractmedia

#Ultra Sound : Frequency : 2,25 – 3,5 MGz

-Diameter of common 0.4 to 1,0 CM

-Cholethiasis : we see stone in Gallblader

-Cholecytitis : *increase of Gallblader wall.

*Change in Gallblader form.

*Concretion.

-Choledocolithiasis: *stone in common bile duct

*Deformation and deylation in common bile duct

**What the mechanisim of jaundice? :

When the stone blocked common bile duct the Bilarubin is going to intestent and then it’s going to the blood and by the blood its absorb to the skin and sclera.**

**What the reason of Mental confusion ? :

Hight level Bilarubin in blood , affect to brain.**

**What the Reason of Hypotenstion ? :

Becouse of Bilarubin its affect to Liver and then to the Heart.**

Chronic Choledocolithiasis:- Ulcer Disease of Deudnum

Complaints -Dry Skin-Fever-Pain in right Hypochandriac

Chronic pain in right hypocondrium -Nausia -Vomiting -Heartburn

Anamnesis morbi -Chronic pain-1 Week-Analgesics

-Chronic pain-1 Mounth-Anti Acid

Anamnsis vitae -Fatty Food -Fried Food -Alcohol

-Excessive Food-Alcohol intake-Previous history of surgery abdominal

Labaratory Test -Leukocytosis with left shift formula-Biochimical blood analysis: Increase bilarubin Increase alanine Increase phosphates amylase

-Leukocytosis with left shift formula-Biochemical : Increase creatinine-Blood Serology : anti bodies to helico.bacter-General urine analysis : Protienuria , Cylnders, erythrosits-PH Meter : Increase acidity

Treatment:-

-Plan hospitalization to surgery Department.

-Plan Operation.

-Cholesistomy

-Bileductomy

-Relax