Pittashaya Vikara (Diseases of Gall Bladder)

Syllabus – subtopics

1. 1Surgical Anatomy and Physiology, Sahaja Vikara (Congenital Anomalies)
2. 2Choledochal Cyst and Congenital Biliary Atresia, Pittashaya Ashmari (Cholelithiasis)
3. •Etiology, Clinical features, Diagnosis, Complications and Management
4. 3Pittashaya Shotha (Cholecystitis) and Choledocholithiasis - Etiopathogenesis, Clinical features, Diagnosis, Complications and Management
5. 4Videographic demonstration of Biliary atresia and its complications on patient/simulation
6. 5Videographic demonstration of MRCP and ERCP on the patient/simulator
7. 6Demonstration of Pittashaya Shotha (Cholecystitis) on the patient/simulator
8. 7Class discussion/Case presentation /Video demonstration/Roleplay/Clinical Diagnosis of Hepatobiliary Diseases

Learning objectives

At the end of this topic the student should be able to… (NCISM Table 3)

• Discuss the gross & microscopic anatomy and histology of the
• Gall Bladder with its anatomical relationships and landmarks, and congenital anomalies, diagnostic criteria, surgical procedures, complications, and post-operative care in Gall Bladder Diseases. Explain the role of laboratory tests, Liver function tests (LFTs), other relevant investigations with their Interpretation, and imaging studies in gallbladder disease. IM,CBL ,DIS,L &GD PP-Practica l,T-CS,INT RS
• Explain Aetiopathogenesis, Classification, Clinical Features, Investigations, Diagnosis, Complications, and management of Choledochal Cyst & Congenital Biliary Atresia
• Describe Aetiopathogenesis, Classification, Clinical Features, Investigations, Diagnosis, Complications, and management of Cholecystitis (Pittashaya Shotha) and Choledocholithiasis
• Demonstrate skills in taking patient history and performing physic al examinations, diagnosis, treatment and communication skills for cholecystitis and Choledocho lithiasis
• Explain the concept and the diagnostic and therapeutic techniques of Magnetic Resonance Cholangiopancreatography (MRCP) and Endoscopic Retrograde Cholangiopancreatography (ERCP) in Biliary and Pancreatic Disorders
• Demonstrate skills in taking patient history, diagnostic and comm unication skills, and performing physical examinations for cholecystitis.
• Demonstrate skills in clinical presentation, diagnostic techniques, etc. through various interactive methods for Gall Bladder cancer
• fostering effective communication and teamwork skills in a clinical setting. &PPT CE,CBA,P- REC Non Lecture Hour Theory S.No Name of Activity Description of Theory Activity NLHT 43.1 Surgical anatomy of Gall Bladder, congenital anomalies of Gall Bladder & Basic Investigations Surgical anatomy of Gall Bladder Activities: 1. Lecture: gross anatomy and microscopic anatomy. 2. Dissection demonstration: gallbladder dissection. 3. Histology lab: examination of gallbladder tissue. 4. Case study presentation: students present gallbladder surgery cases. 5. Interactive session: 3D visualization of gallbladder anatomy. Congenital Anomalies of the Gallbladder Activities: 1. Lecture: classification and types of congenital anomalies. 2. Case study presentation: students present congenital anomaly cases. 3. Radiology session: interpretation of imaging studies (e.g., ultrasound, CT). 4. Surgical demonstration: observation of surgical correction. 5. Group discussion: management and post-operative care. Basic Investigations Activities: 1. Lecture: laboratory tests and LFTs. 2. Case study presentation: students interpret investigation results. 3. Radiology session: interpretation of imaging studies. 4. Group discussion: diagnostic criteria and investigation protocols. 5. Practical session: students practice ordering and interpreting investigations Non Lecture Hour Practical S.No Name of Practical Description of Practical Activity NLHP 43.1 Cholecystitis and Choledocholithiasis Examination Steps: Group Discussion 1. Topic Introduction: Start with a brief overview of cholecystitis, its causes, and clinical presentation. 2. Case Presentation: Present a typical case scenario of a patient with cholecystitis. Include details such as patient demographics, symptoms, and medical history. 3. Discussion Questions: What are the common symptoms of cholecystitis? What differential diagnoses should be considered? What are the key elements in the patient's history that suggest cholecystitis? 4. Interactive Discussion: Encourage participants to share their thoughts and experiences. Facilitate a guided discussion to explore various aspects of diagnosis and management. Role Play 1. Scenario Setup: Create role play scenarios where participants take turns playing the roles of the patient, doctor, and observer. 2. Patient Role: The "patient" presents with symptoms suggestive of cholecystitis (e.g., right upper quadrant pain, nausea, fever). 3. Doctor Role: The "doctor" conducts a thorough history taking and physical examination, focusing on signs and symptoms of cholecystitis. 4. Observer Role: The "observer" provides feedback on the interaction, focusing on communication skills, examination techniques, and clinical reasoning. 5. Debriefing: Conduct a debriefing session to discuss the role play experience, highlighting strengths and areas for improvement. Case Taking and Examination 1. Patient History: Gather a detailed history of the present illness, including the onset, duration, and nature of pain. Ask about associated symptoms such as nausea, vomiting, fever, and changes in bowel habits. Document past medical history, including any previous episodes of similar pain, surgeries, and family history of gallbladder disease. 2. Physical Examination: Inspection: Observe the abdomen for any visible signs such as distension or jaundice. Palpation: Perform gentle and then deeper palpation of the abdomen, focusing on the right upper quadrant. Check for Murphy's sign (pain upon palpation of the gallbladder). Percussion: Percuss the abdomen to identify areas of tenderness or fullness. Auscultation: Listen for bowel sounds and any abnormalities. NLHP 43.2 MRCP & ERCP Demonstration Steps: MRCP (Magnetic Resonance Cholangiopancreatography) 1. Patient Preparation: History and Consent: Explain the procedure to the patient, obtain informed consent, and document relevant medical history. Fasting: Ensure the patient fasts for 4-6 hours before the procedure. Positioning: Position the patient supine on the MRI table. 2. Procedure – By Radiologist ERCP (Endoscopic Retrograde Cholangiopancreatography) 1. Patient Preparation: History and Consent: Explain the procedure to the patient, obtain informed consent, and document relevant medical history. Fasting: Ensure the patient fasts for 6-8 hours before the procedure. Sedation: Administer appropriate sedation and monitor the patient's vital signs. 2. Procedure – By Expert Videographic Demonstration Educational Content: Prepare scripts and visual aids to explain the indications, steps, and potential complications of MRCP and ERCP. Hands-on Training with Simulators 1. Simulator Setup: Ensure the simulator accurately represents the anatomy and pathology of the biliary and pancreatic systems. 2. Practice Sessions: Allow participants to practice MRCP and ERCP techniques on the simulator. 3. Feedback and Debriefing: Provide constructive feedback and conduct a debriefing session to discuss findings and areas for improvement. NLHP 43.3 Case taking and examination of cholecystitis on the patients. Steps: Group Discussion 1. Topic Introduction: Start with a brief overview of cholecystitis, its causes, and clinical presentation. 2. Case Presentation: Present a typical case scenario of a patient with cholecystitis. Include details such as patient demographics, symptoms, and medical history. 3. Discussion Questions: What are the common symptoms of cholecystitis? What differential diagnoses should be considered? What are the key elements in the patient's history that suggest cholecystitis? 4. Interactive Discussion: Encourage participants to share their thoughts and experiences. Facilitate a guided discussion to explore various aspects of diagnosis and management. Role Play 1. Scenario Setup: Create role play scenarios where participants take turns playing the roles of the patient, doctor, and observer. 2. Patient Role: The "patient" presents with symptoms suggestive of cholecystitis (e.g., right upper quadrant pain, nausea, fever). 3. Doctor Role: The "doctor" conducts a thorough history taking and physical examination, focusing on signs and symptoms of cholecystitis. 4. Observer Role: The "observer" provides feedback on the interaction, focusing on communication skills, examination techniques, and clinical reasoning. 5. Debriefing: Conduct a debriefing session to discuss the role play experience, highlighting strengths and areas for improvement. Case Taking and Examination 1. Patient History: Gather a detailed history of the present illness, including the onset, duration, and nature of pain. Ask about associated symptoms such as nausea, vomiting, fever, and changes in bowel habits. Document past medical history, including any previous episodes of similar pain, surgeries, and family history of gallbladder disease. 2. Physical Examination: Inspection: Observe the abdomen for any visible signs such as distension or jaundice. Palpation: Perform gentle and then deeper palpation of the abdomen, focusing on the right upper quadrant. Check for Murphy's sign (pain upon palpation of the gallbladder). Percussion: Percuss the abdomen to identify areas of tenderness or fullness. Auscultation: Listen for bowel sounds and any abnormalities. NLHP 43.4 Case presentation of Carcinoma of Gall Bladder Steps: Group Discussion 1. Topic Introduction: Start with an overview of gallbladder cancer, its epidemiology, risk factors, and clinical presentation. 2. Case Scenario: Present a typical case of a patient with suspected gallbladder cancer, including history, symptoms, and initial findings. 3. Discussion Questions: What are the common symptoms and risk factors for gallbladder cancer? What diagnostic tests are essential for confirming the diagnosis? What are the treatment options and their indications? 4. Interactive Discussion: Encourage participants to share their experiences, insights, and questions. Facilitate a guided discussion on the diagnosis and management of gallbladder cancer. Case Presentation 1. Case Preparation: Select a real or simulated case of gallbladder cancer with comprehensive details. 2. Presentation Components: Include patient history, clinical findings, diagnostic workup, treatment plan, and follow-up. 3. Analysis and Discussion: After presenting the case, engage the participants in analyzing the case, discussing differential diagnoses, and evaluating the management plan. Video Demonstration 1. Video Commentary: Provide a detailed commentary on each video, explaining the procedure, its indications, and potential complications. 2. Interactive Viewing: Encourage participants to ask questions and discuss the videos in real time. Role Play 1. Scenario Setup: Create role-play scenarios where participants take turns playing the roles of the patient, doctor, and family member. 2. Patient Role: The "patient" presents with symptoms suggestive of gallbladder cancer. 3. Doctor Role: The "doctor" conducts a thorough history-taking and physical examination, explains the diagnosis and treatment options, and addresses the patient's and family's concerns. 4. Observer Role: The "observer" provides feedback on the interaction, focusing on communication skills, empathy, and clinical reasoning. 5. Debriefing: Conduct a debriefing session to discuss the role-play experience, highlighting strengths and areas for improvement.