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胆道疾病 Diseases of the Biliary tract

胆道疾病 Diseases of the Biliary tract. ● Anatomy and Physiology ● Examinations for biliary system disease ● Cholelithiasis ● Infection of the biliary tract system ● Biliary ascariasis ● Biliary tract tumor. 第一节 解剖和生理 Anatomy and Physiology.

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胆道疾病 Diseases of the Biliary tract

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  1. 胆道疾病Diseases of the Biliary tract

  2. ● Anatomy and Physiology●Examinations for biliary system disease● Cholelithiasis● Infection of the biliary tract system● Biliary ascariasis● Biliary tract tumor

  3. 第一节 解剖和生理Anatomy and Physiology

  4. 第一节 解剖和生理概要（1）1. Intrahepatic bile ducts● gradation 2. Extrahepatic bile ducts●segment●Vater’s ampulla● oddi’s sphincter3. Gallbladder●Heister’s valve● Hartmann’s pouch● Calot’s triangle

  5. 第一节 解剖和生理概要（2）Physiology● Storage bile● Condense bile● Regulate biliary tract pressure ● Secrete mucus: “White bile”

  6. 第二节 胆道疾病检查方法Examination methods for biliary system disease

  7. 第二节 胆道疾病检查方法（1）1. Laboratory findings2. Ultrasonography3. X-ray examinations ●plain radiography●percutaneous transhepatic cholangiography (PTC)●endoscopic retrograde cholangiopancreatography (ERCP)●during or post operative cholangiogram

  8. 第二节 胆道疾病检查方法（2）●computed tomography (CT)●oral cholecystography●intravenous cholangiography●hypotonic duodenographyRadionuclide scansDuodenal drainageCholangioscopyMagnetic resonance imaging (MRI,MRCP)

  9. 附：先天性胆总管扩张症congenital cystic dilatation of bile duct

  10. 第三节 胆石病Cholelithiasis

  11. 第三节 胆石病—概述（1）1. Prevalence2. Classification●cholesterol●pigment●mixed type●black3. Position●gallbladder●extrahepatic●intrahepatic

  12. 第三节 胆石病—概述（2）4. Mechanism for gallstone formation ●bile stasis●abnormal metabolization●infection●other factors: age, sex, weight, diet Cholesterol stones: Admirand-Small triangular coordinate grapy Pigment stones:

  13. 咖啡与预防胆结石 香喷喷的咖啡，是提神醒脑的饮品，而最新研究还发现，每喝几杯咖啡可以预防胆结石。最新一期美国医学协会期刊报道，美国哈佛大学研究人员发现，每喝两杯三杯咖啡的男性，得到胆结石的几率比不喝咖啡的人低了40%，而每天喝咖啡达四杯以上的话，得胆结石的几更降为45%。不过，无咖啡因的咖啡可就没有这种效果了，只有含咖啡因的咖啡，才能刺激胆囊收缩，并减少胆汁内容易形成胆石的胆固醇。而同样含有咖啡因的茶、可乐等其他饮料，由于咖啡因含量低于咖啡，因此无法达到同样效果。

  14. 重点掌握内容 第三节 胆石病—胆囊结石（1）1. Gallbladder stones(1) Clinical manifestations:●biliary colic, radiation of the pain, neusea, vomiting●tenderness in right upper quadrant, rebound tenderness, muscle rigidity, palpable distended gallbladder, or Murphy’s sign (+)●bile duct stones, cholangitis

  15. 第三节 胆石病—胆囊结石（2）●Mirizzi’s syndrome:(2) Diagnosis:●clinical manifestations: symptoms and signs●assistant examinations: B-US, CT, MRI

  16. 第三节 胆石病—胆囊结石（3）(3) Treatment:● no need for treatment: asymptomatic stones● drug therapies: seldom attack or unsuitable for operation● operative management: cholecystectomy: open and laparoscopic● other treatments: oral dissolution therapy contact dissolution therapy extracorporeal shock wave lithotripsy

  17. 重点掌握内容 第三节 胆石病—肝外胆管结石（1）2. Extrahepatic bile duct stones(1)Clinical manifestations:●Charcot’s triad: abdominal pain, chills and fever, jaundice● deep tenderness with or without rebound tenderness, muscle rigidity or palpable enlarged gallbladder

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