Review of jars short

Review of Jars:

Review of Jars By Professor Atef Allam Professor of Vascular and Endovascular Surgery Head of Vascular Surgery Unit Faculty of Medicine, Al- Azhar University, Cairo, Egypt

Gallbladder:

Gallbladder The gallbladder is a saclike organ that lies on the inferior surface of the liver . The primary function of the gallbladder is to store and concentrate bile between meals. During the inter digestive period,. Bile flows from the liver through the right or left hepatic duct into the common hepatic duct and meets resistance at the closed sphincter of Oddi , which controls flow into the duodenum. Bile then flows to the cystic duct into the gallbladder, where it is concentrated and stored. The mucosa of the gallbladder wall readily absorbs water and electrolytes, leaving a high concentration of bile salts, bile pigments, and cholesterol. The gallbladder holds about 90 ml of bile Within 30 minutes after eating, the gallbladder begins to contract and the sphincter of Oddi relaxes, forcing bile into the duodenum through the major duodenal papilla. During the cephalic and gastric phases of digestion, gallbladder contraction is mediated by cholinergic branches of the vagus nerve. Hormonal regulation of gallbladder contraction is derived from the release of cholecystokinin and motilin secreted by the duodenal mucosa in the presence of fat.

Gall Bladder:

Gall Bladder Sac, pear shape Has funds ,body, infundibulum , duct Thin wall Transparent wall Surface lustre Pink mucosa Has no stones

G B Stones types:

G B Stones types Cholesterol stones A - Pure : 6%, often solitary, consist of pure cholesterol. B - Mixed : 90%, cholesterol is the major component beside ( calcium bilirubinate , phosphate, carbonate palmitate ), and proteins Pigmented stones composed entirely of calcium bilirubinate black, multiple, may be hard and coral-like or soft sludge like

Cholesterol Stones Aetiology:

Cholesterol Stones Aetiology 1- METABOLIC A-Excess cholesterol relative to bile salt ( supersaturated or lithogenic bile ) cholesterol increases with: age , obesity , women , contraceptive piles. B- Reduced bile salt Drugs : oestrogens and some as cholesteramine therapy Ileal Disease : Loss of bile salts ( no absorption ) Bypass : loss of bile salts ( bypassing site of absorption ) Fistulas : Loss of bile salts through the fistula Chronic diarrhoea ( chronic pancreatitis ) – loss of bile salts

Cholesterol Stones Aetiology:

Cholesterol Stones Aetiology 2- Infection Mucous plug may constitute a nidus over which gall stone is formed. 3- Bile stasis Redused contractility as in Pregnancy Oestrogen therapy Truncal vagotomy Log-term parenteral nutrition

Pigmented Stones Aetiology:

Pigmented Stones Aetiology Haemolysis increased bilirubin production as in : Hereditary spherocytosis Sickle-cell Anaemia Thalassaemia , Malaria , and Mechenical destruction of red cells by prosthetic heart valves.

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Pigmented stones

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Pigmented stones

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Pigmented stones

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Mixed cholesterol stones

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Mucocele

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Intussuscipiens Intussusceptum The dilated obstruced sigment Proximal dilated sigment Distal shrunken sigment Appendix

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Skin / anal canal Malignant ulcer Rectum Sigmoid colon

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Multiple polyps Ascending colon

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Anal canal Mass / cancer Rectal wall opened

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Rectal wall devoid of peritoneal covering Rectal wall with peritoneal covering Rectosigmoid junction Anal canal

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Pectoral muscles

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Pectoral muscles

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Fungating mass Nipple Breast removed by simple mastectomy

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Back of the fungating mass Breast removed by simple mastectomy

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Axillary pad of fat containing lymph nodes

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No pectoral muscle Modified radical mastectomy

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Enlarged prostate

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Urethera Cancer Urinary bladder

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Testes Spermatic cord