Gall Stones Elective
Gall Stones Elective
Roll no: 03
SHRI KAMAXIDEVI HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL
Certificate
This is to certify that Mr./Mrs./ Miss BANDI. PRANUSHA is a bonafide student of this
college studying in Intern B.H.M.S. for the academic session 2024-2025
He/She satisfactorily carried out the elective work in the Subject of Medicine in
accordance to the syllabus prescribed by Goa University.
Date:
Principal
ACKNOWLEDGEMENT
2 Introduction 6
3 Review of literature
4 Definition
5 HISTOLOGY
6 EMBRYOLOGY
7 INNERVATION OF
GALLBLADDER
8 BLOOD SUPPLY OF
GALLBLADDER
9 Venous Drainage
10 Lymphatic drainage
11 ANOMALIES
12 CALOT'S TRIANGLE
13 PHYSIOLOGY OF GALL
BLADDER
14 MOTOR ACTIVITY OF
GALL BLADDER
15 NEUROHORMONAL
REGULATION
16
17
18
AIM AND OBJECTIVES
The gallbladder is a small organ which is located beneath the liver. It plays a vital role in the
digestive process, storing and releasing bile into the small intestine. Understanding its
anatomy and function is important for the diagnosis and treatment of disorders such as
gallstones, cholecystitis, and cholangitis. If you experience symptoms such as pain in the
right upper quadrant of the abdomen, nausea, or fever, it is important to seek medical
attention to determine the underlying cause and receive appropriate treatment. In this article,
we will explore the anatomy of the gallbladder, its function, and the common disorders
associated with it.
REVIEW OF LITERATURE
ANATOMY OF GALLBLADDER :
The gallbladder is a pear-shaped organ that is approximately 3-4 inches in length and 1 inch
in diameter. It is located in the right upper quadrant of the abdomen, just beneath the liver.
The gallbladder is divided into three main sections: the fundus, body, and neck.
The fundus is the rounded portion of the gallbladder that is located at the top. The body is the
middle portion of the gallbladder, while the neck is the narrowest part that connects to the
bile ducts. The gallbladder is made up of three layers: the outermost layer, which is called the
serosa; the middle layer, which is made up of smooth muscle cells; and the innermost layer,
which is made up of mucosal cells.
HISTOLOGY
• Muscle layer has poorly developed circular, longitudinal and oblique fibers
• This layer thrown into folds, forming deep diverticula into muscularis named
"Rokitansky -Aschoff sinuses"
• Tubuloalveolar glands in mucosa of infundibulum and neck secretes mucus.
EMBRYOLOGY
• Genesis of gall bladder and cystic duct from distal portion of hepatic
diverticulum(parscystica)
• By end of 4th week of intrauterine life, cystic duct and gall bladder primordium produced
from pars cystica of hepatic diverticulum. By 5th week all elements of biliary tree
recognisable
INNERVATION OF GALLBLADDER
• Pain from GB may be referred to stomach, inferior angle of right scapula, right shoulder.
• Cystic artery-gall bladder, cystic duct, hepatic ducts, and upper part of bile duct.
•Rest of GB is drained by one or two cystic veins which enter into right branch of portal vein.
Lymphatic drainage
• Lymph of sub serosa &sub mucosal
• Sub serosa vessel of GB Connected with sub capsular lymph channel of the liver
ANOMALIES
• Classic description of extrahepatic biliary tree and its arteries applies only in one third of
patients
• Phrygian cap-common anomaly where fundus is folded upon body, present in 5% of cases
• Left-sided gallbladder with cystic duct emptying into left hepatic duct rare
• Incidence of duplication with 2 separate cavities and 2 separate cystic ducts - 1 in ever 4000
persons
• Duplication occurs in 2 major varieties
• More common form in which each gallbladder with its own cystic duct emptying
CYSTIC DUCT
• Arises from neck or infundibulum and extends to join common hepatic duct
• Lumen measures 1 to 3 mm
• Length around 3cm but varies depending on union with common hepatic duct
CALOT'S TRIANGLE
• Boundaries:
• Most dangerous anomaly is tortuousity of right hepatic artery with or without short cystic
artery known as 'caterpillar turn' or 'Moynihan' hump'
• Bile composition -water, electrolytes, bile salts, proteins, lipids, bile pigments
• Hydrochloric acid, partly digested proteins, and fatty acids in duodenum increases bile
production and flow through secretin
• Gallbladder mucosa has the greatest absorptive power per unit area of any structure in body
• Rapid absorption prevent rise in pressure within biliary system normally
•Epithelial cells secrete glycoproteins and hydrogen ion
• Glycoproteins protect mucosa from lytic action of bile and facilitate passage of bile through
cystic duct
gallbladder contraction
• CCK released into bloodstream by acid, fat, and amino acids in duodenum
NEUROHORMONAL REGULATION
• Stimulators of contraction:-
-Parasympathomimetic drugs
-CCK
• Inhibitors of contraction:-
• The presence of stones in the gallbladder is referred to as cholelithiasis, from the Greek
chol- (bile) +lith- (stone) +-iasis (process).
• If gallstones migrate into the ducts of the biliary tract, the condition is referred to
as choledocholithiasis
• form from the solid constitutes of the bile; they may vary greatly in size, shape, &
composition.
• Uncommon in children & young adults but become more prevalent with increasing age.
2% in south-7 % in north.
• ↑ in women, especially multiparous women & person ↑ 40 years of age.
RISK FACTORS
• Women
• Birth control pills
• Obesity
• Diabetes
• Sedentary life style
• Multiparity
• Pregnancy A family history
•Liver disease
•Rapid weight loss.
CHOLESTEROL STONES
• Composed mainly of cholesterol (> 50% of stone composition) & comprises multiple layers
of cholesterol &mucin glycoproteins.
• Pure cholesterol stones are not common; they comprise less than 10% of all stones.
• Most other cholesterol stones contain variable amounts of bile pigments & calcium.
•If excessive cholesterol or insufficient bile acids are secreted, bile becomes supersaturated
with cholesterol which then precipitates out as cholesterol crystals & stones.
• The incidence increase with age, & the prevalence higher in women. Stones are usually
smooth & whitish yellow to tan.
PIGMENT STONES
•It probably form when unconjugated pigments in the bile precipitate to form stone.
•In these people bile contains an excess of unconjugated bilirubin.
•Pigment stone are dark due to the presence of calcium bilirubinate & are usually formed
secondary to hemolytic disorders such as sickle cell disease & spherocytosis, & in those with
cirrhosis. Two types are recognized, black & brown.
• Pigment stone cannot be dissolved & must be removed surgically
• Rare
• Formed in bile duct usually after bacterial infection caused by bile stasis.
•The bacteria responsible for the infection enzymatically catalyze the conversion of bilirubin
glucuronide to insoluble unconjugated bilirubin. > Major constituents are precipitated
calcium bilirubinate & bacterial cell bodies.
MIXED STONES
• It may be combination of cholesterol & pigment stones or either of these with some other
substances.
• Calcium carbonate, phosphate, bile salts, & palmitate make up more common minor
constituents.
PATHOPHYSIOLOGY
Formation of precipitates
• Epigastric distress, such as fullness, abdominal distention & vague pain in the right upper
quadrant.
• Such a bout of biliary colic is caused by contraction of the gallbladder, which cannot release
bile because of obstruction by the stone.
•When distended, the fundus of the gallbladder comes in contact with the abdominal wall in
the region of the right ninth & tenth costal cartilages. o Produces marked tenderness in the
right upper quadrant on deep inspiration & prevents full inspiratory excursion.
•If dislodged & no longer obstructs the cystic duct, the gallbladder drains & the inflammatory
process subsides after a relatively short time. o If continues to obstruct the duct, abscess,
necrosis & perforation with generalized peritonitis may result.
JAUNDICE
•Occurs in a few patients & usually occurs with obstruction of the CBD.
•The bile, which is no longer carried to the duodenum, is absorbed by the blood & gives the
skin & mucous membrane a yellow color.
•frequently accompanied by marked itching of the skin
• The excretion of the bile pigments by the kidneys gives the urine a very dark color.
•The feces, no longer colored with bile pigments, are grayish, like putty, & usually described
as clay-colored.
VITAMIN DEFICIENCY
•Obstruction of bile flow also interferes with absorption of the fat soluble vitamins A, D, E, &
K. O May exhibit deficiencies of these vitamins. o If biliary obstruction has been prolonged
(eg, bleeding caused by vitamin K deficiency, which interferes with normal blood clotting)
Research input
RESEARCH
•Leptin levels & lipoprotein profiles in patients with cholelithiasis.
OBJECTIVE:
To determine the relationships between serum leptin & levels of lipoprotein(a) [Lp(a)], Apo
lipoprotein A-1 (ApoA-1) & apolipoprotein B (ApoB) in patients with cholelithiasis.
RESULTS:
•A total of 90 patients & 50 controls were included. S.levels of leptin, Lp(a), T. cholesterol,
triglyceride & ApoB were significantly ↑ed, & levels of ApoA-1 & HDL-C were Led, in
patient with cholelithiasis compared with controls. S. leptin in patients
with cholelithiasis were +vely correlated with Lp(a) & ApoB & -vely correlated with ApoA-1
CONCLUSIONS:
•Patients with cholelithiasis have ↑ leptin levels & an altered lipoprotein profile compared
with controls, with ↑ ed leptin levels being associated with ↑ ed Lp(a) & ApoB levels, & ed
ApoA-1 levels, in those with cholelithiasis.
ASSESSMENT & DIAGNOSTIC FINDINGS
o Abdominal ultrasound
o Ultrasonography
o Endoscopic retrograde
cholangiopancreatography
ABDOMINAL ULTRASOUND
o If gall bladder stone is suspected, an abdominal x-ray may be obtained to exclude other
causes of symptoms. However, only 10 to 15% gall stone are
ray studies.
ULTRA SONOGRAPHY
Most accurate if the patient fasts overnight so that the gall bladder is distended.
Detect calculi in the gall bladder or a dilated common bile duct with 90% accuracy.
Obesity, ascites, & distended bowel may be difficult to examine satisfactorily with an
ultrasound.
Stones are acoustically dense & produce an acoustic shadow. Stones also move with
changes in position.
Polyps may be calcified & reflect shadows, but do not move with change in posture.
When a stone obstructs the neck of the gallbladder, the gallbladder may become very
large, but thin-walled.
Taken up by the hepatocytes & excreted rapidly through the biliary tract.
Then scanned & image of the gall bladder & biliary tract are obtained.
CHOLECYSTOGRAPHY
Oral cholangiography may be performed to detect gallstones & to assess the ability of
the gallbladder to fill, concentrate its contents, contract & empty.
To prevent contraction & emptying of the gallbladder, the patient is NPO after the
contrast agent is administered.
If the gallbladder is found to fill & empty normally & to contain no stones,
gallbladder disease is ruled out.
Permits direct visualization of structures that could once be seen only during
laparotomy.
Multiple position changes are required during the procedure, beginning in the left
semiprone position to pass the endoscope.
Can be carried out even in the presence of liver dysfunction & jaundice.
Useful for distinguishing jaundice caused by liver disease from that caused by biliary
obstruction.
For investigating the G.I. symptoms of a patient whose gallbladder has been removed,
for locating stones within the bile ducts, & for diagnosing cancer involving the biliary
system.
Bile is aspirated & samples are sent for bacteriology & cytology.
A water-soluble contrast agent is injected to fill the biliary system. The fluoroscopy
table is tilted & the patient repositioned to allow x-rays to be taken in multiple
projections.
Note:
Performed under moderate sedation on a patient who has been fasting; the patient
receives local anesthesia & IV sedation.
Flexible needle is inserted into the liver from the right side in the midclavicular line
immediately beneath the right costal margin.
Successful entry of a duct is noted when bile is aspirated or upon the injection of a
contrast agent.
Nonsurgical removal
Surgical management
Cooked fruits, rice or tapioca, lean meats, mashed potatoes, non–gas-forming veg,
bread, coffee or tea may be added as tolerated. Avoid eggs, cream, pork, fried foods,
cheese, gas-forming vegetables & alcohol.
Dietary management may be the major mode of therapy in patients who have had only
dietary intolerance to fatty foods & vague g.i. symptoms.
NONSURGICAL REMOVAL OF GALLSTONES
Dissolving Gallstones
Intracorporeal Lithotripsy
DISSOLVING GALLSTONES
Can be infused through a tube or catheter inserted percutaneously directly into the
gallbladder; a tube or drain inserted through a T-tube tract to dissolve stones not
removed at the time of surgery; an ERCP endoscope; or a transnasal biliary catheter.
In the latter procedure, the catheter is introduced through the mouth & inserted into
the CBD. The upper end of the tube is then rerouted from the mouth to the nose & left
in place.
This enables the patient to eat & drink normally while passage of stones is monitored
or chemical solvents are infused to dissolve the stones.
This method of dissolution of stones is not widely used in patients with gallstone
disease.
Method used when the size of stone not more than 20 mm in diameter.
Stone Removal by Instrumentation
Used to remove stones that were not removed at the time of cholecystectomy or have
become lodged in the CBD.
A catheter & instrument with a basket attached are threaded through the T-tube tract
or fistula formed at the time of T-tube insertion; the basket is used to retrieve &
remove the stones lodged in the common bile duct.
A second procedure involves the use of the ERCP endoscope. After the endoscope is
inserted, a cutting instrument is passed through the endoscope into the ampulla of
Vater of CBD.
Another instrument with a small basket or balloon at its tip may be inserted through
the endoscope to retrieve the stones.
The patient is closely observed for bleeding, perforation & the development of
pancreatitis or sepsis.
The ERCP procedure is particularly useful in the diagnosis & treatment of patients
who have symptoms after biliary tract surgery, for patients with intact gallbladders, &
for patients in whom surgery is particularly hazardous.
Derived from lithos, meaning stone & tripsis, meaning rubbing or friction.
Uses repeated shock waves directed at the gallstones in the gallbladder or CBD to
fragment the stones.
After the stones are gradually broken up, the stone fragments pass from the
gallbladder or CBD spontaneously are removed by endoscopy, or dissolved with oral
bile acid or solvent.
Requires no incision & no hospitalization, patients are usually treated as OPD, but
several sessions are generally necessary.
Intracorporeal Lithotripsy
A laser pulse is directed under fluoroscopic guidance with the use of devices that can
distinguish between stones & tissue.
Produces rapid expansion & disintegration of plasma on the stone surface, resulting in
a mechanical shock wave.
Electro-hydraulic lithotripsy uses a probe with two electrodes that deliver electric
sparks in rapid pulses, creating expansion of the liquid environment surrounding the
gallstones.
Patient Education
Managing Pain:
Resuming Activity:
Light exercise (walking) immediately.
Allow special adhesive strips on the puncture site to fall off. Do not pull them off.
Resuming Eating
If you had fat intolerance before surgery, gradually add fat back into your diet in small
increments.
Follow-Up Care
Report any sign & symptoms of infection at or around the puncture site: redness,
tenderness, swelling, heat, or drainage.
Biliary disease:
Hepatitis
Chronic cholecystitis.
Acute cholecystitis.
Choledocholithiasis.
Cholangitis.
Gallstone pancreatitis.
Gallstone ileus.
Gallbladder carcinoma.
Summary
Definition.
Risk factors.
Pathophysiology.
Clinical manifestations.
Diagnostic test.
Management.
Conclusion
The presence of stones in the gallbladder is referred to as cholelithiasis with three
types – cholesterol, pigment & mixed.
care & patient education is of utmost importance for preventing gall stones & related
complications.
HOMOEOPATHIC MANAGEMENT
1. ARSENICUM ALBUM:
Restlessness. Pain, all burning in nature. Great exhaustion.
Restlessness. All complaints increase after cold drinks,
physical exertion between 12-2 am. Fear of death with anxiety.
Offensive putrid discharges. Burning pain relived by heat.
Sight of smell of food causes gastric complaints. Pain
abdomen.
2. BELLADONA :
Constant retching. Burning and constrictive pains. Active
congestion. Flushed red skin more in face. Sensitive liver.
Appendicitis with spasmodic pain in stomach. Over
sensitiveness. Complaints more on movement, touch, draft of
air. Better by sitting erect or standing.
3. BERBERIS:
“An excellent remedy for renal calculi, also, for gall-stones
associated with renal disease. Pain shooting the patient
cannot make the slightest motion, sits bent over to painful
side with relief. Symptom peculiar to Berberis is a bubbling
feeling as if water coming up through the skin Stitching pains
under border of false ribs in right side, shoot from hepatic
region down through abdomen.” FARRINGTON .
Radiating pains from a particular point puts Berberis almost
alone for radiating pains. Has cured renal colic many times,
because of its well-known ability to shoot out in every
direction. It cures gall-stone colic when little twinges go in
every direction from that locality. The liver is full of suffering.
Sudden stabbing like a knife puncturing the liver Dreadful
suffering, Berberis, when indicated, will let the little gall-stone
loos, and it will pass through, and the patient will take a long
breath. Anything that is spasmodic can be relieved instantly.
KENT
4. CARDUS MARINUS:
One of the great medicines for gallbladder stones. There is
increased acidity in the stomach. Empty eructation’s,
heartburn and nausea, vomiting of bile, followed by burning,
stitching, sore pains in the stomach. Much distension and
sharp wandering colic pains and stitching in the abdomen.
Terrible attacks of gall-stone colic. Pain on the right, bellow the
last ribs in the region of the liver, the taste in mouth is bad
and the skin is yellow-coloured. The gall-bladder is enlarged
and tender, the region of the liver is uncomfortable and there
is sensation of fullness and constipation alternates with
diarrhoea with clay colour stools. The complaints are
aggravated by lying on the right side, and on stooping causes
stitches on the right bellow ribs, worse from motion and
pressure on the affected part Better from sitting up in bed and
from lying on the unaffected side
5. CALCAREA CARBONICA:
The abdomen may feel swollen on the right and be very
sensitive to pressure, with cutting pains that extend to the
chest and are worse from stooping, the person feels worse
from standing, exertion, and better from lying on the painful
side. Calcarea carbonica is often indicated for people who
tired easily, feel cold and sluggish with clammy hands and
feet, crave sweets, and tend to feel anxious and overwhelmed
when ill.
6. CHELIDONIUM MAJUS:
This remedy is indicated when pain upper abdomen extends
to the back, right shoulder, and shoulder-blade. The abdomen
is distended, with a constricting feeling as if a string were
pulled across it. Pain is worse from motion, and lying on the
left with the legs drawn up may help. The person may feel
nauseous, especially after eating fat or drinking something
cold. The person may feel tired, worse from being cold, and
worse in the early morning
7. CHINA:
Cinchona Unless some symptom or symptoms call specifically
for another drug, put your patient on a course of Cinchona
Pain in the hepatic region, worse from touch. Shooting in
region of liver, tenderness and pain on touching the part. Liver
region sensitive to least pressure. Obstruction in gallbladder
with colic, periodic reoccurrence, yellow skin and conjunctivae,
constipation with dark greenish scytale. Biliary calculi.
Intensely sensitive to touch, to motion, to cold air Periodicity
pains come on regularly at a given time each day, or every
night at 12 o’ clock. Drenching night sweats.
8. NUX-VOMICA:
Gall-stone colic with sudden severe pains on right side,
spasms of abdominal muscles with stitching pains in liver.
Jaundice, aversion to food, fainting turns, gall-stones
Constipation nearly always Liver swollen, indurated, sensitive,
with pressure and stinging Cannot bear tight clothing.
Oversensitive, irritable, touchy. Ineffectual urging to stool,
irregular peristalsis. Chilly, if he uncovers or moves.
9. DIOSCOREA:
Hard, dull pain, gall-bladder, at 7 p.m. Neuralgia and
spasmodic affections of liver and gall-ducts. Cutting,
squeezing, twisting pain. Colic begins at umbilicus and
radiates to all parts of body even extremities. A constant pain,
aggravated at regular intervals by paroxysms of intense
suffering. Unbearably sharp, cutting, twisting, griping or
grinding pains, dart about and radiates to distant parts. Worse
doubling up. Better stretching out, or bending back. Better
hard pressure
10. LITHIUM CARB:
Gall-stones Violent pain in hepatic region between ilium and
ribs. Soreness and pain in bladder sharp, sticking Red nose is
characteristic
11. CHIONANTHES:
A great liver and gall-stone-colic medicine. Better lying on
abdomen. Heat with aversion to cover. Very bitter eructation’s.
Hot, bitter, sour, sets teeth on edge Hypertrophy of liver:
obstruction jaundice Soreness. Nausea and retching with
desire for stool. Sensation of double action in stomach, while
vomiting, one tying to force something up, the other sucked it
back. Colic and cold sweat on forehead
12. LYCOPODIUM:
Pain in liver, recurrent bilious attacks with vomiting of bile.
Subject to gall-stone colic. After Lyc. The attacks come on less
frequently, the bilious secretion becomes normal and the gall-
stones have a spongy appearance, as though being dissolved.
Lyc patients are always belching: sour eructation’s like strong
acid burning in pharynx. Bloating: obliged to loosen clothes.
Worse cold drinks, often warm drinks. Worse afternoons: 4-8
pm aggravation Generally, craving for sweets
13. HYDRASTIS:
Skin yellow, stools white and frequent: fullness and
tenderness over hepatic region. Catarrhal inflammation of
mucous lining of gall-bladder and biliary ducts. Cutting from
liver to right scapula. < lying on back on right side.
14. HEPAR:
LILIENTHAL gives Hepar as one of the remedies of gall-stone
colic. It has stitches in region of liver Hepatitis, stools white or
green. Is extremely sensitive mentally and physically. Cannot
bear the slightest touch: or pain. Cannot stand draughts:
craves vinegar
15. VERAT. ALB:
Is in Kent’s repertory for gall-stone colic. It has, Hyperaemia of
liver, gastric catarrh, putrid taste, disgust for warm food, great
pressure on hepatic region with vomiting and diarrhoea. In
verat cases, there will be profuse sweating, cold sweat on
forehead, Hippocratic face Pain maddening, driving patient to
delirium Typically, cold skin, cold face, cold back, cold hands,
feet and legs, cold sweat.
16. MERC.SOL:
Pressing pains, stitching in liver. Cannot lie on right side.
Jaundice: violent rush of blood to head: bad taste tongue
moist and furred soreness hepatic region from gall-stones.
Violent stitches in hepatic region, could not breathe or
eructate Worse night worse warm in bed worse for the profuse
sweat. Foulness of mouth and sweat Mere loves bread and
butter
17. PHOSPHORUS:
Probably more important for the treatment of liver, leading to
gall-stones, then for the acute attack? Great tenderness liver
region. Craving for ice-cold drinks, vomited when warm,
vomiting followed by great thirst. Worse lying on left side.
Anxious and restless in the dark ETHER FARRINGTON:
“In the passage of gall-stones, when remedies fail to relieve, I
find that ether, externally and internally, is very good. Acting
better than chloroform.”
18. CHLOROFORMUM:
Cholesteric gall-stones and biliary colic. CLARKE says:
“Chloroform will dissolve gall stones, and cases have been
treated by injection of chloroform into gall-bladder Hot wet
flannels: Squeeze a flannel out in hot water, and apply. Have a
hot bottle over this, to keep up the moist relaxing heat.
19. CARLSBAD WATERS:
Almost specific, RUDDOCK says, for gall-stone colic.
20. Iris versicolor:
Epigastric burning. Heart burn. Colic in region of gall stone.
White dry coated tongue with red streak in the center.
21. Leptandra:
Jaundice. Tongue is yellow coated. Burning and dull aching
pain in liver and gall bladder.
22. Magnesium phosphoricum:
Distension of abdomen.. Severe colicky and crampy pain in
abdomen. Pain worse by cold and better by pressure, bending
double and warmth.
RUBRICS;
In Boericke’s repertory:
Abdomen, gall-bladder – biliary calculi
(cholelithiasis) – Aur.; Bapt.; Berb.v.; Bolod.; Bry.;
Cal.c.; Card.m.; Chel.; Chionanth.; Cholest.; Cinch.;
Diosc.; Feltauri; Ferr.s.; Gels.; Hydr.; Jug.c.; Lach.;
Lept.; Myr.; Nux-v.; Pichi.; Pod.; Ptel.; Tarax.
Abdomen, gall-bladder, Biliary colic – Ars.; Atrop.
Sul.; Bell.; Berb.v.; Calc.c.; Card. M.; Chionanth.;
Cinch.; Col.; Dig.; Diosc.; Gels.; Hydr.; Ipec.; Lyc.;
Morph. Acet.; Nux v.; Op.; Tereb.
In complete repertory:
Abdomen, pain, general, liver, colic, gall-stones
– Aml-n, Arge, Ars, Atro, Aur, Bamb-a, Bapt, BELL,
BERB, Bold, Bry, Calc, Calc-f, CARD-M, Cham, Chel,
CHIN, Chion, Chlf, Chlol, Chol, Coloc, Cupr, Dig, Dios,
Erig, Euon, Fab, Fel, Ferr-s, Gels, Hep, Hydr, Ip, Iris,
Jug-c, Kali-ar, Kali-bi, Kali-c, Kreos, Lach, Laur, Lept,
Lith-be, Lith-c, Lob, LYC, Mag-c, Mag-m, Mag-p, Mag-
s, Mang, Menth, Merc, Merc-d, MORG, Morph, Myric,
NAT-S, Nux-v, Op, Ozone, Phos, Podo, Ptel, Puls,
Rhus-t, Ric, Sang, Sep, Sil, Sulph, Tab, Tarax, Ter, Trio,
VERAT.
1. Antipsoric:
Berb, Calc, Lyco, Nat S Psor and Tub
2. Antisycotic
Berb, Calc, Psor, Nat s Psor and Tub
3. Remedies in both miasm
Berb , Calc, Psor, Tub , Nat p
4. All three miasm
Lyco, Tub
1. CASE REPORT:
USG report shows multiple calculi of 10.9mm size seen in GB lumen with
signs of cholecystitis and grade 1 hepatomegaly.
Physical generals:
App: increased
Diet: Mixed
Craving: sweets(+3)
Aversion: Milk
Thermals: Hot
Past history: Ns
Mental generals:
She is stressful about her own shop she has to look after her house shop
and family
She suppresses her anger stays silent and alone she says that she goes to
the same person who had made her angry everytime, whenever she feels
low she closes door cries alone she feels better after crying and when
someone console her she cries more. She is worried about her children’s
future.
General examination:
Pulse:78/m
RR: 18/m
BP: 114/60mmhg
Temp: 98.2 F
Tongue: Dry white coated
Systemic examination:
GIT : on examination;
Totality of symptoms:
2 Suppresses emotions
3 Oversensitive
4 Aversion milk
5 Desire sweets(+3)
6 Thermally hot
8 Distension of abdomen
Miasm:
Sycotic
Diathesis
Scrofulous
Prescription:
1st follow up :
App: Good
Prescription: Berberis v Q
15 Drops in 30 ml water
2. CASE REPORT:
A male patient of moderately built aged 37 years came to
OPD on 4/5/24.
He came with complaints of colicky pain around umbilicus and
right hypochondriac since 4-5 days says cannot describe
where pain is exactly. He feels better after drinking warm
water. He also complained of bloating of abdomen after eating
anything since 1 month. Heavy sensation in abdomen since 4
months .
He says he is on anti depressant treatment ( Escitalopram)
USG report suggests normal gall bladder with hyperechoic
multiple stones measuring 3mm-5mm in size with in
gallbladder lumen. With grade 1 fatty liver.
Physical generals:
App: Good
Diet: Mixed
Cravings: not specific
Aversion: Dal
Thirst: 3L/ days
Stools: 2t/ day unsatisfactory
Urine: 6-7 t/ day, 2 t/ night
Perspiration: Localised forehead
Sleep: Disturb, dreams are not specific
Thermals: Hot
Past history : 2 months back operated for lipoma
Family history: mother DM on allopathy treatment
Mental generals:
He says that he was in depression because of family reasons
now he got separated from his parents since 2-3 yrs.
Incident :
Mother and elder brother were sick so his wife gave up and
started staying with her parents she was not ready to stay
with her in laws so he was in confusion and facing conflict
whom to choose ,he tried to solve it but at the end he lost
himself and give up . Now he says that he had accepted the
reality and moved on . Before this event he was very happy
and used to share everything and spend time with friend but
after this event he isolated himself and doesn’t share anything
to anyone.
He says that his professional life doesn’t let him to remain in
depression.
After this incident he started on with anti depressant.
General examination:
Pulse: 82/min
RR: 18 r/m
BP: 120/90 mmHg
Weight : 74 kgs
Tongue: clean
Nails: No pallor
Conjunctiva: No pallor
Systemic examination:
GIT On examination;
Inspection distension of abdomen present
palpation mild tenderness present in right hypochondrium and
epigastric region.
No guarding
Auscultation normal bowel sounds
Totality of symptoms:
1 Regret
2 conscientious
3 secretive
4 Depression
5 Reproach himself
6 Thermals Hot patient
7 Gall stones
8 Fatty liver
Miasm :
Syphilitic
Diathesis :
Scrofulous
Prescription:
1st follow up :
App: Good
Thirst: increased
Sleep : Good
Prescription:
Chelidonium Q
3. CASE REPORT :
A female patient of moderate build, aged 30 years, was apparently
healthy 3 months back, when she developed sudden pain in epigastric
region and right hypochondrium,She complained of dull pain in the right
hypochondriac region which was aggravated after food, with sour
eructation’s and regurgitation of food for 3 months. She complained of
pain after eating, pain in the epigastric region, and hypochondrium
aggravated at night, after having fatty food, and milk
She was also having complaints of Mouth ulcers, sore throat, and hair fall
which were aggravated before menses She had complaints of constipation
for 3months with stitching pain and post-delivery hernia after a caesarean
section
Patient was apparently healthy for 3 months back, when she developed
sudden pain in the epigastric region and right hypochondrium, she was so
distressed with the pains and gastric troubles after eating food. She stated
pain in the epigastric region is aggravated after having food, milk and at
night. Mouth ulcers, sore throat and hair fall aggravated before menses.
Constipation since 3 months with stitching pain, Post-delivery hernia after
caesarean section
Physical generals:
Thirst: decreased,
Dreams: NS.
Mental Generals:
She gets angry easily, irritable, doesn’t like contraindications, likes to cook
different foods, likes to read, and likes music, her sleep was good before,
but after marriage due to adjustment issues it got disturbed.
General examination:
Pulse : 88b/m
BP: 128/78mm Hg
RR: 16r/m
Temp: 98.3F
Tongue : clean
Nails: no pallor
Conjunctiva: no pallor
Systemic examination:
Totality of symptoms:
Miasm:
Sycotic
Diathesis
Scrofulous
Prescription:
4)Appetite Increased
Prescription :
She complained of dull pain in the right hypochondriac region which was
aggravated about 30 min after lunch. She also complained of eructations,
which were sour and were associated with regurgitation of food. The
complaints started gradually about 3 months back. At first, the patient
had consulted an allopathic physician who advised her for
ultrasonography (USG) of the whole abdomen
On USG, multiple calculi of about 3-9 mm were seen in the GB lumen, with
increased thickness of GB wall (3-5 mm) The doctor advised her to
undergo cholecystectomy, but the patient was reluctant to undergo any
surgery and came for homoeopathic treatment, as the discomfort
gradually increased
Physical generals,
appetite : good
Mental generals
She was irritable, afraid of being alone and had a tendency to weep
easily.
General examination:
Pulse : 84b/ m
BP: 118/84mm Hg
Temp: 98.4F
Tongue: clean
Nails: No pallor
Conjunctiva: No pallor
systemic examination:
GIT: on examination;
no significant abnormalities were found, except mild tenderness in the
right hypochondrium
Totality of symptoms:
1 Irritable
3 weeping tendency
4 chilly Thermally
5 Desire salt
9 eructations sour
Miasm
Sycotic
Diathesis
Scrofulous
Prescription:
While analysing the case, the general and particular symptoms were
classified as per the intensity and evaluated as per their merit
Characteristic mental generals, physical generals, particulars and a few
diagnostic symptoms were considered for erecting the totality of
symptoms . Considering the totality, complete repertory was selected and
repertorisation was done with RADAR software. After repertorisation, from
the list of drugs Lycopodium was selected after further confirmation from
Materia medica. It was prescribed in potency, 30, 12 doses , three dose
daily in the morning on empty stomach, and the patient was asked to
report after 1 month
The patient reported next almost about 2 months after the first visit, and
narrated that there was a gradual reduction of symptoms during this while
and even after the medicine was finished, so she did not turn up for
follow-up
But the intensity was much less than before Lycopodium was prescribed
again in 30 potency, 12 doses , three dose daily.
The patient reported next time after a month and at that time, she had no
signs or symptoms She was advised USG of the abdomen, which showed
normal GB without any stones .She was very elated as she was completely
cured.