MIRIZZIS SYNDROME CHOLECYSTITIS & GALLBLADDER/ LIVER FLUSH GULRAN DISEASE

HEPATOBILIARY SYSTEM

Anatomy & Physiology

Gallstone formation

Risk Factors

overweight, age near or above 40 female, or pre-menopausal, the condition is more prevalent in North and South American Indians, Hispanics, and those of Northern European descent than other ethnicities.

A lack of melatonin Researchers believe that gallstones may be caused by a combination of factors, including inherited body chemistry, body weight, gallbladder motility (movement), and perhaps diet.

No clear relationship has been proven between diet and gallstone formation; however, low-fiber, highcholesterol diets and diets high in starchy foods have been suggested as contributing to gallstone formation

Other nutritional factors that may increase risk of gallstones include: Rapid weight loss, constipation, eating fewer meals per day, eating less fish, and low intakes of the nutrients folate, magnesium, calcium, and vitamin C.

Diagnostic Procedures

Laboratory
Blood Tests Blood test shows an elevation in bilirubin and serum transaminases Liver function tests Likely show increases across all enzymes (AST, ALT, ALP, GGT) with raised bilirubin

On the other hand, wine and wholegrain bread may decrease the risk of gallstones. Pigment gallstones are most commonly seen in the developing world.

 Risk factors for pigment stones include: Hemolytic anemias (such as sickle-cell disease), cirrhosis, and biliary tract infections. People with erythropoietic protoporphyria (EPP) are at increased risk to develop gallstones.

 Additionally, prolonged use of proton pump inhibitors has been shown to decrease gallbladder function, potentially leading to gallstone formation.

 Presence of stones in the gallbladder is referred to as cholelithiasis

TYPES: Cholesterol stones Pigment stones Mixed stones

 Signs & symptoms

Murphys triad

Causes
Rapid weight loss Hemolytic anemias prolonged use of proton pump inhibitors

Pathophysiology of gallstone formation

Treatment Diagnosis Oral ursodeoxycholic acid Endoscopic retrograde sphincterotomy (ERS) following endoscopic retrograde cholangiopancreatography (ERCP). Extracorporeal shock wave lithotripsy

Surgery

Open cholecystectomy Laparoscopic cholecytectomy

Cholelithiasis complications

MIRIZZIS SYNDROME

Classification
Type I - No fistula present Type IA - Presence of the cystic duct Type IB - Obliteration of the cystic duct

 Types II-IV Fistula present Type II - Defect smaller than 33% of the CBD diameter Type III - Defect 3366% of the CBD diameter Type IV - Defect larger than 66% of the CBD diameter

Mirizzi Pathophysiology

TREATMENT fig. 3

CHOLECYSTITIS & CLEANSING PROGRAM

Other Diagnostic procedures tender right upper quadrant with or without Murphy's sign Ortner's sign tenderness when hand taps the edge of right costal arch. Georgievskiy Myussi's sign (phrenic nerve sign) pain when press between edges of sternocleidomastoid Boas' sign Increased sensitivity below the right scapula (also due to phrenic nerve irritation).

Definition, Signs and Symptoms, Diagnoses

Differential Diagnosis

ACALCULOUS CHOLECYSTITIS
Acute cholecystitis that occurs in the absence of gallstones

Pathophysiology of Cholecystitis

Treatment
Aside from in the fig. 1

Supportive measures are usually instituted prior to surgery.

measures include fluid resuscitation and broad spectrum antibiotics or a cephalosporin In cases of severe inflammation, shock, insertion of a percutaneous drainage catheter into the gallbladder ('percutaneouscholecystostomy tube') and treat the patient with antibiotics until the acute inflammation

CLEANSING PROGRAM
A regimen called a "gallbladder flush" or "liver flush" is a popular remedy

 Epsom Salts are Magnesium Sulfate. From the herbal point of view both the magnesium and the sulfur are considered hot, expanding (centrifugal) or "heat expelling," therefore they provoke dilation produces a mild dilation of the bile ducts as well as other vessels and the bowels to void.

Diet
Foods in Cholecystitis Diet
1. Olive Oil 2. Raw Beetroot Juice 3. Black Seed Oil 4. Hemp 5. Lemon Juice/ Apple juice (fresh, organic) 6. Vinegar 7. Avocados 8. Blackberries 9. Lecethin Granules 10. Dandelion

Rules For a Cholecystitis Diet

1. Avoid Fatty Foods 2. Avoid Alcohol 3. Eat Less, Eat Regularly 4. Take Supplements

High cholesterol and fatty foods to avoid:

Saturated Oils and Fats. Fatty Meats Organ Meats. Chicken Skin. Egg Yolks. Deep Fried Foods cheese ice cream Fatty Milk Products Donuts, Cakes, Pastries.. Cookies and chips Creamed

Avoid
Red meat (duck, lamb, and pork), nuts, eggs, and chocolates, carbonated drinks, black tea, coffee, and vegetables such as cauliflower and cabbage. Do not overeat . Do not skip any meals, especially breakfast.

 Refined carbohydrates consumption. Avoid animal foods if possible and move to a vegetarian diet. Restrict consumption of eggs to about three per week. Avoid spicy foods such as such as wasabi and hot peppers as they can irritate gastrointestinal tract and worsen cholecystitis symptoms.

Sample Diet Plan

Breakfast- Oatmeal porridge, Whole grain bread, Fresh fruit juice and smoothies, cottage cheese salad, herbal tea. Lunch- Rice or Pasta along with baked potato and chicken stew. Dinner- Clear vegetable or chicken soup, Whole grain bread toast with grilled tuna salad. Low fat pudding with green tea without milk or sugar .

 Get cholecystitis nutrition from foods such as potatoes, pasta, rice, yogurt, low fat milk and whole grain foods. Include foods that are high in fiber. Herbal colon cleansing can help with cholecystitis - non-irritant herbal tea, mild, cleansing blend

Lifestyle check
It is important to maintain a healthy weight as this helps prevent cholecystitis. If planning on losing weight, do not go on a crash diet as crash diets. Eating a well-balanced diet and engaging in some form of daily exercise is the best way to stay healthy and fit.

Issue on Gallbladder Flush

Swallowing several ounces of pure olive oil at one sitting makes for a very large, fatty meal - and such a great load of fat could potentially trigger a sustained, severe contraction of the gallbladder. If there are actual stones contained inside the gallbladder, such a forceful contraction could result in an excruciating bout of right upper quadrant abdominal pain for the owner of the gallbladder - and a possible unplanned trip to the operating room for an emergency cholecystectomy (removal of the gallbladder).

 Combine a fat with an akalai, the fat turns into soap - a classic saponification reaction. The "broken up gallstones" in the feces are actually chips of olive oil soap, created in the intestine by the action of the alkaline secretions of the pancreas upon fat (the olive oil).
Institute of Nutrition Education and Research 1601 N. Sepulveda Blvd., Ste 342 Manhattan Beach, California 90266

So, where do we stand?

Update on weight loss mgt.

END