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2. Gall stones 2

3. What are the gall stones? What are the composion of their? Which group of people more likely affected? Why they are more common in female? What are the clinical presentation? How can diagnosed & treated? 3

4. Objects: 1.explain to students what is gall stones. 2.identification which group of people more susceptible to disease. 3. understanding pathophysiology of gall stones disease. 4.understanding the complication of gall stones. 5.explaination methods of treatment and advantage & disadvantage of each one. 6.understanding pattern of clinical presentation & approaches to reach diagnosis. 4

5. Gall stones: is a calculus (stone) formed within the gallbladder as a concretion of bile components. 5

6. Composition: 3 types 1.Cholesterol stones Cholesterol stones vary from light yellow to dark green or brown or chalk white and are oval, usually solitary. To be classified as such, they must be at least 80% cholesterol by weight (or 70%, according to the Japanese- classification system). 6

7. 2.Biliruben stones Bilirubin ("Pigment", "Black Pigment") stones are small, dark (often appearing black), and usually numerous. They contain less than 20% of cholesterol (or 30%, according to the Japanese- classification system). 7

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9. 3.Mixed stones Mixed ("Brown Pigment") stones typically contain 20–80% cholesterol (or 30–70%, according to the Japanese- classification system) 9

10. Signs and symptoms: Gallstones may be asymptomatic, even for years. These gallstones are called "silent stones" and do not require treatment. The size and number of gallstones present does not appear to influence whether or not patients are symptomatic or asymptomatic. 10

11. A characteristic symptom of gallstones is a "gallstone attack", in which a person may experience intense pain in the upper-right side of the abdomen, often accompanied by nausea and vomiting, that steadily increases for approximately 30 minutes to several hours. 11

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13. Risk Factors: females (especially before menopause). people near or above 40 years. more prevalent among both North and South Americans and among those of European descent than among other ethnicities. 13

14. Researchers believe that gallstones may be caused by a combination of factors, including inherited body chemistry, body weight, gallbladder motility (movement), and low calorie diet. The absence of such risk factors does not, however, preclude the formation of gallstones. 14

15. Diagnosis: Diagnosis can be made using ultrasound. 15

16. Treatment: A. Medical: 1. By oral ursodeoxycholic acid, it may be necessary for the patient to take this medication for up to two years. It especially effective for cholesterol type, but Gallstones may recur, however, once the drug is stopped. 16

17. 2.extracorporeal shock wave lithotripsy (often simply called "lithotripsy"), which is a method of concentrating ultrasonic shock waves onto the stones to break them into tiny pieces. 17

18. Surgical: Cholecystectomy (gallbladder removal) has a 99% chance of eliminating the recurrence of cholelithiasis. Surgery is only indicated in symptomatic patients. The lack of a gallbladder may have no negative consequences in many people. 18

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20. THANK YOU 20